Psychosocial and Behavioral Health Among Youth and Adults With Diabetes

Psychosocial and behavioral health concerns for people with diabetes have received increased attention over the past several years, and since the publication of the American Diabetes Association’s position statement calling for psychosocial care for people with diabetes, screening and treatment options have become more widespread. In this review, we use national datasets to describe the prevalence of psychosocial and behavioral health conditions in people with diabetes, which occur at higher rates than in the general population. These datasets were selected due to their large sizes, representativeness of the samples, and measurement of relevant constructs. Lifetime prevalence of depression in adults with diabetes is 25% (compared to 20% in the general adult population); anxiety diagnoses are reported by 20% of adults with diabetes (compared to 17.5% of adults without diabetes); eating disorders occur in 10% of females with diabetes, and disordered eating occurs in up to 38% of people with diabetes. Diabetes distress is also commonly experienced by people with diabetes; >30% of people with both type 1 and type 2 diabetes report clinically significant levels of diabetes distress. In addition, we highlight the correlates and consequences of the psychosocial concerns most commonly experienced by people with diabetes, including depression, diabetes distress, anxiety, and disordered eating, as well as serious mental illnesses. Specifically, we note that females and young adults with diabetes are more likely to experience clinical diagnoses of depression, anxiety, and eating disorders than males or older adults with diabetes. Depression has been consistently associated with elevated glycemic outcomes in adults and youth, including higher glycated hemoglobin (A1C) levels and greater risk for diabetic ketoacidosis. In recent years, more studies have explored these topics in youth with diabetes and in representative populations. Finally, we identify measurement issues and review options for treatment and implications for clinical practice and future research.