Depression is three times more common in those with diabetes (Golden, Lazo, & Carnethon, 2008). Anxiety and depression are increased in the presence of lower perceived control over diabetes (Hudson, Bundy, Coventry, & Dickens, 2014).

They identified poorer emotional health is associated with negative perceptions of diabetes including perceptions about the seriousness and severity of consequences. Those on insulin therapy, longer duration of diabetes or with a Hba1c above 6.5 are more likely to experience suicidal ideation.

Depression and diabetes have a bidirectional association. A diagnosis of either predicts the future diagnosis of the other (Tabak, Akbaraly, Batty, & Kivimaki, 2014; Goldney & Wittert, 2009).

Prospective data from the Healthy Women Study (n=523) identified those with depression symptoms at baseline, increased symptoms of anger, stress and experiencing very stressful life events had an increased risk of developing metabolic syndrome in 15-year follow up (Raikkonen, Matthews, & Kuller, 2007).

A meta-analysis of depression and incidence of diabetes found that diabetes incidence was 60% higher in depressed participants compared to non-depressed controls RR 1.60, 95% CI 1.37-1.88 (Mezuk, Eaton, Albrecht, & H, 2008).

The 3DFD model developed for diabetes integrates medical, psychological and social care in diabetes with suboptimal glycaemic control. They identified this approach improved Hba1c, reduced psychological distress and improved social functioning.

Interventions included psychological therapy, mental health assessment, medication and social support with patient-led conferences. The aim was to optimise diabetes care. At 12 month follow up there were highly significant reductions in Hba1c – average of 15mmol/mol, improvement in depression scores and patient satisfaction (Doherty, Gayle, Morgan-Jones, & Archer, 2016).