The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision
Open accessAbstract
Studies have identified significant linkages between depression and diabetes, with depression associated with poor self‐management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure ‘depression’ in a consistent manner. Because the diagnosis of depression is symptom‐based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of ‘emotional distress’ be considered as a core construct to link diabetes‐related distress, subclinical depression, elevated depression symptoms and major depressive disorder ( MDD ). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient‐centred interventions can occur.
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DD is directly linked with poor glycemic control and problematic self-care behaviors, unlike depression.
“Although often confused with depression, unlike depression DD is directly linked with poor glycemic control and problematic self-care behaviors [2–6].”
From Diabetes distress in adults with type 1 diabetes: prevalence, incidence and change over time (2016) · cites this paper as [5]
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Fisher, L., Gonzalez, J. S., & Polonsky, W. H.
- Affiliations
- University of California, San Francisco (US)
- Albert Einstein College of Medicine (US)
- University of California San Diego (US)
- Corresponding author
- Fisher, L.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2014-06-18
- Volume
- 31
- Issue
- 7
- Pages
- 764-772
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- PMC
- PMC4065190
- OpenAlex
- W2036323100
- Cited by
- 470
- References
- 49
- Citations by year
- 2026: 47 · 2025: 30 · 2024: 34 · 2023: 36 · 2022: 32 · 2021: 40 · 2020: 43 · 2019: 45 · 2018: 45 · 2017: 44 · 2016: 27 · 2015: 32 · 2014: 14 · 2013: 1
- FWCI
- 6.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (DK094863)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- diabetes distress, depression, emotional distress, major depressive disorder, subthreshold depression, diabetes self-management, anxiety disorders, patient-centered care
- MeSH terms
- Affect, Anxiety, Depression, Diabetes Mellitus, Emotions, Humans, Self Care, Severity of Illness Index, Medication Adherence
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