Co-occurrence of diabetes and depression: conceptual considerations for an emerging global health challenge.
BACKGROUND
Considering the relationships between diabetes and depression may enhance programs to reduce their individual and shared disease burden.


METHODS
This paper discusses relationships between diabetes and depression, the range of influences on each, conceptual issues central to their definition, and interventions including comprehensive, population approaches to their prevention and management. Foundational and exemplary literature was identified by the writing team according to their areas of expertise.


RESULTS
Diabetes and depression influence each other while sharing a broad range of biological, psychological, socioeconomic and cultural determinants. They may be viewed as: (a) distinct but sometimes comorbid entities, (b) dimensions, (c) parts of broader categories, e.g., metabolic/cardiovascular abnormalities or negative emotions, or (d) integrated so that comprehensive treatment of diabetes includes depression or negative emotions, and that of depression routinely considers possible diabetes or other chronic diseases.


CONCLUSIONS
The choice of literature relied primarily on the authors' knowledge of the issues addressed. Some important perspectives and research may have been overlooked.


CONCLUSIONS
Collaboration among primary care and specialist clinicians as well as program and public health managers should reflect the commonalities among diabetes, depression, and other chronic mental and physical disorders. Interventions should include integrated clinical care and self-management programs along with population approaches to prevention and management. Self management and problem solving may provide a coherent framework for integrating the diverse tasks and objectives of those living with diabetes and depression or many other varieties of multi-morbidity.
Peers for Progress, American Academy of Family Physicians Foundation, and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC 27599-7440, USA. edfisher@unc.edu
Edwin B
EB
Fisher
Juliana C N
JC
Chan
Hairong
H
Nan
Norman
N
Sartorius
Brian
B
Oldenburg
D002908:Chronic Disease; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D003863:Depression / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D019468:Disease Management; D014943:Global Health; D006801:Humans; D015994:Incidence; D009341:Negativism; D012648:Self Care