During a symposium presented during the 82e American Diabetes Association (ADA) Scientific Sessions, Professor Katharine Barnard-Kelly, PhD, Chair of the RESCUE (Reducing Suicide Rates Among Individuals with Diabetes) Collaborative Community Steering Committee, Reducing Suicide Rates in Diabetes) from the United States Food and Drug Administration (FDA), discusses the relationship between suicide/self-harm and type 1 diabetes (T1D).
The risk of suicide is significantly higher in people with diabetes, particularly in the context of T1D, and could represent up to 7% of deaths in this population. However, in reality, this could only be the tip of the iceberg.
What the data reveals
Suicidal thoughts are present in 15% of people with T1D compared to 9.4% in the general population. This figure can reach up to 61% in adolescents and young adults with T1D. People with T1D are 3 to 4 times more likely to attempt suicide. The World Health Organization estimates that for every suicide death, there are at least 20 suicide attempts among people with diabetes.
The complexities of intentional self-harm (AI) behavior are different for people with T1D. Besides typical acts of self-harm, these people are also likely to engage in insulin mismanagement with the intent to harm themselves.
Suicide and AI rates are likely to be significantly underestimated in people with T1D. A study of 160 cases of insulin overdose found that 90% of cases were either suicidal or parasuicidal and only 5% were accidental. Another problem is that death certificates or International Classification of Diseases codes used to report causes of death are often unreliable, which adds to the under-reporting of suicides in T1D.
In addition, there are gender differences in suicide risk. Men are more likely to commit suicide than women; however, women make more suicide attempts. Men are also less likely to seek help for their mental health issues.
Why is the risk higher in diabetes?
The management of diabetes is becoming increasingly cumbersome and complex, and for many it can be associated with depression, self-harm and suicidal thoughts and acts. Diabetes itself is a psychologically difficult condition. Despite improvements in the medical management of T1D, the emotional and psychological burden of living with diabetes is still not taken into consideration.
People managing their diabetes are often concerned about their self-esteem, the strength of their relationships, what the future holds, and their educational and employment opportunities.
The role of technology
Significant technological advances in the field of diabetes have improved glycemic control, quality of life and psychosocial functioning, but the psychological burden associated with the use of these complex systems remains unknown.
Professor Barnard-Kelly points out that technology is “NOT” the cause of suicide and IA but rather has allowed clinicians to identify the extent of the problem. However, technologies facilitate harmful behaviors by simplifying the administration of insulin and its potential misuse.
Identification difficulties
Currently available depression and suicide screening tools are not effective enough to identify suicide risk in people with T1D.
Not only do healthcare professionals fail to correctly estimate the risk of suicide in their patients, they often feel under-supported to tackle this issue.
FDA RESCUE Collaborative Community
The FDA RESCUE Collaborative Community was created to facilitate collaboration among the various stakeholders involved in diabetes management to improve the identification of suicide and IA in people with diabetes. diabetes and to provide the necessary support for those at risk.