Unlocking the Connection of Diabetes and Depression

When a person receives a life-altering diagnosis, such as diabetes, very often they begin to experience symptoms of depression, adding layers of complexity in treating an already complex disease.

“Certainly with any diabetes diagnosis there is a process of grieving,” said Matt Denhalter, licensed clinical social worker with Intermountain Cedar City Hospital in Utah. “But there is a really strong connection between certain diagnoses and depression — not just situational depression, there is quite a bit of evidence to suggest a biological connection between diabetes and depression as well.”

In fact, Denhalter said in his experience treating roughly 150 people per year, he has fewer than 10 percent of patients who do not have a co-occurring depression diagnosis; meaning, more than 90 percent of his patients have a co-occurring primary medical disorder and secondary mental health disorder, often depression, but many anxiety disorders as well.

It is facts like these that make Denhalter extremely grateful to offer integrated health services to address both issues.

“That’s the genius of mental health integration,” Denhalter said. “Quite a few people have both mental and physical health problems, but their provider might screen regularly for diabetes and heart issues, and completely miss the concurrent depression or anxiety disorder. Here, it’s built into our program to look at both.”

Denhalter’s role as a licensed clinical social worker is to dive into the mental health side of a patient’s treatment plan, while his colleagues on the physical health side handle the regulation and treatment for patients.

“I do a lot of education about managing diabetes, but then we move into the impact of how it’s affecting their quality of mood, their ability to think, their ability to move from thought to action and their level of motivation,” Denhalter said. “All of those things seem to be dramatically impacted by diabetes, especially in the first year.”

Denhalter said he tries to show patients that they don’t have to “give up” everything in their life because of their diagnosis. After acknowledging the need for change, such as an increased awareness of what they choose to eat and drink, Denhalter helps them to see there are so many parts of their life that will be unaffected.
“Once we work to uncover their motivation and help them understand how to manage this disease and even slow its progress, then we get to work on managing their depression,” Denhalter said.

In many cases, medication can be helpful in treating depression symptoms, but Denhalter said people often overestimate what medication will actually do.

“I compare an anti-depressant to oil for a machine,” Denhalter said. “It helps the machine run better but doesn’t do the real work.”

In other words, it takes a lot of personal motivation and effort in order to succeed. For Denhalter and his patients, the key is to uncover what each patient’s individual needs are, and then frame their day intentionally to meet those needs.

“We all know what it feels like to just ‘get through the day,’ but we can only live in survival mode for so long,” Denhalter said. “A simple, intentional framework can make all the difference… Framing makes a good day great, and a hard day tolerable.”

For example, if Denhalter has an introverted patient who needs quiet time to re-energize, they develop a framework for the morning that includes intentionally getting up early to watch the sunrise while exercising with no other distractions. In another instance, a patient might need more human connection than they are getting. In one such case, Denhalter helped his patient arrange a regular phone call with the patient’s sister each morning to ensure that need was met first, so that the patient was energized and ready to take care of her many other responsibilities.

“You have to be pretty serious about finding solutions to your needs,” Denhalter said. “Therapy is not talk, therapy is action.”

Fortunately for patients who take advantage of the integrated health model Intermountain Health offers, the action taken can help both the mental and physical aspects of a person’s diagnosis.

Matt Denhalter, LCSW, is a licensed clincial social workwer with Intermountain Medical Group, and works with patients to provide mental health integration with their primary care physician at Intermountain Health Cedar City Clinic in Utah.  For more information on diabetes, click here or see your primary care doctor.

About Intermountain Health

Headquartered in Utah with locations in seven states and additional operations across the western U.S., www.intermountainhealth.org is a nonprofit system of 33 hospitals, 385 clinics, medical groups with some 3,900 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For more information or updates, see https://intermountainhealthcare.org/news.