How to Talk About Diabetes & Depression with Adolescents

Learn from the experts about how best to support teens with diabetes and engage in difficult health and well-being conversations

Managing diabetes is demanding and often feels like an emotional rollercoaster. According to a recent report from the Substance Abuse and Mental Health Services Administration (SAMHSA), adolescents with diabetes are at a higher risk for depression. In response to the SAMHSA report, diaTribe spoke with several experts on what to do beyond talking about the numbers.

What Can I Do to Help? Advice from the Experts on Addressing Depression

We reached out to pediatric specialist and clinical psychologist Dr. Korey Hood (Stanford University), Dr. Bill Polonsky (President of the Behavioral Diabetes Institute and a member of The diaTribe Foundation’s advisory board) and Dr. Marisa Hilliard (Baylor College of Medicine and Texas Children’s Hospital). Discussions with these specialists led to three big conclusions about addressing adolescent depression:

1) Talk often and early

Guardians should be aware of the mental health complications that accompany diabetes from the start and should be actively learning about these factors with their child and healthcare team well before the onset of adolescence. One way guardians can encourage teens to talk about their feelings is by expressing their own feelings as an example. Dr. Hood remarked, “Saying, ‘I was really angry when this happened,’ or ‘I was sad when this happened to our family’ is really healthy” for both guardians and children.

Parents and guardians should also check in on a regular basis. Basic questions such as “how are things going? Are you feeling good/sad/frustrated?” can encourage important discussions and show adolescents that someone cares. Tracking trends in a teen’s mood over long periods of time, more than just a couple of days, is very helpful in detecting signs of mental health concerns. One diabetes-specific signal of depression is a noticeable change in diabetes management.

Dr. Hilliard recommended the following key tips for effective communication:

• Ask open-ended questions to get more descriptive responses.

• Do not make assumptions.

• Refrain from acting alarmed or alarming.

• Do not dismiss the adolescent’s concerns.

2) Advocate for adolescents.

While it may be difficult to speak often and openly about feelings, whether due to strained relationships between adolescents and guardians, personality traits, or adjusting to recent diagnoses, loved ones can still advocate for a teen’s mental health. It is vital to allow opportunities for private conversations between teens and their healthcare provider. Dr. Hood also recommends helping teens with diabetes connect with peers also living with diabetes.

3) Your healthcare team can be helpful! Include them in the conversation.

If you see signals that indicate depression, the first action is to consult a healthcare provider. Drs. Hood, Hilliard and Polonsky emphasize the absolute importance of prioritizing professional advice well before consulting internet or peer resources. On an even more serious note, our contributors stressed that mention of suicide or self-harm should never be downplayed.

Q&A with SAMHSA

SAMHSA’s National Survey on Drug Use and Health found that 1 in 7 adolescents (12-17 years old) with type 1 or type 2 diabetes had a major depressive episode in the past year, compared to 1 in 11 adolescents without diabetes. We spoke with Lisa Rubenstein, a public health advisor at SAMHSA who was one of the authors of the report, to learn more about how to respond to these troubling numbers.

diaTribe: What should every family of a person with diabetes understand about the relationship between diabetes and mental health? 

Rubenstein: Mental health is part of overall health. Every family should understand that all youth, including those with diabetes, need to have all of their health needs addressed, mental health along with physical health. In particular, if parents or caregivers think that their youth may be experiencing depression or other mental health challenges, they should discuss this with their child and reach out together to the child’s primary care provider and ask him or her to partner with a behavioral health provider to follow-up.

diaTribe: How can family members best recognize depression and provide support, especially for adolescents?

Rubenstein: Families can play a key role in supporting their youth. They can help them access treatment and encourage them to maintain their treatment plan. Treatments that involve medications, psychotherapy, and other elements of an individualized treatment program can help the youth to improve their coping skills, manage symptoms, improve daily functioning and go on to lead a full and meaningful life. Family members can contact SAMHSA’s national helpline: 1-800-662-4357 (HELP) for information on local treatment facilities and resources. If a youth has thoughts or plans of harming themselves or others, families should immediately call SAMHSA’s National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to the Suicide Prevention Lifeline.

For additional resources on addressing mental health in adolescents, see below:

• The Center for Epidemiologic Studies provides a screening test for depression that is helpful in assessing your personal mental state or prompting discussions with a loved one. The screening quiz will prompt you to consider the relevance of simple statements such as “I couldn’t get ‘going’,” and “I felt sad,” and then give you an explanation of your results.

• For skills and strategies for healthy managing of diabetes, check out Diabetes Initiative

• Dr. Polonsky’s book about diabetes burnout, which you can learn about here.

• The Mindset chapter of Adam Brown’s Bright Spots & Landmines – PDF download for free/name-your-own-price or on Amazon.com ($6)

• Dr. Hood’s book, Type 1 Teens.

• Dr. Hilliard recommends this resource from Diabetes.org.

• diaTribe resource on addressing mental health

• To learn more about depression and other mental disorders, visit https://www.samhsa.gov/disorders/mental or http://diabetes.yale.edu/teens/depression.aspx