The intersection of diabetes and mental health
Through her work as a general practitioner, Dr Jan Orman has years of experience dealing with the complex needs of diabetes patients. In addition, her work as a consultant to the Black Dog Institute – an organisation that aims to prevent and treat mental illness in the community – has given her a unique perspective from which to pursue research. The link between diabetes and mental illness is well established, with research showing that having diabetes doubles the risk of developing depression. Up to half of people with diabetes are thought to also have a mental illness such as depression or anxiety. Living with diabetes requires a high level of self-care from patients, and the daily demands of blood glucose testing, taking medications, and following diet and exercise plans can be gruelling. Managing a chronic condition can take its toll, and when it leads to depression self-care becomes even more of a burden. Finding ways of helping patients through such a difficult confluence of conditions becomes of vital importance.
myCompass is a free, online, self-help program that is designed to address symptoms of stress, anxiety and depression through personalised treatments. It means that people suffering from mental health conditions have 24/7 access to support that is convenient, low-cost, and proven to be effective. The service is especially valuable to those in rural and remote communities, and currently has more than 17,000 subscribers around the country. As Dr Orman knew well from experience in general practice, there is not much time to discuss diabetes patients’ emotional wellbeing because management of the disease itself is so complex and time consuming. Aware that the myCompass platform was an important aid to mental health away from the GP’s office, she wondered if a module designed just for diabetes patients could be of immense value. Dr Orman applied for a cofunded grant with the RACGP Foundation and Diabetes Australia was given funding to research the viability of a diabetes-specific myCompass module.
Talking and testing: research in focus
Dr Orman began by talking to groups of general practitioners and diabetes patients about the need for the new my Compass module, and also about the kind of content that was most desired by those with the disease. Around ten GPs and 17 patients were included at this stage in the research, and their insights were invaluable. With the help of the material collected during the interview stage, a team of mental health professionals then began to create the clinical content for the module. Blending techniques from both cognitive behavioural therapy (CBT) and acceptance and commitment theory (ACT), the module followed the myCompass structure of three ten-minute interactive sessions, with additional tasks set in between. With the content and technical development completed, it was now time to move to the third stage of the project: testing with real patients.
A group of 41 volunteers participated in the study, all aged between 18 and 75, diagnosed with diabetes, and also experiencing at least mild depressive symptoms. The average age of participants was 47 years, while women were in the majority (63%) and employed (56%). The participants reported low levels of self-care, with poor adherence to recommended exercise and diet regimens. The group was asked to use the new myCompass diabetes module for a period of four weeks, and then report back at the end of the trial. The results showed that using the myCompass module had significant effects. Improvements were noticed for depressive symptoms; anxiety symptoms; distress related to diabetes; daily functioning; and adherence to self-care routines. As a result of Dr Orman’s research and development, the diabetes module of the myCompass resource was added as a permanent component of the program.
A new way to assist patients
Living with diabetes can be draining, both physically and emotionally, but visits to the doctor can leave little room for discussion about the psychological symptoms the disease often induces. The myCompass diabetes module produced with the help of the RACGP Foundation and Diabetes Australia gives GPs a valuable tool to recommend to patients who are overwhelmed by the demands of their condition. The resource helps to make GPs more confident when broaching the subject of mental health, as some diabetes patients are reluctant to be referred to mental health professionals. For those with only mild and moderate depressive symptoms, the use of a free resource that they can access privately and in their own time could be far more appealing.
Since the release of the new module it has been regularly included in the Black Dog Institute’s professional training programs, which were delivered more than 100 times throughout Australia in 2016 alone. Dr Orman has also delivered dozens of face-to-face presentations at mental health conferences sponsored by the Australian government. Hundreds – perhaps thousands – of GPs and psychologists have already been made aware of the efficacy and value of the myCompass diabetes program. Patients being treated for diabetes have been provided with a free, easily accessible resource that will help thousands to help themselves. The Black Dog Institute’s promotion of the new module has also contributed to the ongoing effort to raise mental health awareness in the community, showing just how powerful partnerships between the RACGP Foundation, Diabetes Australia and other likeminded organisations can be.
We're always looking for partners who want to create a healthier Australia. To find out more about the RACGP Foundation's work, or how you can partner with us to create a healthier Australia, visit foundation.racgp.org.au/foundation
Dr Jan Orman
RACGP Foundation Grant Recipient 2013
RACGP Member: 24 years
General Practitioner, The University of Sydney; GP Services Consultant, The Black Dog Institute