The association between diabetes and depression has been well known for at least three decades1. Major advances in the past two decades have improved understanding of the biological basis for the relationship between depression and diabetes. A bidirectional relationship might exist between type 2 diabetes and depression: just as type 2 diabetes increases the risk for onset of major depression, a major depressive disorder signals increased risk for onset of type 2 diabetes2.
Many people do not realise the significance of the condition and that there is a legal requirement by the DVLA to report diabetes and safety critical workers are tested for diabetes. The condition leaves people at daily risk of low or high blood sugars and can cause people to act as if drunk, have sudden loss of consciousness, and impaired awareness and concentration leading to devastating consequences if not correctly managed on site.
Across the UK, there are 2.73 million people employed either directly or indirectly by the construction industry3. 700 people are diagnosed a day with diabetes (one person every two minutes) and with a national prevalence of 7% it can be estimated that 199,100 people in the construction industry have diabetes. If we add into this, more than half of the people working in the construction industry have reported experiencing mental health issues4, it is clear more still needs to be done to address and support people with these health challenges.
Dr Partha Kar Associate National Clinical Director, Diabetes with NHS England leading on digital innovation says “It’s potentially the most devastating health crisis of our time. Diabetes can affect all aspects of someone’s life, and we know that people with diabetes experience disproportionately high rates of mental health problems such as depression, anxiety and eating disorders.”5.
Three in five people with diabetes experience emotional or mental health problems6 and male site workers in construction are three times more likely to commit suicide than the average UK male. These shocking mental health statistics are a vivid reminder of the difficulties faced by many working in the construction industry every day.
The construction industry lifestyle is undoubtedly both challenging and stressful. Long and demanding working hours, working away from home on site for weeks at a time and the lingering unease in the industry, are just some of the factors contributing to poor mental health, food choices and possibly diabetes. In a workforce that is predominantly male, specific risks associated with male mental health and healthy lifestyle choices also need to be considered along with the “tough guy” image widespread in this industry. Asking for help and opening up about emotions or health conditions are just not things that come naturally to many of those working in the industry. The combination of these factors results in many suffering in silence7.
A significant report on diabetes and mental health lead Chris Askew, Chief Executive of Diabetes UK, to say, “diabetes affects more than 4.5 million people in the UK and is the fastest-growing health crisis of our time. It can lead to heart disease, stroke, kidney failure and lower limb amputations. This new research brings to light the isolation that can come from managing an invisible condition, and how detrimental living with diabetes can be to a person’s emotional wellbeing without the right support”8.
People with diabetes and mental health problems show poorer compliance with treatment recommendations than people with diabetes without depression, and more frequently have cardiovascular risk factors such as smoking, obesity, sedentary lifestyle and poor glycaemic (sugar) control, which can impact on their health-related quality of life1. Poor glycaemic (sugar) control on site could lead to a person acting as if drunk or blacking out, putting themselves, other staff and the company at risk of litigation. We know safety critical workers are tested for diabetes, but they are then unregulated back on site. The DVLA expected those on higher medications to be testing before driving machinery, does your company ensure this is happening?
The 2011 No Health Without Mental Health report estimated that introducing collaborative care for the treatment of depression in people with type 2 diabetes would save the NHS and social care about £3.4 million in 4 years, with a further £11.7 million of benefits to individuals owing to improved productivity9. As diabetes is not specifically reported in the construction industry, we are unable to estimate savings but with an estimated 199,100 people with diabetes in the industry even saving one day per person absence would have significant financial benefit, never mind the decreased risk and liability associated to the condition.
The current work on mental health in the construction industry is incredible and inspiring. By adding diabetes understanding and health, we can increase the impact and help more people throughout the sector improve their lives, decrease absenteeism and increase safety.
- BMJ – Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study) : results from the MADIABETES cohort https://bmjopen.bmj.com/content/8/9/e020768
- NCBI – The Mental Health Comorbidities of Diabetes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439400/
- Statista -Construction Industry in the UK – Statistics & Facts https://www.statista.com/topics/3797/construction-industry-in-the-uk/
- pbctoday – Stress and mental health issues in construction https://www.pbctoday.co.uk/news/health-safety-news/stress-mental-health-construction/51065/
- NHS England -Diabetes and mental health: Call out for examples of best practice https://www.england.nhs.uk/blog/diabetes-and-mental-health-call-out-for-examples-of-best-practice/
- Diabetes UK https://www.diabetes.org.uk/about_us/news/three-in-five-people-with-diabetes-experience-emotional-or-mental-health-problems
- UK Construction Online https://www.ukconstructionmedia.co.uk/features/mental-health-construction-industry/
- Open Access Government investigates the link between diabetes and mental health https://www.openaccessgovernment.org/diabetes-mental-health/52327/
The Lancet – Poor mental health in diabetes: still a neglected comorbidity https://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00144-8/fulltext