Mental Health in Diabetes: Never a Better Time.

We present this special issue of the Canadian Journal of Diabetes at a very unusual time in all of our lives. Not only has the COVID-19 pandemic had an impact on populations worldwide, the mortality and health-related consequences of this disease have been magnified in some communities over others, specifically for individuals with diabetes. Clearly, we are living through a global crisis that not only affects our health and mental health, but also has disrupted the economy, education and employment. As difficult as it is for us all, living with diabetes during this time of uncertainly caused by the COVID-19 pandemic heightens the already daunting task of diabetes self-management. Routines are disrupted, finances may be challenged and in this era of self-isolation, social supports are not as available. As diabetes care providers, the more we can help patients cope with the mental health impact of the pandemic, the better equipped they will be to perform all the behaviours necessary to keep their blood glucose levels in target. It is in this context that we offer this special issue on mental health and diabetes.

Planning this special issue started prior to the pandemic and was based on the beliefs that diabetes has an impact on the mental health of the person living with the condition, and that mental health affects a person’s ability to perform diabetes-related self-care. As stress increases, self-care decreases. So, we have organized this issue to highlight this bidirectional relationship. In providing diabetes care on a day-to-day basis, we see the effect diabetes exerts on emotional health. Patients do not have the luxury of taking a break from diabetes. Not a day goes by without having to be reminded of this demanding condition that requires constant, ongoing self-care decisions. Ironically, the more invested in diabetes self-management our patients are (which is our explicit goal), the larger the psychological impact it will have. Yared et al (1) present a paper describing how a multidisciplinary type 1 clinic has incorporated the assessment and management of diabetes distress into their practice. Hendrieckx et al (2) performed an audit in Australia examining how persons with diabetes want to connect to their diabetes providers to address diabetes distress. Lafontaine (3) examines spousal support and relationship happiness in those with type 2 diabetes. Morgan et al (4) offer a paper on self-compassion, adaptive reactions and health behaviours that adds to our understanding of living well with diabetes. Morrissey et al (5) present a paper on the role of diabetes distress in adolescents and young adults living with type 1 diabetes. deMolitor et al (6) present a public health perspective on the concept of diabetes distress. Additionally, there are contributions examining the potential for negative mental health impacts in the form of bereavement and grief reactions in those with type 1 diabetes (Fraser [7]) and an important perspective paper on self-injury and suicide in those with diabetes (Barnard-Kelly et al [8]). With regard to psychological stressors in economically disadvantaged populations, Kalra et al (9) report on a scoping review of the rates of depression and diabetes distress in South Asians from low- and moderate-income countries.

This issue also offers a number of papers on mental health issues as they relate to diabetes. Cimo et al (10) present the outcomes of a diabetes education intervention in those living with diabetes and mental health disorders. Wong and Mehta (11) examine the efficacy integration of psychiatric care into diabetes education clinics for patients with comorbidities of depression and diabetes. Stenov et al (12) offer the diabetes support needs of those living with serious mental health disorders. Alessi et al (13) examine alcohol use and clinical outcomes in youth and adults with type 1 diabetes, and Mehta and Hirji (14) review the outcome of structured education for patients living with type 2 diabetes and substance abuse. Benson et al (15) examine depression in girls with type 2 diabetes, obesity and polycystic ovary syndrome. Finally, Riggin explores the relationship between gestational diabetes and perinatal mental health (16).

We hope that the papers in this issue inform and empower the Canadian diabetes professional community to continue to broaden our ability to address the important quality of life issues that are a central part of living with diabetes. Stay safe.