I had the opportunity to attend the first Mental Health Issues in Diabetes Conference, which was held in Philadelphia, Pennsylvania, on Monday, October 7, 2013, and was co-sponsored by JDRF and Universal Health Services.
This gathering of clinicians, psychiatrists, psychologists, social workers, parents, and PWDs was informative and eye-opening. The goal of the day was to share the aspects of what is known in research with mental health challenges and diabetes, and identify gaps in care.
The keynote and introductory remarks indicated that although there is still little research about connections between mental health and diabetes, we know data supports the view that there is a greater risk for people with type 1 to develop mental health issues.
Individual clinic research centers’ models of care were discussed in a series of five panels, highlighting what some clinics are already doing to address mental health issues in diabetes, and offering perspectives from parents, providers, and people with diabetes.
One of the most insightful points to me revolved around the visual understanding of distribution of staff. Out of all of the presenters showcasing their centers, on average there were one or two psychosocial professionals in each endocrine clinic, whereas there are endless lists of fellows, doctors, and endocrinologists. Why is that? I learned the major problem is that measuring behavior is hard. It’s a lot easier to measure numbers. There is not enough of an “n-value” to prove money should be spent on these types of jobs—the majority of these psychologists, social workers, and the like are funded through special grants, major gifts, and endowments.
After lunch, the faculty dove a little deeper in to some health-specific issues such as depression and eating disorders as they relate to type 1. Women living with diabetes are 2.4 times more likely to develop an eating disorder than those without and all people with diabetes are 1.26 times more likely to develop depression. Type 1s are already bogged down with dozens of extra tasks each day. We judge ourselves based off of a number, hour after hour, day after day. Of course we get burned out sometimes, and after listening to the panel on eating disorders and depression, I was able to glean that we really are forcing ourselves to count food, which is not considered a natural thing. Historically, humans are not trained to do that. Could you imagine counting carbohydrates for baby formula? We are basically forced to become obsessed with counting and measuring. This of course can lead to depression and disordered eating.
One psychologist commented on the “primary prevention” approach she takes with her model, making sure the entire team, including the family, is fully aware of age-appropriate, diabetes-related tasks and using child development to steer those tasks to become goal-oriented. She also asserts that there are so many factors in today’s society which can trigger a mental health breakdown, such as divorce, genetics, death in the family, abuse, etc., and wants to ensure healthcare teams understand what to ask during visits with patients. The most surprising thing to me was learning the frontal lobe of our brains, which controls risk management and decision making, is actually not fully developed until the age of twenty-five. Scary to think, but it makes sense when it comes to diabetes self-care, as I’m pretty sure I’m not the only one of us who had troubled A1c values throughout adolescence and young adulthood.
Overall it was a jam-packed day full of statistics, but it was an amazing opportunity to understand why mental health issues and diabetes are so challenging to tackle together, and to recognize what causes these issues to arise. The conclusion centers on the need for a drastic increase in funding for research and ultimately staff and faculty to help identify and then rectify these issues before they start.