This article was exclusively written for The European Sting by Ms. Madhu Shruti Mukherjee, a 2nd year medical student under the West Bengal University of Health Sciences. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.
Lazarus and Folkman had described ‘coping’ to be “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.” But what happens when a disorder with which one has to ‘cope’ alters their coping system itself?
Unlike many communicable diseases like Tuberculosis known as ‘social diseases’, diabetes has had the reputation of a loner. With no possibility of an infectious spread, diabetic patients are not encouraged to find community- the management having to do with choices that are perceived as individual. This kind of perception presents a lack of social support for the sufferers of this disorder, and makes its way towards a more concerning diagnosis- clinical depression caused by a chronic illness, with the CDC claiming on meta analysis that diabetics are 2 times more likely to develop depression than non-diabetics.
Yet the mechanism through which social support acts is not very well established. For instance, there is not enough scientific literature in support of social involvement and diabetic distress- however some cross-sectional studies(Ramkission et al) have shown positive correlation between social support and WHO-5 Well Being Index, but no correlation between social support and HbA1c level or glycemic control. However, an article published in the American Journal of Nursing by Sandy Harper Jacques argues that diabetic depression should not be dismissed as commonplace for a chronic health issue- with social support, diabetics can combat lethargy associated with disease management and lead to positive results in glycemic control.
Another interesting social aspect of diabetes which may factor into diabetic depression is discrimination. While most diabetics don’t exactly call their disorder a ‘disability’, it requires accommodation in workplaces and educational institutes much in the way that traditional disabilities do. Whether being allowed to take regular meals to prevent hypoglycemic conditions or breaks for regular blood sugar checks and subcutaneous insulin injections, diabetes has chronic disability-like ramifications. This discrimination can also occur due to various other factors- the association of injections with illicit drug use, the effects of hypoglycemia mimicking alcohol intake, etc. Further on, in countries with Out Of Pocket Payment model of healthcare, diabetics can suffer in family life and face social rejection due to their disease driving them into debt.
For a disorder where a lack of regimen can descend into diabetic complications like nephropathy and retinopathy, the only way to improve regularity is through social interaction and promoting healthy practices as community activities. One of the most important steps in that direction is conducting more cross-sectional and cohort studies so that policymakers would be better convinced to make provisions for patients. Using advocacy campaigns to educate the general public about the effects of diabetes along with training physicians to keep a clinical eye out for diabetic depression will help treat diabetes in its entirety- not only as a disease of the body, but as a disease of the mind and community.
About the author
A 2nd year medical student under the West Bengal University of Health Sciences, Madhu Shruti Mukherjee is currently serving as the General Assist to the National Public Health Officer for SCOPH in Medical Students Association of India(MSAI), an affiliated NMO of IFMSA. She takes keen interest in Global Health Advocacy including Mental Health, ensuring Universal Health Coverage and health impact of Climate Change. She has helped conduct sessions and activities on NCDs and Health Inequities, and written several articles on remodeling public health approaches to meet modern lifestyle needs.
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