Diabetes is one of the most demanding chronic diseases because the course of the disease depends almost entirely on the patient. It often requires a significant change in lifestyle, which if not made, can lead to increased health deterioration and even death.
Diabetes is a metabolic disease usually caused by both heredity and lifestyle. Insulin, the hormone responsible for metabolism of glucose in the blood, is either not produced in the body anymore or the body cannot utilize it effectively. Therefore, the glucose cannot proceed from the blood to the cells and the cells cannot function normally. The retention of sugar in the blood leads to various health problems.
The typical signs of increased sugar in the blood are feeling unwell, increased urination, dehydration and severe thirst, weight loss, and a reduced immune response.
Diabetes and depression
Diabetes has a strong impact on the quality of life, physical, and emotional health of the patients. About 50-75% of the patients develop serious, long-term complications, which are the main cause of morbidity, disability, and mortality in diabetic patients.
A frequent comorbid condition in diabetes is depression, which is recognized in only one third to one half of all diabetic patients. Depressive symptoms are related to poor health care (e.g. diet, physical activity, insulin use) and may lead to an increased risk of complications. In general, depression in chronic diseases is related to decreased overall functioning, low work performance, and poor utilization of health services.
After an antidepressant treatment or cognitive-behavioural psychotherapy the condition of diabetes improves.
Diabetes and the risk of suicide
There is relatively little research directly addressing the link between diabetes and suicidal behaviour. Suicide rates in diabetics are similar to those in the general population.
Nevertheless, health problems associated with poor adherence to prescribed treatments represent a significant risk. Suicidal thoughts seem to be more frequent in adolescents with diabetes who follow their treatment instructions poorly. The risk of suicidal behaviour is increased in diabetic patients who suffer from depression which itself is a risk factor for suicidal behaviour.
In a Slovenian study of patients with diabetes, 31% of participants reported passive suicidal thoughts, and 15% reported active suicidal thoughts.
Passive suicidal thoughts are those that don’t relate directly to suicide, but to the lack of will to live: people have a sense of meaninglessness in life, thinking that it would be better if they would not wake up in the morning, and that it would be better if they ceased to exist. Active suicidal thoughts pertain to the act of suicide, which may include intention, time and place, and the method of suicide.
In the Slovenian study the presence of suicidal thoughts was significantly correlated with signs and symptoms of depression, both independent from diabetic complications. Among adolescents with diabetes who are trying to commit suicide, insulin abuse is the most common method.
How to act?
Special attention to the management of depression in patients with diabetes is critical in preventing suicidal behaviour, reducing morbidity, and reducing mortality. The literature recommends regular monitoring of signs and symptoms of depression, timely referral and continued cooperation with a mental health professional, monitoring of suicidal thoughts in people with depression, and controlling the access of insulin in patients with acute depression.