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INTRODUCTION

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Endocrine disorders often cause or co-occur with depression. Thyroid, parathyroid, and adrenal disease, as well as diabetes and abnormalities in the hypothalamic–pituitary–thyroid (HPT) and hypothalamic–pituitary–adrenal (HPA) axes, can all result in depression. Treatment of these endocrine conditions often ameliorates the depressive symptoms, but if persistent, they can be addressed with somatic, behavioral, and psycho therapies.

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DIABETES MELLITUS

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DESCRIPTION

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Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia that develops as a result of decreased secretion of insulin and/or impaired tissue response to insulin.1 Type 1 diabetes is caused by autoimmune destruction of pancreatic beta cells, which leads to decreased insulin secretion. Type 2 diabetes—the most common form—is due to an impaired tissue response to insulin and decreased secretion of insulin. Untreated diabetes can lead to cardiovascular, renal, neurologic, and ophthalmologic damage. Diabetes is strongly associated with depression, as evidenced by the increased prevalence of depression in individuals with diabetes compared to the general adult population.2 Untreated depression in those with diabetes can have a profound impact upon glycemic control and self-care behaviors, resulting in a greater risk of end-organ complications, disability, diminished quality of life, and increased mortality.

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EPIDEMIOLOGY

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In the United States, 29.1 million people (9.3% of the population) have diabetes. However, more than a quarter of them remain undiagnosed (Fig. 14-1).3 Type 1 diabetes accounts for 5% of all diagnosed cases,3 and type 2 diabetes accounts for 90% to 95% of all diabetes cases in the United States.3 It is being diagnosed more often in children and adolescents due to increasing rates of childhood obesity.3 Gestational diabetes affects 3% to 5% of pregnant women.4 Postpartum, women with gestational diabetes have a 17% to 63% risk of being diagnosed with type 2 diabetes within 5 to 16 years.5

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Figure 14-1

Mean risk of depression for selected illnesses (percentage prevalence for particular disease).

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In the United States, there are significant racial and ethnic differences in those who are 20 years or older and diagnosed with diabetes (Table 14-1).

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TABLE 14-1Age-Adjusteda Percentage of People Aged 20 Years or Older with Diagnosed Diabetes, by Race/Ethnicity, United States, 2010–20123
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Compared with the general population, the prevalence of depression is three ...

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