Self-harm and suicide ‘very common’ in type 1 diabetes

Depression, self-harm and suicide among people with type 1 and type 2 diabetes are “underappreciated” among health care practitioners, according to Catherine Barnard Kelly, PhD, who founded the Reducing Suicide Rates in Individuals with Diabetes (RESCUE) advocacy group in 2021.

“We have the most advanced technology to achieve glycemic control, but the mental burden is still unacceptable,” she said in a panel discussion with other RESCUE speakers during the 82nd American Diabetes Association (ADA) Scientific Sessions in New Orleans.

Notably, suicide and self-harm are “very common” among young people with type 1 diabetes who receive insulin, said Barnard Kelly, a psychologist and visiting professor at the Southern Health NHS Foundation Trust, Southampton, UK. Insulin deficiency or overdose is the most common way to harm oneself.

However, “through a multi-pronged approach to awareness, education and identification, we have an opportunity to intervene on the link between suicide and diabetes,” she said, noting that the goal is to “raise awareness and arm.” [doctors and others] With messages that could ultimately save a young person’s life if adopted into clinical practice and through mental health screenings.”

The rationale behind RESCUE was also described in a brief report published in Diabetes technology and its treatments.

Six key messages

RESCUE now has “nearly 30 members across academia, clinical practice, industry, advocacy, government, and regulatory bodies.” [including the US Food and Drug Administration]and diabetics from several countries,” said Barnard Kelly Medscape Medical News.

She identified six key messages from the symposium:

  • “The prevalence of suicide is much higher among diabetics than among the general population.

  • Talking about suicide does not increase an individual’s suicide risk.

  • Current screening tools for depression and suicidality are not sensitive enough to be effective among patients with diabetes.

  • It is very difficult to identify suicidal acts among diabetic patients.

  • The World Health Organization reports that there are 20 suicide attempts for every suicide.

  • Healthcare providers often underestimate the prevalence of suicide among patients and feel they are ill-equipped to initiate conversations with their patients about suicide.”

Barnard Kelly also provided some sobering statistics that highlight the need for greater awareness.

A study reported that out of 160 cases of insulin overdose, 90% were suicides.

Adolescents and young adults with type 2 diabetes are 61% more likely to report suicidal thoughts than those without diabetes.

The risk of depression is two to three times higher in people with diabetes. Another study reports that 7% of deaths among people with type 1 diabetes are due to suicide.

Survey on screening for depression and suicide risk in diabetes

During the symposium, Daniel R. Chernavsky, MD, reported the results of a small online survey of healthcare professionals treating type 1 or type 2 diabetes, which outlined their concerns about depression screening and suicide risk assessment in people with diabetes.

The respondents were primarily from the United States (103), but they were also from the United Kingdom (18), Slovenia and the Netherlands (5), said Chernavsky, senior director of medical affairs at Dexcom in Charlottesville, Virginia.

They included 59 physicians, 21 nurses, 17 diabetes educators, 15 psychologists, seven dietitians, four social workers, and six “other” health care professionals, with a mean age of 46 years (range, 25–72). years) were working over a median of 14 years (range 0.5-45 years).

Nearly three quarters (72%) reported that at least one of their patients had attempted suicide. The most common self-injury behaviors in their patients were insulin omission or a very large insulin dose and, in lesser cases, overeating.

Almost all respondents (95%) believed that routine visits to a diabetes clinic were appropriate times to discuss depression, self-injury and suicidal ideation – at every visit (42% of participants) or at some visits (52%).

Only 30% were satisfied with patients asking about self-harm or suicide.

Psychologists and social workers were very comfortable, but others were less comfortable or uncomfortable at all.

Several respondents expressed concerns such as, “What do I do?” “Will I make the problem worse?” “Shall I give the patient the idea?” Some reported having “limited resources” or a “feeling of conquest”.

They identified the need to “better understand what [they could] Do to support and care for patients” and “more knowledge about how to deal with them [patients’] answers” ​​to screening questionnaires.

Diabetic psychiatric examination

Shed Majidi, MD, said guidelines from the ADA and the International Society of Child and Adolescent Diabetes recommend routine screening of diabetes patients for psychiatric conditions, including depression.

Majidi, MD, associate director of the Childhood and Adolescent Diabetes Program at Children’s National Hospital, Washington, D.C., noted that depression is associated with elevated A1c levels.

She identified the following issues to address when considering a program of depression screening and suicide risk assessment in a diabetes clinic:

  • Scoring Screening Questionnaires: Who Will Do It?

  • Depression Screening Discussion: Who Would Do It? How will the person be notified of the result?

  • Suicide risk assessment: who will conduct it? What is the process for bringing someone to the emergency department?

  • Resources/Referral: Who will initiate and follow up?

Next steps

The RESCUE advocacy group prepares educational and support materials for healthcare professionals who treat people with diabetes as well as other materials for the patients themselves.

ADA Scientific Sessions 2022. Submitted June 3, 2022.

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