Teens with Type 1 + Depression
You may already know that depression and diabetes are related, and it turns out that teenagers with type 1 can be especially susceptible to depression. According to SAMSA’s National Survey on Drug Use and Health, more adolescents between the ages of 12 and 17 with type 1 or type 2 diabetes experienced a major depressive episode (MDE) within the past year than their peers without diabetes. Experiencing MDEs is different from experiencing diabetes distress, and it’s important to distinguish between the two in order to best address mental health issues in teens with diabetes.
“[The research] is concerning because depression can affect not just your mood and your energy level, but also how you take care of yourself. That includes taking care of diabetes,” says Molly L. Tanenbaum, Ph.D. Molly is an instructor in the Department of Pediatrics at the Stanford University School of Medicine. It can be difficult to identify the reasons behind symptoms of depression. “If we point to diabetes first, we miss an opportunity to learn what’s going on and to offer support.”
Symptoms of depression can be identified via a PHQ-9 screening questionnaire and can include:
- Depressed mood
- Loss of energy
- Loss of interest or pleasure in activities
- Difficulty sleeping, or sleeping too much
- Difficulty focusing and making decisions
- Loss of appetite, or eating too much
- Feelings of hopelessness
- Thoughts of suicide
These symptoms last for two weeks or more and vary from teenager to teenager. If you think you’re experiencing symptoms of depression or thoughts of hurting yourself, let your healthcare team know right away.
“Two people could get the same score on a questionnaire, and one could be feeling really distressed and discouraged about diabetes, and the other could be feeling down and struggling with school but with diabetes not really being a main source of distress,” says Dr. Tanenbaum. “Also, it might not be an either-or situation because someone who is depressed can also be feeling burned out by diabetes. So it’s important to assess current symptoms and stressors to help determine what our treatment plan would be and what would make sense to focus on.”
It Takes a Village
Diabetes doesn’t only impact the individual living with it. What can clinicians, parents and other people on diabetes support teams do to help teenagers struggling with depression?
Joe Solowiejczyk, R.N., M.S.W., C.D.E., is the founder of A Mile in My Shoes, a company that provides patients and families with the resources to thrive while living with diabetes. Joe has had type 1 for over 50 years, and he says it’s important for clinicians to acknowledge how hard life with diabetes actually is.
“Making comments like, ‘It’s not that hard,’ are insensitive and totally irrelevant. It’s important for caregivers and clinicians to listen to the subtext of conversations with teenagers,” Joe says. “The thing that’s hard for teenagers with diabetes is they have to come to terms with the fact that their body has broken down in some way. It’s existential kinds of stuff: as a kid with diabetes, you have to come to terms with your mortality on a daily basis.”
Dr. Tanenbaum agrees that it’s important to find out the root of any problem that seems to be presenting itself. “I would encourage caregivers to avoid jumping too quickly to the conclusion that diabetes and someone’s numbers are to blame for a bad mood. There could be plenty of reasons for a bad mood, like something that happened at school or with a friend.”
In-person conversations can help correctly diagnose depression. “I think it’s maybe more difficult to distinguish between the diabetes distress and depression if you’re just having someone fill out a depression questionnaire, but if you are talking one-on-one it’s more straightforward because someone can tell you whether and how diabetes is contributing to what’s been going on.
“The hope is that, in the near future, there will be more mental health professionals with specialized training in working with individuals with diabetes,” says Dr. Tanenbaum.
“Family dynamics also impact how a teenager handles the demands of diabetes. The mental framework of a family dealing with type 1 diabetes is formed on the day of diagnosis,” Joe says. “Clinicians are critical in supporting the emotional reaction of parents of a newly diagnosed child from the outset, and this can affect the family’s collective attitude toward diabetes in the future.”
“If parents don’t set the boundaries for how diabetes will be dealt with, you have potential for dysfunctional emotional and psychological coping. How the parents deal with the initial diagnosis and feeling the powerlessness of not being able to take it away will have a direct impact on what the kid’s personal experience will be of having diabetes.”
Parents and caregivers have many options for helping their child get the support they need, but they shouldn’t forget to ask for support for themselves. “Ask someone else for help or advice—maybe another parent of an adolescent with diabetes, or maybe a member of the clinic team,” advises Dr. Tanenbaum. “If it’s possible to connect your adolescent with other adolescents with diabetes through a camp or local events, that support can be really important as well.”
“Down the road,” says Joe, “It’s important for parents to maintain a sense of perspective. If they treat every aspect of diabetes management with their teenagers as they would treat any other behavioral issue, then the kids have a great chance of doing okay. What they then end up getting is the message [that says] it sucks and you have to do it.”
How to Cope
If you’re a teen with type 1 and you think you may be experiencing depression, know where you can go for help. Remember that depression is treatable. Confide in a parent or another adult you trust and talk to your healthcare team about how you’re feeling. Acknowledge when you’re struggling and know that it’s okay to feel like you might fall apart under all of the demands of a chronic condition. If you’re feeling the weight of diabetes distress, be compassionate toward yourself and try not to self-criticize.
Joe says, “The misconception is that if you’re incapacitated, somehow you’ve done something wrong. It’s quite the opposite. It takes courage to fall apart. I have not met any person in my life with diabetes, including teenagers, who do not fall apart from time to time. They need to know that’s okay.”
Joe is well-known in the diabetes community for his response to falling apart: on his Diabetes Depression Days, Joe allows himself to complain about, dwell on and be overwhelmed by all of the feelings associated with the demands of diabetes.
“It’s important to exaggerate and make it as silly and overdone as possible in order for the healing to occur. It’s like swallowing the hair of the dog that bit you—what you get is permission to say, ‘It sucks. I can live with it.’ It’s not either-or.”
“Somehow, that gets me back on the beam, in addition to having Diabetes Depression Days, in addition to having gone to see a therapist about all the rage and anger and frustration that comes with living with this thing for 56 years.”
PHQ Screeners: Patient Health Questionnaire – 9
AMERICAN FOUNDATION FOR SUICIDE PREVENTION. “RISK FACTORS AND WARNING SIGNS.”
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