Approach to Stress and Mental Disorders in Patients with Diabetes

  • Kyung Bong Koh


The relationship between stress and diabetes, mechanism linking stress to diabetes, psychological response and adaptation, stress management, and approach to mental disorders in patients with diabetes were reviewed. Mental disorders such as depressive disorders, schizophrenic disorder, bipolar disorder (depressive type), and sleep disorders may increase the risk of diabetes. Management for patients with both psychiatric disorders and diabetes should focus first and foremost on improving the psychiatric disorders. Psychosocial approach for diabetic patients with depression should be supportive by allowing the patients to ventilate their emotions, minimizing self-esteem injury, and maintaining hope. In particular, cognitive behavioral therapy is recommended, and appropriate antidepressants need to be used for these patients. It should be noted that antipsychotics can alter metabolic status in patients with schizophrenic disorder and bipolar disorder. Hypnotics should be used for a short-term period. If possible, diabetic patients with potential psychiatric disorders should be referred to psychiatrists for assessment.


Stress Diabetes Stress management Mental disorders Antidepressants Psychosocial approach Cognitive behavioral therapy 


  1. 1.
    Sadock BJ, Sadock VA. Synopsis of psychiatry – behavioral sciences/clinical psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar
  2. 2.
    Rubin RT, King BH. Endocrine and metabolic disorders. In: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry, vol. 2. 6th ed. Baltimore: Williams & Wilkins; 1995.Google Scholar
  3. 3.
    Kravitz AR, Isenberg PH, Shore MF, et al. Emotional factors in diabetes mellitus. In: Marble AL, et al., editors. Joslin’s diabetes mellitus. 11th ed. Philadelphia: Lea and Ferbiger; 1971.Google Scholar
  4. 4.
    Koch MF, Milnar GD. Psychiatric aspects of patients with unstable diabetes mellitus. Psychosom Med. 1974;36:57–62.CrossRefGoogle Scholar
  5. 5.
    Unger J, Schwartz Z. Diabetes management in primary care. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2013.Google Scholar
  6. 6.
    Koh KB, Lee HC. Stress perception of patients with non-insulin-dependent diabetes mellitus. J Korean Neuropsychiatr Assoc. 1992;31:1084–91.Google Scholar
  7. 7.
    Koh KB, Bae JH. Coping strategy of patients with diabetes mellitus. J Korean Neuropsychiatr Assoc. 1988;27:685–92.Google Scholar
  8. 8.
    Kimball CP. The biopsychosocial approach to the patient. Baltimore: Williams & Wilkins; 1981.Google Scholar
  9. 9.
    Robinson N, Fuller JH. Role of life events and difficulties in the onset of diabetes mellitus. J Psychosom Res. 1985;29:583–91.CrossRefGoogle Scholar
  10. 10.
    Slawson PF, Flynn WR, Kollar EJ. Psychological factors associated with the onset of diabetes mellitus. JAMA. 1963;185:166–70.CrossRefGoogle Scholar
  11. 11.
    Stein SP, Charles E. Emotional factors in juvenile diabetes mellitus: a study of early life experience of adolescent diabetics. Am J Psychiatry. 1971;128:700–4.CrossRefGoogle Scholar
  12. 12.
    Schwartz LS, Springer J, Flaherty JA. The role of recent life events and social support in the control of diabetes mellitus: a pilot study. Gen Hosp Psychiatry. 1986;8:212–6.CrossRefGoogle Scholar
  13. 13.
    Bradley C. Life events and the control of diabetes mellitus. J Psychosom Res. 1979;23:159–62.CrossRefGoogle Scholar
  14. 14.
    Surwit RS, Schneider MS. Role of stress in the etiology and treatment of diabetes mellitus. Psychosom Med. 1993;55:380–93.CrossRefGoogle Scholar
  15. 15.
    Evans MB. Emotional stress and diabetic control: a postulated model for the effect of emotional distress upon intermediary metabolism in the diabetic. Biofeedback Self Regul. 1985;10:241–54.CrossRefGoogle Scholar
  16. 16.
    Koh KB. Psychiatric aspects of diabetes mellitus. New Med J. 1987;30:25–8.Google Scholar
  17. 17.
    Ford CV. The somatizing disorders: illness as a way of life. New York: Elsevier Biomedical; 1984.Google Scholar
  18. 18.
    Surridge DHC, Williams EDL, Lawson JS, et al. Psychiatric aspects of diabetes mellitus. Br J Psychiatry. 1984;145:269–76.CrossRefGoogle Scholar
  19. 19.
    Kolb LC, Brodie HK. Modern clinical psychiatry. 10th ed. Philadelphia: WB Sunders Co; 1982.Google Scholar
  20. 20.
    Browne JL, Nefs G, Pouwer F, et al. Depression, anxiety and self-care behaviors of young adults with type 2 diabetes: results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) study. Diabet Med. 2015;32:133–40.CrossRefGoogle Scholar
  21. 21.
    Fowler JE, Budzynski TH, Vandenbergh RL. Effects of an EMG biofeedback relaxation program on the control of diabetes. Biofeedback Self Regul. 1976;1:105–12.CrossRefGoogle Scholar
  22. 22.
    Surwit RS, Feinglos MN. The effects of relaxation on glucose tolerance in non-insulin dependent diabetes. Proceedings of the 14th Meeting of the Biofeedback Society of America, Denver; 1983.Google Scholar
  23. 23.
    Lammers CA, Naliboff BD, Straatneyer AJ. The effects of progressive relaxation on stress and diabetic control. Behav Res Ther. 1984;22:641–50.CrossRefGoogle Scholar
  24. 24.
    Landis B, Jovonovic L, Landis E. Effect of stress reduction on daily glucose range in previously stabilized insulin-dependent diabetic patients. Diabetes Care. 1985;8:624–6.CrossRefGoogle Scholar
  25. 25.
    Felinglos MN, Hastedt P, Surwit RS. Effects of relaxation therapy on patients with type I diabetes mellitus. Diabetes Care. 1987;10:72–5.CrossRefGoogle Scholar
  26. 26.
    Koh KB. Clinical characteristics of patients with diabetes mellitus referred for psychiatric consultation. J Korean Neuropsychiatr Assoc. 1990;29:1022–8.Google Scholar
  27. 27.
    Johnson B, Eiser C, Young V, et al. Prevalence of depression among young people with type 1 diabetes: a systematic review. Diabet Med. 2013;30:199–208.CrossRefGoogle Scholar
  28. 28.
    Goodnick PJ, Henry JH, Buki VMV. Treatment of depression in patients with diabetes mellitus. J Clin Psychiatry. 1995;56:128–36.PubMedGoogle Scholar
  29. 29.
    Anderson RJ, Freedland KE, Clouse RE, et al. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24:1069–78.CrossRefGoogle Scholar
  30. 30.
    Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142(Suppl):S8–S21.CrossRefGoogle Scholar
  31. 31.
    Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28:2668–72.CrossRefGoogle Scholar
  32. 32.
    Vileikyte L, Gonzalez JS. Recognition and management of psychosocial issues in diabetic neuropathy. Handb Clin Neurol. 2014;126:195–209.CrossRefGoogle Scholar
  33. 33.
    Hood KK, Huestis S, Maher A, et al. Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes specific characteristics. Diabetes Care. 2006;29:1389–91.CrossRefGoogle Scholar
  34. 34.
    Anderson BJ, Edelstein S, Abramson NW, et al. Depressive symptoms and quality of life in adolescents with type 2 diabetes. Diabetes Care. 2011;34:2205–7.CrossRefGoogle Scholar
  35. 35.
    Lustman PJ, Griffith LS, Clouse RE. Depression in adults with diabetes: results of 5-yr follow-up study. Diabetes Care. 1988;11:605–12.CrossRefGoogle Scholar
  36. 36.
    Lustman PJ, Clouse RE. Practical considerations in the management of depression in diabetes. Diabetes Spectr. 2004;17:160–6.CrossRefGoogle Scholar
  37. 37.
    Katon WJ, Lin EH, Russo J, et al. Cardiac risk factors in patients with diabetes mellitus and major depression. J Gen Intern Med. 2004;19:1192–9.CrossRefGoogle Scholar
  38. 38.
    van Bastelaar KM, Pouwer F, Geelhoed-Duijvestijn PH, et al. Diabetes-specific emotional distress mediates the association between depressive symptoms and glycaemic control in type 1 and type 2 diabetes. Diabet Med. 2010;27:798–803.CrossRefGoogle Scholar
  39. 39.
    Koh KB. Stress and psychosomatic medicine. 2nd ed. Seoul: Ilchokak; 2011.Google Scholar
  40. 40.
    Williams MM, Clouse RE, Lustman PJ. Treating depression to prevent diabetes and its complications: understanding depression as a medical risk factor. Clin Diabetes. 2006;24:79–86.CrossRefGoogle Scholar
  41. 41.
    Lustman PJ, Griffith LS, Freeland KE, et al. Cognitive behavior therapy for depression in type 2 diabetes: a randomized controlled trial. Ann Intern Med. 1998;129:613–21.CrossRefGoogle Scholar
  42. 42.
    Tovote KA, Fleer J, Snippe E, et al. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care. 2014;37:2427–34.CrossRefGoogle Scholar
  43. 43.
    Safren SA, Gonzalez JS, Wexler DJ, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care. 2014;37:625–33.CrossRefGoogle Scholar
  44. 44.
    Snoek FJ, van der Ven NC, Twisk JW, et al. Cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled type 1 diabetic patients: long-term effects on HbA moderated by depression. A randomized controlled trial. Diabet Med. 2008;25:1337–42.PubMedGoogle Scholar
  45. 45.
    Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database Syst Rev. 2012;12:CD008381. Scholar
  46. 46.
    Williams MM, Clouse RE, Rubin EH, et al. Evaluating late-life depression in patients with diabetes. Psychol Ann. 2004;34:305–12.Google Scholar
  47. 47.
    Daubresse J-C, Kolanowski J, Krzentowski G, et al. Usefulness of fluoxetine in obese non-insulin-dependent diabetics: a multicenter study. Obes Res. 1996;4:391–6.CrossRefGoogle Scholar
  48. 48.
    Min SK. New psychiatry. Seoul: Ilchokak; 2006.Google Scholar
  49. 49.
    Kaplan SM, Mass JW, Pixley JM. Use of imipramine in diabetics. JAMA. 1960;174:511–7.CrossRefGoogle Scholar
  50. 50.
    Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complicat. 2005;19:113–22.PubMedGoogle Scholar
  51. 51.
    Hirschfield RMA. Management of sexual side effects of antidepressant therapy. J Clin Psychiatry. 1999;60(Suppl 14):27–30.Google Scholar
  52. 52.
    Clayton AH, Pradko JF, Croft HA, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63:357–66.CrossRefGoogle Scholar
  53. 53.
    Deshmukh R, Franco K. Managing weight gain as a side effect of antidepressant therapy. Cleve Clin J Med. 2003;70:614–23.CrossRefGoogle Scholar
  54. 54.
    Smith KJ, Béland M, Clyde M, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res. 2013;74:89–99.CrossRefGoogle Scholar
  55. 55.
    Smith KJ, Pedneault M, Schmitz N. Investigation of anxiety and depression symptom co-morbidity in a community sample with type 2 diabetes: associations with indicators of self-care. Can J Public Health. 2016;106:e496–501.CrossRefGoogle Scholar
  56. 56.
    Cassidy F, Ahearn E, Carroll BJ. Elevated frequency of diabetes mellitus in hospitalized manic-depressive patients. Am J Psychiatry. 1999;156:1417–20.PubMedGoogle Scholar
  57. 57.
    Yu BP, Ortiz T, Chong YS, et al. Use of novel antipsychotic medications in diabetes: a retrospective review. Drug Benefit Trends. 2002;14:42–5.Google Scholar
  58. 58.
    Koro CE, Fedder DO, L’Italien GJ, et al. Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population-based case-control study. Br Med J. 2002;325:243–7.CrossRefGoogle Scholar
  59. 59.
    Wirshing DA, Wirshing WC, Kysar L, et al. Novel antipsychotics: comparison of weight gain liabilities. J Clin Psychiatry. 1999;100:3–16.Google Scholar
  60. 60.
    Fagiolini A, Frank E, Houck PR, et al. Prevalence of obesity and weight change during treatment in patients with bipolar 1 disorder. J Clin Psychiatry. 2002;63:528–33.CrossRefGoogle Scholar
  61. 61.
    Knutson KL, Cauter EB, Zee P, et al. Cross-sectional associations between measures of sleep and markers of glucose metabolism among subjects with and without diabetes. Diabetes Care. 2011;34:1171–6.CrossRefGoogle Scholar
  62. 62.
    Cappuccio FP, D’elia L, Strazzullo P, et al. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2010;33:414–20.CrossRefGoogle Scholar
  63. 63.
    Koh KB. Guidance of drug administration for insomniacs. Drug Inf. 1986;129:86–7.Google Scholar
  64. 64.
    Min SK. Clinical psychopharmacology. Seoul: Jungangmunhwa Co; 2003.Google Scholar
  65. 65.
    Koh KB. Symptoms of depression and differential diagnoses. Drug Inf. 1987;1:48–50.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Kyung Bong Koh
    • 1
  1. 1.Department of PsychiatryYonsei University College of MedicineSeoulKorea

Personalised recommendations