Addressing the mental health needs of people living with diabetes in Ireland

Rationale

There is an increasing trend in the proportion of people developing diabetes mellitus worldwide: 10.5% of the world’s population between 20 and 79 years of age (536.6 million people) was estimated to have diabetes in 2021, with a projected increase to 12% by 2045 (Sun et al., 2022). Similarly, depression is also a relatively common condition, with approximately 8-12% of people worldwide estimated to experience its symptoms at some point during their lifetime (Andrade et al., 2003). Both diabetes and depression are potentially serious health conditions which can shorten lifespan and lower quality of life if left undiagnosed and untreated. Although diabetes is often viewed as a purely physical condition, and depression as a distinctively mental one, both have overarching consequences for both physical and mental health. Despite the exact underlying processes being unknown, depression has been found to increase the risk of type 2 diabetes by 20–60%, while people with diabetes are 20–30% more likely to develop depression than people without diabetes (Chireh et al., 2019; Hasan et al., 2015; Rotella & Mannucci, 2013). The strength of the diabetes-depression association is a crucial factor for informing healthcare policies on assessing and preventing their comorbidity.

This policy brief argues that mental health is a relevant topic of interest when considering practice in diabetes healthcare. This policy brief also provides practical recommendations based on official healthcare guidelines and research findings.

In Ireland, 4-7% of the population is estimated to have diabetes (Health Service Executive, 2025; Scottish Diabetes Group, 2023; Sun et al., 2022). Such prevalence estimates are relatively low compared to the global estimate of 10.5% (Sun et al., 2022), however, diabetes estimates for Ireland are likely to lack accuracy given that the Irish national diabetes registry was only established in 2025 (Lynch, 2025). On the other hand, in 2022, more than 40% of Ireland’s adult population met diagnostic criteria for at least one mental health disorder based on their self-reported symptoms (Hyland et al., 2022), suggesting that people in Ireland often experience elevated levels of mental health problems. In this regard, the national clinical guidelines (Department of Health, 2024) and the integrated model of diabetes care (National Clinical Programme for Diabetes, 2024) state that healthcare professionals should be alert to the presence of depression and/or anxiety, difficulties with self-management, and mental health distress when providing advice or care for people with diabetes. Due to the recency of mental health problems being incorporated into Ireland’s diabetes care guidelines, there is currently no knowledge about the extent to which diabetes distress is adequately assessed and the extent to which mental health needs are met in people living with diabetes in Ireland.

Evidence

The evidence implies that the processes through which diabetes and depressive symptoms potentially affect each other are robust and largely similar across different European countries, cultures, and socioeconomic backgrounds. There are a number of factors that the prevalence of diabetes and depression might be dependent upon, including age, country or region, as well as healthcare accessibility. Diabetes and depression more commonly appear together in countries with poorer quality of, and poorer access to, healthcare (Graham et al., 2018), perhaps because of a lack of preventive measures against developing comorbidity. However, among European people over the age of 50, the prospective relationship between type 2 diabetes and depressive symptoms seems to be stable, regardless of the country’s geographical location (Gottfried et al., 2025b), socioeconomic and healthcare factors, and the sociodemographic characteristics of the population (Gottfried et al., 2025a). This stability gives us the opportunity to set guidelines on preventing this comorbidity that are applicable and effective across different countries.

In Ireland, in 2025, public focus group workshops for people with type 1 or type 2 diabetes highlighted the subjective importance of mental well-being and the management of everyday stress associated with living with diabetes (Gottfried, et al., 2026). Common topics included the effects of diabetes on daily routines (e.g. having to plan a daily schedule around meals), the quality of interaction with healthcare practitioners (e.g., healthcare professionals never having time to ask how you feel), and the awareness and understanding of diabetes by peers and family (e.g., being embarrassed to tell other people you are diabetic). While the level of medical treatment might be appropriate and sufficient, it is the area of mental health and managing life with the disease in which the healthcare system often fails to meet people’s needs. GPs and other healthcare practitioners understand the medical and physiological consequences of diabetes but might be less familiar with its psychosocial impact on daily life. Not paying closer attention to these indirect secondary complications might leave people with diabetes exposed to higher risk of mental health problems and a reduced overall quality of life. That being said, factors affecting mental health when living with diabetes are numerous and varied. In Figure 1 presented below, we captured some of the important factors on mental health and diabetes, based on the discussions had between workshop attendees. Generally, attendees agreed that mental health is important for effective dealing with practical issues of living with diabetes, like the need to monitor blood glucose levels on a regular basis and to adjust diet and physical activities accordingly. Many attendees considered emotional support and empathetic acknowledgment of diabetes-related problems from GPs and other people to be beneficial for mental health.

Figure 1: An infographic about mental health aspects of living with diabetes

Practical recommendations

For people with diabetes, healthcare practitioners, social media, and dedicated diabetes organizations are the primary sources of information on diabetes. The preventive role of healthcare practitioners is pivotal, because for some people, their GP might be the only trusted source of information on diabetes, or the only person with whom they discuss their diabetes-related problems. Consequently, it is important that GPs aim to have a basic understanding of common psychosocial challenges of living with diabetes, and be able to point their clients to the relevant services and further sources of information on this matter.

However, the identification of people at risk must be followed by the provision of appropriate services if prevention and treatment programmes are to be effective. The nature of these services is very similar to the existing services for mental health conditions in the general population, however minor adjustments could be made to accommodate the specific challenges related to diabetes. Counselling sessions, peer support groups, and dedicated meetings/workshop events have the potential to provide people living with diabetes with information, a sense of solidarity, and the opportunity to share experiences and discuss strategies in managing the mental health burden.

As unidentified problems cannot be addressed or treated, the first step in the prevention process should be the promotion of reliable information sources and spreading awareness of the risk of depression comorbidity to people with diabetes and healthcare practitioners . From a policy perspective, the most targeted and feasible option in Ireland might be to promote relevant national guidelines for healthcare practitioners, such as the Integrated Model of Care for people with Type 2 Diabetes Mellitus (National Clinical Programme for Diabetes, 2024) or the National Clinical Guideline No. 17 (Department of Health, 2024), and monitor the awareness among GPs. The aim of these guidelines is to provide GPs with a better knowledge of the long-term non-medical challenges commonly reported by people with diabetes, and highlighting the risk of depressive symptoms, alongside the benefits of periodical mental health screening.

Supporting and promoting the follow-up services, which are often run by charities or non-profit organizations such as Diabetes Ireland or Thriveabetes, can help prevent the development of depression or other serious mental health issues in people with diabetes, ultimately improving their quality of life. Table 1 (below) lists some issues with the potential to negatively affect the mental health of people with diabetes, alongside the suggested steps for their mitigation. The actions we suggest are specifically targeted at tackling diabetes-depression comorbidity in people with diabetes.

An advantage for policy makers might be that these policies have the potential to be effective internationally, given the assumed diabetes-depression comorbidity stability outlined in our rationale. Observing the process of their implementation and evaluation in other European countries’ healthcare systems can guide the implementation process in Ireland. Also, because the prevention of mental health issues is preferable and easier than their treatment, the suggested measures have the potential to be cost-benefit efficient in the long run.

Table 1: Issues negatively affecting mental health of people living with diabetes in Ireland and potential ways to address them

Conclusion

Our research has demonstrated a clear association between depressive symptoms and diabetes diagnosis across European countries. For people of an older age, the association is stable and does not change regardless of most sociodemographic characteristics or major socioeconomic and healthcare aspects in their country of living. The stability of the connection between diabetes and depressive symptoms suggests that if diabetes causes depression, and/or the other way around, there is a similar mechanism across different countries. Such similarity means that the key principles in international healthcare guidelines for treating mental health in diabetes, e.g. the 2026 EASD evidence-based clinical practice guideline (Speight et al., 2025), have the potential to be effective in Ireland as well, if steps are made to facilitate adherence among local healthcare professionals.

Feedback from people with diabetes in Ireland suggests a gap in implementing guidelines into practice, with people reporting that their healthcare provision was not sufficiently addressing the mental health burden associated with diabetes (Gottfried, et al., 2026). Despite the existence of official guidelines for healthcare professionals on how to assess mental health in patients with diabetes, there is a need for further efforts to implement the recommended procedures into diabetes healthcare practice in Ireland. Additional services like peer support groups or a provision of educational materials on diabetes for family members and the general public could also be efficient at targeting sources of mental health risk for people living with diabetes.

Acknowledgement

This publication has emanated from research conducted with the financial support of the Health Research Board under Grant numbers [SDAP-2023-001] and [KTA-2024-030].

References

Andrade, L., Caraveo-Anduaga, J. J., Berglund, P., Bijl, R. V., De Graaf, R., Vollebergh, W., Dragomirecka, E., Kohn, R., Keller, M., Kessler, R. C., Kawakami, N., Kiliç, C., Offord, D., Ustun, T. B., & Wittchen, H.-U. (2003). The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research, 12(1), 3–21. https://doi.org/10.1002/mpr.138

Chireh, B., Li, M., & D’Arcy, C. (2019). Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies. Preventive Medicine Reports, 14, 100822.

Department of Health. (2024). National Clinical Guideline No. 17. https://www.diabetes.ie/wp-content/uploads/2024/05/Adult-Type-1-Diabetes-Mellitus-v2.pdf

Gottfried, J., Fitzgerald, A., Flynn, G., Gajewska, K., Lloyd, C., Nouwen, A., O’Donnell, S., Power, S., Rodrigues, R., Schmitz, N., & Deschênes, S. (2026). “We are more than just a number”: Mental health needs in the context of diabetes healthcare in Ireland [version 1; peer review: awaiting peer review]. HRB Open Res, 9(2). https://doi.org/10.12688/hrbopenres.14301.1

Gottfried, J., Gajewska, K., Hernández, B., Kenny, R. A., Lloyd, C., Nouwen, A., O’Donnell, S., Rodrigues, R., Schmitz, N., & Deschênes, S. (2025a). Diabetes and depressive symptoms: Examining the potential roles of country-level and individual-level factors across European countries [Manuscript in review].

Gottfried, J., Gajewska, K., Hernández, B., Kenny, R. A., Lloyd, C., Nouwen, A., O’Donnell, S., Rodrigues, R., Schmitz, N., & Deschênes, S. (2025b). Prospective associations between diabetes and depressive symptoms across European regions: A secondary analysis of ELSA, TILDA, and SHARE datasets. European Journal of Public Health, ckaf132. https://doi.org/10.1093/eurpub/ckaf132

Graham, E. A., Thomson, K. H., & Bambra, C. L. (2018). The association between diabetes and depressive symptoms varies by quality of diabetes care across Europe. European Journal of Public Health, 28(5), 872–878. https://doi.org/10.1093/eurpub/cky050

Hasan, S. S., Mamun, A. A., Clavarino, A. M., & Kairuz, T. (2015). Incidence and risk of depression associated with diabetes in adults: Evidence from longitudinal studies. Community Mental Health Journal, 51, 204–210.

Health Service Executive. (2025). Diabetes. https://www.hse.ie/eng/about/who/cspd/ncps/diabetes/

Hyland, P., Vallières, F., Shevlin, M., Bentall, R. P., Butter, S., Hartman, T. K., Karatzias, T., Martinez, A. P., McBride, O., Murphy, J., & Fox, R. (2022). State of Ireland’s mental health: Findings from a nationally representative survey. Epidemiology and Psychiatric Sciences, 31, e47. https://doi.org/10.1017/S2045796022000312

Lynch, D. (2025, March 10). HSE team appointed to develop diabetes registry. The Medical Independent. https://www.medicalindependent.ie/in-the-news/hse-team-appointed-to-develop-diabetes-registry/

National Clinical Programme for Diabetes. (2024). Integrated Model of Care for people with Type 2 Diabetes Mellitus. https://www.hse.ie/eng/about/who/cspd/ncps/diabetes/moc/hse-integrated-model-of-care-for-people-with-type-2-diabetes-mellitus.pdf

Rotella, F., & Mannucci, E. (2013). Depression as a risk factor for diabetes: A meta-analysis of longitudinal studies. The Journal of Clinical Psychiatry, 74(1), 4231.

Scottish Diabetes Group. (2023). Scottish Diabetes Survey 2023. NHS Scotland. https://www.diabetesinscotland.org.uk/wp-content/uploads/2024/11/Scottish-Diabetes-Survey-2023.pdf

Speight, J., Hermanns, N., Jensen, W., Kanc, K., Karagiannis, T., Law, M., Mocan, A., Rutters, F., Sturt, J., Zaccardi, F., & Holt, R. (2025). 2026 EASD evidence-based clinical practice guideline for assessing and managing diabetes distress among adults with type 1 diabetes and type 2 diabetes. European Association for the Study of Diabetes. https://www.easd.org/uploads/Final-Draft_EASD-Diabetes-Distress-Guideline.pdf

Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C. N., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119