Facts to consider:
- Those who suffer from diabetes are two times as likely to have diagnosed depression.
- Total health care expenditures for diabetics with co-occurring depression are 4.5 time higher than for those individuals without depression. (1)
- One of the principal and most costly effects of depression is that of non-adherence with treatment regimen.
- Depressed patients are three times as likely as non-depressed patients to be noncompliant. (2)
Adult Day Service programs are perfectly suited to decrease the negative effects of depression on diabetes and non-adherence; we treat each participant as a whole person through an integrated, team approach and through individualized care. When a participant experiences co-morbidity; it is impossible to treat each diagnosis separately, as i neither had an impact on the other. In this article I will be discussing the complications that may arise when diabetes and
Treating depression for participants with diabetes is a crucial step to ;
- Improving adherence to treatment regimen;
- Experiencing better quallity of life and
- Reducing health care expenditures.
If non-compliance is identified during the assessment, this may be an indicator that depression is co-occurring with diabetes
- If non-compliance is discovered during the assessment process; inquire about lifestyle choices/habits; healthy weight, exercise, staying on prescibed diet, taking medication as prescribed, etc.
- Determine if there is an emotional component to the participant’s non-adherence, some examples;
- Using food as a coping tool
- Little interest due to feelings of helplessness and hopelessness
- Family lack of support or sabotage
- Passive suicidality
- Be sure that the center social worker is informed of the possible interaction and is providing interventions to address the participant’s mood disorder.
- Be sure that the center RN is informed of the possible interaction and is monitoring the participant frequently for health complications
- Refer the participant to the center’s licensed psychological clinician to provide targeted and professional counseling or group therapy session aimed at reducing the participant’s depression.
- Provide group education/support session co-led by the center’s RN and social worker/psychological clinician.
- RN and/or social worker maintain regular contact to ensure that gains continue to be achieved.
The primary goal of Adult Day services is to help our participants achieve the highest level of health (mental and physical) possible. It is crucial to take into account the importance of a stable mood on multiple chronic conditions and to remember that few, if any, health complaints occur in a vacuum.
1. “Comorbid Depression is Associated with Increased Health Care Use and Expenditures in Individuals with Diabetes” Leonard E. Egede, MD, MS et al. Diabetes Care, March 2002, Vol. 25 no. 3 464 470 http://care.diabetesjournals.org/content/25/3/464.short.
2. “Depression is a Risk Factor for Noncompliance With Medical Treatment. Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence. M. Robin DiMattteo, PhD, Heidi S. Lepper, PhD; Thomas W. Croghan, MD Arch Intern Med/Vol 160 July 24, 2000. http://stressandimmunity.osu.edu/Img/Pubs/107.pdf