Common types of therapy include:. In addition to therapy, there a number of different medications that can help. When deciding on a mental health treatment plan involving medication, talk to your mental health care provider about your family history of mental health and your own diabetic condition.

A diabetes diagnosis can cause prolonged stress which may possibly cause a rise in blood sugar. Stress can also make following your diabetes maintenance routine more difficult. Experts suggest looking for patterns; be aware of your stress level each time you log your blood sugar and see if a pattern emerges.

If you notice a pattern, you can learn to spot your stress warning signs and take action to prevent stress and keep your blood sugar low.

This may mean working with a professional to learn relaxation and coping techniques. Just as diabetes therapy must be reviewed and adjusted frequently in order to find a long-term solution to care, finding the right mental health treatment can take time and be a process of trial and error.

Like with many other chronic conditions, the sooner you get help, the better. The mental health comorbidities of diabetes. JAMA , 7 , — Bowyer, V. Understanding the sources of diabetes distress in adults with type 1 diabetes. Journal of Diabetes and Its Complications, 29 4 , Undertreatment of mental health problems in adults with diagnosed diabetes and serious psychological distress: the behavioral risk factor surveillance system, Diabetes care , 33 5 , — Antidepressant medication use and glycaemic control in co-morbid type 2 diabetes and depression.

Diabetes and Mental Health Breadcrumb Home. How are diabetes and mental health connected? People living with type 1 or type 2 diabetes are at increased risk for depression, anxiety and eating disorders. People with type 1 diabetes are twice as likely to live with disordered eating. Identification One of the biggest challenges to treatment of mental health conditions for people with diabetes is low rates of detection.

Treatment and Therapies Mental health conditions - just like diabetes - are treatable. Therapy Therapy is an extremely helpful treatment option and people with and without mental health conditions can benefit from it. Common types of therapy include: Cognitive-behavioral therapy CBT. CBT has two main aspects.

The cognitive part works to develop helpful beliefs about your life. The behavioral side helps you learn to take healthier actions. CBT often works well for depression, anxiety and bipolar disorder, but it can also be used for other various conditions.

Family therapy helps family members communicate, handle conflicts and solve problems better. Forms of family therapy often are used for treating eating disorders and bipolar disorder.

Dialectical- behavioral therapy DBT focuses on teaching skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Learn more about different kinds of therapy here. Aims: To prospectively examine psychosocial factors in patients presenting with recurrent or single episode DKA and compare with people who have not had DKA.

Methods: Case-controlled study consecutive adult DKA admissions April to December at Western Health, Melbourne. Data were prospectively collected regarding diagnosed mental health disorders, likely depression Patient Health Questionnaire PHQ-9 , diabetes distress Problem Areas in Diabetes PAID questionnaire and presence of adverse social factors.

A control group without a history of DKA was also recruited. Results: Of patients admitted with DKA consecutive episodes , 70 consented to participate and 73 age-matched Type 1 diabetes controls were recruited.

As a group, DKA patients had significantly more unemployment, illicit drug use and tobacco smoking, a lower level of formal education and less regular medical contact compared with controls.

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Top of the page. Condition Basics What is diabetic ketoacidosis DKA? What causes it? Garrett C J, Moulton C D, Choudhary P, Amiel S A, Fonagy P, Ismail K The psychopathology of recurrent diabetic ketoacidosis: A case—control study.

Diabet Med. Download references. CG, TL, SA, PF and KI devised the study. CG and CM analysed data. All authors contributed to manuscript. CG is guarantor for contents of article. is in receipt of a National Institute for Health Research NIHR Senior Investigator Award NF-SI and was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care CLAHRC North Thames at Barts Health NHS Trust.

is supported by an NIHR Academic Clinical Lectureship. The views expressed are those of the author s and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Diabetes and Metabolism Department, Barts Health NHS Trust, London, UK. Deancross Personality Disorder Service, East London Foundation Trust, London, UK. Division of Psychology and Language Sciences, University College London, London, UK. You can also search for this author in PubMed Google Scholar.

Correspondence to Christopher J. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

The trial was registered prospectively with International Standard Randomised Controlled Trial Number Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article belongs to the topical collection Health Education and Psycho-Social Aspects, managed by Massimo Porta and Marina Trento.

Reprints and permissions. Garrett, C. According to the World Health Organization over million people globally experience depression, but it goes undiagnosed and is often untreated because of the stigma around mental health issues.

Depression is estimated to affect one in four people with diabetes type 1 and type 2. Adolescents with type 1 diabetes have five times the rate of depression than adolescents who do not have T1D. Adults with T1D who also have depression, face worse health outcomes if the depression is untreated and lose more time from work, have increased healthcare costs, and have higher HbA1cs than individuals without depression.

Adolescents with T1D and depression have higher HbA1cs, an increased risk for diabetic ketoacidosis DKA and severe hypoglycemia , and have more issues when transitioning to adult care for their diabetes.

In children and adolescents, symptoms of depression can be similar but there may be some differences. In children, symptoms may also include:. The good news is that depression can be treated and outcomes improve, especially when depression is treated early. The American Diabetes Association ADA recommends that all people with type 1 diabetes should be screened by their healthcare providers for depression on a regular basis, so treatment or a referral to a mental health provider can be made.

Getting treatment for depression early is key and can help to improve your long term medical and psychological outcomes. Finding a mental health provider that is knowledgeable about diabetes can help.

Getting support for anyone living with type 1 diabetes is important; if you are experiencing symptoms of depression this can be even more important.

Talk with your friends and family can be key. They often will want to help you, so asking for what you need rather than having them guess or do something unintentionally unhelpful will be important.

Depending on your relationships with your family and friends, it may be difficult to talk to them.

To reduce the risk of including people with type 2 diabetes, we only recruited individuals aged 35 years or younger. We used age in addition to ICD codes in order to comply with the findings of the REDSIAM network working group dedicated to endocrine disorders.

REDSIAM was set up to promote the collaboration of teams working on the French national information system and it develops and validates algorithms used to identify specific diseases [ 7 ].

For each individual, the first hospitalisation in mentioning type 1 diabetes was considered the index hospitalisation. People who died during the index hospitalisation were excluded.

This hospitalisation was either the first hospitalisation for the diagnosis of type 1 diabetes or a follow-up for previously diagnosed type 1 diabetes.

Among the people included following hospitalisation in , we identified subsequent hospitalisations for non-inaugural ketoacidosis ICD codes E We then defined two groups: young adults with hospitalisation for ketoacidosis and young adults without hospitalisation for ketoacidosis. Epidemiological follow-up focused on medical and psychiatric hospital data from the index hospitalisation to The main outcome of interest was hospitalisation for a suicide attempt, identified by at least one main, related or associated ICD diagnosis code from X60 to X As this study was retrospective and registry based, we were unable to assess the degree of suicidal intent present in those with self-injury and these presentations were likely along the spectrum from suicide attempt to self-harm with no suicidal intent at all.

The following variables were assessed during the index hospitalisation for all people included in the study: age and sex. Psychiatric disorders were identified for the years and , before or during the index hospitalisation.

Qualitative variables were expressed as percentages. The groups were compared at 1, 2, 3 and 9 years after the index hospitalisation. Then, after adjustment for age, sex and history of psychiatric disorders, survival analyses were performed using a Cox proportional hazards regression model to explore the association between hospitalisation for ketoacidosis and subsequent hospitalisation for a suicide attempt.

We followed individuals until hospitalisation for a suicide attempt, the end of the 9 year follow-up period, or death, whichever came first.

A ketoacidosis event that occurred during the epidemiological follow-up was considered a time-dependent covariate, meaning that it was only considered if it occurred before a potential hospitalisation for a suicide attempt. We then included an interaction between time and the exposure to ketoacidosis.

The time lapse was the period of time between the first hospitalisation for ketoacidosis and the first hospitalisation for a suicide attempt. To estimate the risk of a recurrent ketoacidosis event, we created a second model in which we added both the first and the second ketoacidosis exposure as time-dependent covariates.

We were then able to estimate, both separately and overall, the impact of the first and the second ketoacidosis events on the risk of hospitalisation for a suicide attempt.

Statistical significance was set at a p value of 0. SAS software was used for the data analyses SAS Institute, Version 9. The present study was approved by the French Institute of Health Data and by the French data protection authority, which did not require informed consent for the use of registry data.

In , 16, persons aged 18—35 years were admitted to hospital with type 1 diabetes. Between and , 9. People with ketoacidosis were younger and more likely to have a history of psychiatric illness. There was no significant difference for gender.

At nine years, individuals with type 1 diabetes who were hospitalised for ketoacidosis were more likely to have been hospitalised for a subsequent suicide attempt 7.

The number of hospitalisations for a suicide attempt was significantly higher in the ketoacidosis group Table 1.

In individuals with ketoacidosis, 4. Comparatively, only 1. Table 2 shows the risk of hospitalisation for suicide attempt associated with recurrent episodes of ketoacidosis. The rate of hospitalisation for a suicide attempt in people with vs without ketoacidosis was 2. at 2 years of follow-up and 4.

Psychiatric history was strongly associated with subsequent hospitalisation for a suicide attempt. During the 9 years of follow-up, The survival analyses are presented in Table 4. After adjustment for age, sex and psychiatric history, at least one hospitalisation for ketoacidosis was associated with subsequent hospitalisation for a suicide attempt HR 2.

Sex and age at index hospitalisation were not associated with a subsequent hospitalisation for suicide attempt but a psychiatric history was strongly associated with this event HR 5. At 1 year, the risk of hospitalisation for suicide attempt for people with type 1 diabetes previously hospitalised for ketoacidosis was 4.

When we added an interaction between time and the exposure to ketoacidosis to the model, the association between hospitalisation for ketoacidosis and suicide attempts decreased over time and was no longer significant after 5 years Table 5 and Fig.

When we included both the first and the second ketoacidosis exposure in a model as time-dependent covariates, the risk of hospitalisation for suicide attempt after the first ketoacidosis event was not significantly modified after accounting for the second ketoacidosis event.

The risk for a second ketoacidosis event was similar to the risk for a single ketoacidosis event data not shown. Interaction between time and the time lapse between the first hospitalisation for ketoacidosis and a subsequent hospitalisation for a suicide attempt.

Results are statistically significant when the CI does not include or cross 1. To the best of our knowledge, this is the largest study aiming to determine whether diabetic ketoacidosis episodes could be associated with hospitalisation mentioning a suicide attempt.

Our results showed that people with type 1 diabetes and a history of hospitalisation for diabetic ketoacidosis have an increased risk of being hospitalised for a suicide attempt in the 9 years following the index hospitalisation.

We also observed that during the 9 years of follow-up, an alarming Approximately 0. Our study found a strongly increased prevalence of suicide attempts in people with type 1 diabetes and ketoacidosis hospitalisation as well as in people with type 1 diabetes without ketoacidosis hospitalisation, as previously reported [ 9 ].

It is clear that the functional disabilities and comorbidities that often accompany diabetes can lead to a decreased quality of life that could increase the risk of depression and suicidal thoughts [ 10 ]. In type 1 diabetes, depression and psychiatric disorders are associated not only with an increased risk of suicide attempts but also with an increased risk of hospitalisation for glycaemic disorders [ 4 , 11 ].

Suicidal ideation is a common feature of depression and it is well known that depression is two to three times more prevalent in people with type 1 diabetes than it is in the general population [ 11 , 12 , 13 , 14 ].

Major depressive disorders have been found in As expected, the increased prevalence of depression in type 1 diabetes is also associated with an increased risk of suicide [ 10 , 14 , 15 , 16 ]. A recent meta-analysis suggested that the RR of suicide associated with type 1 diabetes is 2.

This study found no association between female sex and suicide attempts. Though it may seem surprising, this observation does not appear to be specific to people with type 1 diabetes since previous studies in populations with specific psychiatric and physical disorders did not find an increased risk of suicide attempt in women compared with men [ 17 ].

Johnson et al. found consistent evidence that severe symptoms of depression were associated with higher levels of HbA 1c in people with type 1 diabetes [ 11 ]. One recognised pathway between depression, suicidal ideation and ketoacidosis is impaired glycaemic control, and a recent longitudinal study has suggested a relationship between depression symptoms and blood-glucose-related outcomes over time [ 18 ].

The authors found a relationship between changes in depression symptom status and likelihood of diabetic ketoacidosis diabetic ketoacidosis in In the Type 1 Diabetes Exchange Clinic Registry, participants with higher depression scores were more likely to miss insulin doses and experience diabetic ketoacidosis [ 4 ].

Likewise, the results of the Diabetes-specific Cognitive Behavioral Treatment Program DIAMOS study suggested that reduced depression symptoms could explain improved glycaemic control [ 19 ]. One explanation for our results is that higher incidence of diabetic ketoacidosis and suicide attempts were both related to depression and mental illnesses.

In young adults with diabetes, depression has a clear influence on glycaemic control and the occurrence of diabetic ketoacidosis, and at the same time it encourages suicidal ideation.

This may explain the association between hospitalisation for diabetic ketoacidosis and the higher incidence of suicide attempts observed in our results. It is possible, however, that the emotional distress linked to hospitalisation for ketoacidosis induces or aggravates depressive symptoms, leading to an increased risk of suicide attempts.

Unfortunately, causality cannot be determined in this study: we do not know whether a hospital stay for ketoacidosis increases the likelihood of depression and suicide attempt or whether being depressed and at increased risk of suicide influences self-care, leading to hospital admission for ketoacidosis.

The identification of risk factors is crucial for developing effective suicide prevention strategies, and healthcare professionals need to be made aware of the higher risk of suicide in certain subgroups of patients.

The primary implication of our study is that all people with type 1 diabetes hospitalised for diabetic ketoacidosis and hyperglycaemic coma should be screened for depressive symptoms and suicidal ideation.

It is also important to find the most appropriate tools with which to screen and detect depression and suicidal ideation in these patients. The ADA recommends the Patient Health Questionnaire PHQ as a valid and relevant depression screening and monitoring tool for people with diabetes [ 6 ].

The PHQ-8 is a standardised and validated measure of self-reported depression symptoms and their severity. It has been used in numerous patient-based studies, including several focused on diabetes [ 4 , 5 , 18 , 20 ].

With the PHQ-9, a suicidal ideation rate of The Position Statement of the ADA recommends an assessment of symptoms of diabetes distress, depression and anxiety during the initial medical consultation, at periodic intervals, and when there is a change in disease, treatment or personal circumstances [ 6 ].

Considering the increased risk of suicide attempt following hospitalisation for ketoacidosis, our results suggest the need for systematic evaluation of depression symptoms and suicidal ideation whenever a person with type 1 diabetes is hospitalised for ketoacidosis.

Moreover, in our study, we found that people with a history of psychiatric disorders and ketoacidosis had an extremely high risk of attempting suicide in the year following their hospital stay.

We showed previously that people diagnosed with both type 1 diabetes and schizophrenia had a higher risk of hospitalisation for acute diabetes complications, suicide and hospital mortality [ 3 ]. Our results strongly suggest that any hospitalisation for ketoacidosis in people with type 1 diabetes and a history of psychiatric illness should automatically lead to a psychiatric assessment in an effort to minimise the risk of suicide after hospital discharge.

Collaboration between endocrinologists and mental health professionals should also be promoted. One of the strengths of this study is the population-based design using the French hospital databases, which provided detailed epidemiological information and allowed us to collect 9 years of follow-up data after the index hospitalisation.

We do acknowledge that our work has limitations. First, we limited patient age to 35 years in an attempt to select only those with type 1 diabetes mellitus.

We cannot exclude that a few individuals with type 2 diabetes may also have been mistakenly included in our study. However, because type 2 diabetes is rare in individuals under 35 years of age, the number possibly included in our study is likely to be limited.

Second, the diagnoses were based on hospital reports only, and the quality of these diagnoses cannot be guaranteed. Third, we did not have access to information about other comorbidities such as previous suicide attempts, drug addiction, alcohol abuse, socioeconomic status, glycaemic control, blood glucose monitoring or the frequency of missed insulin doses.

These confounding factors could limit the interpretation of our results. Fourth, we did not include the whole population of individuals with type 1 diabetes in France in our study.

According to data from the French national information system, published by The National Agency for Public Health, 40, patients aged 18—34 years were treated with insulin in However, the French hospital database used in our study includes discharge abstracts for people hospitalised in all public or private hospitals in France.

Thus, we can assume that all people with type 1 diabetes hospitalised in France for ketoacidosis were included in our study. Fifth, hospitalisation for suicide attempt might be considered to represent the greatest severity in either lethality of injury or severity of mental disorder considering that treatment for a suicide attempt does not systematically result in hospitalisation.

Consequently, the suicide attempts that were not severe enough to warrant admission to hospital were not included in our study. Finally, our data source limited our analysis to hospitalised individuals only, and the occurrence of death from suicide without hospital admission was not detected.

These limitations must be considered. In conclusion, our study suggests that hospitalisation for ketoacidosis is a warning sign for suicide risk in young adults with type 1 diabetes.

Our findings fully support the recommendation that screening for depression and suicide risk should be part of the routine clinical assessment of patients with type 1 diabetes and ketoacidosis. This paper represents an important step in better defining the prevalence of suicide attempts in this at-risk population and we believe that our findings are significant as they are based on data from all young people hospitalised in France for type 1 diabetes.

We expect that the identification and treatment of depression in younger adults with diabetic ketoacidosis could lead to a reduction in suicide attempts. The use of these data by our department was approved by the National Committee for data protection.

We are not allowed to transmit these data. Umpierrez G, Korytkowski M Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.

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Rev Epidemiol Sante Publique 65 Suppl 4 :S—S Data were prospectively collected regarding diagnosed mental health disorders, likely depression Patient Health Questionnaire PHQ-9 , diabetes distress Problem Areas in Diabetes PAID questionnaire and presence of adverse social factors.

A control group without a history of DKA was also recruited. Results: Of patients admitted with DKA consecutive episodes , 70 consented to participate and 73 age-matched Type 1 diabetes controls were recruited. As a group, DKA patients had significantly more unemployment, illicit drug use and tobacco smoking, a lower level of formal education and less regular medical contact compared with controls.

Conclusions: Mental health disorders and adverse socioeconomic factors appear to be common in patients with DKA. The diagnosis of DKA presents an excellent opportunity to screen for depression and offer appropriate intervention.