Correspondencewwwthelancetcom Vol 388 August 6 2016 561sample O ✓ Solved

Correspondence Vol 388 August 6, sample of people with type 1 and type 2 diabetes was seven times higher (14·3%) than in the general p o p u l a t i o n ( 2 · 3 % ) . Pa r t i c i p a n t s with insulin-treated type 2 diabetes reported more frequent depressive symptoms (34.3%) and even more prevalent suicidal ideation (19%) than individuals with type 1 diabetes. Participants with diabetes and at least moderate depressive symptoms reported higher suicide ideation rates (>40%) than those with diabetes and no depressive symptoms (5·8%).3 The suicide rate in young men (ages 20–24 years) with type 1 diabetes is complex, understudied, and higher than the expectations of Kyvik and colleagues, 4 suggesting that the cause of death is often misclassifi ed as diabetes-related, rather than due to mental health issues or suicide.

Depression is associated with increased mortality in diabetic populations. Similarly, depressive symptoms have been shown to increase mortality risk in people with diabetes but not in those without diabetes.5 These pieces emphasise the eff ect of mental health on diabetes, and further ignorance will only lead to increasing numbers of articles chronicling the ballooning costs of the diabetes epidemic. We declare no competing interests. *Gemma C Macdonald, Lesley V Campbell [email protected] Diabetes Centre, St Vincent’s Hospital, Sydney, NSW 2010, Australia 1 Krug EG. Trends in diabetes: sounding the alarm. Lancet 2016; 387: 1485–86.

2 Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry 2016; 3: 171–78. 3 Handley TE, Ventura AD, Browne JL, et al. Suicidal ideation reported by adults with Type 1 or Type 2 diabetes: results from Diabetes MILES-Australia.

Diabet Med 2015; published online Nov 3, 2015. doi: 10.1111/dme.13022. 4 Kyvik KO, Stenager EN, Green A, Svendsen A. Suicides in men with IDDM. Diabetes Care 1994; 17: 210–12. 5 Zhang X, Norris SL, Gregg EW, Cheng YJ, Beckles G, Kahn HS.

Depressive symptoms and mortality among persons with and without diabetes. Am J Epidemiol 2005; 161: 652–60. Division of Neonatology, Erasmus University Medical Centre, Sophia Children’s Hospital, Rotterdam, the Netherlands (JVB); Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK (JVB, AS); and School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, Netherlands (JVB, AS) 1 GBD Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.

Lancet 2015; 386: 2287–323. 2 Flenady V, Koopmans L, Middleton P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377: 1331–40. 3 Aune D, Saugstad OD, Henriksen T, Tonstad S.

Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311: 1536–46. 4 Amegah AK, Quansah R, Jaakkola JJ. Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence. PLoS One 2014; 9: e113920.

5 US Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, 2014. Mental illness: the forgotten burden on diabetes populations? In April, The Lancet discussed the high cost of diabetes and an urgent call for action.

The Comment by Etienne Krug (April 9, p 1485)1 focuses on physical interventions without mentioning the burden of mental illness in diabetes, in which depression and diabetes distress are common. Depression also has a bidirectional relationship with type 2 diabetes, showing causative and consequential implications: mental health is an essential consideration in diabetes prevention and management. The 2011 UN initiative aims to r e d u c e p r e m a t u r e d e a t h s f r o m non-communicable diseases. Vigo and colleagues 2 warned of large numbers of people with severe mental illness dying prematurely from non-communicable diseases. S u i c i d a l i d e a t i o n i n a l a r g e Freedom of expression and health: is the association causal?

Article 19 of The Universal Declaration of Human Rights1 declares the right to freedom of opinion and expression as one of the fundamental human rights. The violation of human rights deserves condemnation by civilised society. Health-care workers are entrusted with the task of mitigating pain in all forms, and preventing premature death due to all causes. Clearly, homicide deserves the highest condemnation by physicians as members of civilised society. Physical or mental harming of individuals for their expression of contrary views by organised groups is the worst form of humanity; it refl ects the distortion of collective wisdom.

However, the condemnation of such events by The Lancet (May 7, p 1880)2 needs more caution. The scientific community is testing ways to study the relations between human rights and health at present,3 and evidence of an association between the two is under investigation. To upgrade one domain of human rights—ie, the right to freedom— to causal of health, is premature. The Lancet manifesto reads “Improving lives is the only end goal that mattersâ€, but there is a fl ipside: the aim is to be achieved through scientific principles. We as professionals should not attempt to achieve our objectives through means other than evidence, delivered by robust research.

In the long term it may be deleterious both for the science, and the success of the mission. I declare no competing interests. Varun M Malhotra [email protected] Department of Community Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana 508254, India 1 The Universal Declaration of Human Rights. UN. human-rights/ (accessed May 8, 2016). 2 The Lancet.

No free expression, no health. Lancet 2016; 387: 1880. 3 Hunt P, Yamin AE, Bustreo F. Making the case: what is the evidence of impact of applying human rights-based approaches to health? Health Hum Rights 2015; 17: 1–10.

Sh au nl Freedom of expression and health: is the association causal? References Reflective Journal Name: Date: 1. Summarize and reflect on this week’s, readings and learning activities. 2. How will these concepts impact your own professional practice now or in the future?

Reflective Journal Rubric 20 pts Exemplary Developing Needs Improvement Discussion Criteria 10 Points 7 Points 4 Points Faculty Comments Application of Course Knowledge Journal contributes reflections and unique perspectives or insights gleaned from weekly objectives or examples from the healthcare field. Journal entry has limited application of course knowledge and demonstration of perspectives. Journal does not reflect application of course knowledge and personal insights or examples from healthcare. Grammar, Syntax, APA Format APA format, grammar, spelling, and/or punctuation are accurate, or with zero to three errors. Four to six errors in APA format, grammar, spelling, and syntax noted. Journal entry contains greater than six errors in APA format, grammar, spelling, and/or punctuation or repeatedly makes the same errors after faculty feedback.

Paper for above instructions

Reflective Journal

Name: [Your Name]
Date: [Today's Date]

1. Summary and Reflection

This week’s readings and discussions primarily focused on the complex relationship between mental health and chronic illnesses, with a particular emphasis on diabetes. Notably, the correspondence published in The Lancet elucidated the alarming prevalence of depressive symptoms and suicidal ideation among individuals with both type 1 and type 2 diabetes (Macdonald & Campbell, 2016). The statistics presented highlighted that the rates of depressive symptoms in diabetes populations were significantly higher than in the general population, emphasizing the need for integrated care approaches that account for both physical and mental health.
The reported figures, such as 14.3% of individuals with diabetes experiencing depressive symptoms versus 2.3% in the general population, spotlight a public health issue that is often underestimated (Macdonald & Campbell, 2016). Furthermore, the correspondence revealed that individuals with insulin-treated type 2 diabetes had even higher rates of depressive symptoms (34.3%) and suicidal ideation (19%) than those with type 1 diabetes. This disparity calls for increased awareness among healthcare professionals regarding the psychological burdens faced by their diabetic patients.
Another critical point from the readings was the bidirectional relationship between diabetes and depression, suggesting that depression can both contribute to and result from diabetic conditions (Vigo, Thornicroft, & Atun, 2016). The urgency for mental health considerations in diabetes management becomes even more apparent when we examine the increased mortality rates associated with depressive symptoms among people with diabetes (Zhang et al., 2005).
Moreover, the correspondence drew attention to the often misclassified causes of death in young men with type 1 diabetes. It pointed out that mental health issues, including suicide, may be underreported or inaccurately classified as deaths related directly to diabetes (Kyvik et al., 1994). This observation underlines a crucial aspect of healthcare: the need for accurate data collection and analysis to better understand the intersectionality of chronic physical illnesses and mental health.
The discussion also prompted a reflection on the importance of a holistic approach to patient care. The rising trend of diabetes and its associated complications, intertwined with mental health concerns, underscores the urgent need for integrated healthcare systems that address both physical and mental health (Handley et al., 2015). In contemporary clinical practice, healthcare providers should be trained to recognize signs of depression and suicidal ideation in their patients with diabetes and to implement treatment plans that encompass mental health resources.
As a future healthcare professional, I find these readings significantly impactful. They serve as a crucial reminder of the necessity for a comprehensive, patient-centered approach in my practice. Recognizing that a patient's mental health can profoundly affect their physical health—and thus their management and outcomes of chronic diseases like diabetes—is essential.

2. Impact on Professional Practice

Moving forward in my professional practice, the insights gained from this week's readings will deeply influence my approach to patient care. Firstly, it underscores the importance of adopting an interdisciplinary framework that includes mental health professionals in the management of chronic diseases. Incorporating regular mental health screenings into diabetes care protocols would be a practical way to address this issue.
Secondly, I aim to develop empathetic communication skills that facilitate open discussions about mental health. Many patients may feel stigmatized or reluctant to discuss their mental health issues; thus, creating an environment of trust and safety will be paramount. As clinicians, we must cultivate an atmosphere where patients feel comfortable sharing their emotional struggles.
Additionally, the readings highlighted the need for ongoing education and training in both diabetes management and mental health awareness for healthcare providers. Understanding the signs and symptoms of depression and how they present uniquely in diabetic populations will place me in a better position to provide holistic care. Also, continuing education can help mitigate biases that may inadvertently affect the treatment of patients who are suffering from both physical and mental health issues.
Finally, I intend to stay abreast of the current literature regarding diabetes and mental health. The rapidly evolving field of healthcare demands that practitioners are informed and adaptable. By keeping informed of new research and data, I can contribute to evidence-based practices that prioritize both health aspects effectively.

References

1. Macdonald, G. C., & Campbell, L. V. (2016). Mental illness: the forgotten burden on diabetes populations? The Lancet, 388(10045), 561.
2. Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. Lancet Psychiatry, 3(2), 171-178.
3. Handley, T. E., Ventura, A. D., Browne, J. L., et al. (2015). Suicidal ideation reported by adults with Type 1 or Type 2 diabetes: results from Diabetes MILES-Australia. Diabet Med, published online Nov 3, 2015.
4. Kyvik, K. O., Stenager, E. N., Green, A., & Svendsen, A. (1994). Suicides in men with IDDM. Diabetes Care, 17(3), 210-212.
5. Zhang, X., Norris, S. L., Gregg, E. W., Cheng, Y. J., Beckles, G., & Kahn, H. S. (2005). Depressive symptoms and mortality among persons with and without diabetes. Am J Epidemiol, 161(7), 652-660.
6. Amegah, A. K., Quansah, R., & Jaakkola, J. J. (2014). Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence. PLoS One, 9(10), e113920.
7. Flenady, V., Koopmans, L., Middleton, P., et al. (2011). Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet, 377(9774), 1331-1340.
8. Aune, D., Saugstad, O. D., Henriksen, T., & Tonstad, S. (2014). Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA, 311(15), 1536-1546.
9. GBD Risk Factors Collaborators. (2015). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 386(10010), 2287-2323.
10. Hunt, P., Yamin, A. E., & Bustreo, F. (2015). Making the case: what is the evidence of impact of applying human rights-based approaches to health? Health and Human Rights, 17(1), 1-10.