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The NDSS is administered by Diabetes Australia
The NDSS is administered by Diabetes Australia
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Screening for emotional health concerns in diabetes care: tools and conversations that help

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Emotional health is a fundamental component of diabetes care. Current guidelines recommend routine assessment of emotional wellbeing as part of person-centred diabetes care12.

Emotional health concerns are common among people living with diabetes and can affect diabetes management, engagement with healthcare and diabetes outcomes. Australian research has shown that severe diabetes distress affects approximately one in four people with type 1 diabetes and one in five people with insulin-treated type 2 diabetes, while symptoms of depression and anxiety are also common3.

Although discussing emotional health can add to an already busy consultation, it is often central to a person’s ability and motivation to manage their diabetes effectively. Validated questionnaires can help identify concerns that might otherwise go unnoticed, support meaningful conversations and guide appropriate referral and support4.

When to check in about emotional health

Emotional wellbeing can change throughout a person’s diabetes journey. Current diabetes guidelines recommend that emotional wellbeing is assessed routinely as part of person-centred diabetes care and revisited over time.

Consider discussing emotional health:

  • at diagnosis
  • during routine diabetes reviews
  • when treatment plans change
  • when diabetes management is suboptimal
  • when emotional concerns are suspected
  • whenever a person expresses concerns about coping with diabetes5.

Recognising signs that someone may need additional support

Some people may not recognise the impact diabetes is having on their emotional wellbeing, while others may find discussing emotional health challenges difficult. Health professionals can play an important role in recognising when additional support may be needed.

Look for signs of emotional or mental health challenges such as:

  • skipping insulin or medication doses
  • higher HbA1c or unstable blood glucose levels
  • unhealthy or uncontrolled eating
  • risk-taking behaviours
  • missing clinic appointments.

These signs do not always indicate a mental health condition, but they may signal the need for further discussion.

Communication comes first

People living with diabetes do not always raise emotional health concerns themselves. Creating a trusting, person-centred environment can help people feel more comfortable discussing their experiences and support needs.

A simple statement can help start the conversation:

  • “Sometimes it can be stressful living with diabetes.”
  • “Managing diabetes every day can be challenging.”

You can follow up with open-ended questions, such as:

  • “How have you been feeling about managing your diabetes recently?”
  • “What has been the hardest part of living with diabetes lately?”

Using the 7 As model to guide conversations

Conversations about emotional health can be guided by the 7 As model, a practical framework that helps health professionals identify concerns, assess support needs and plan appropriate follow-up care for people with diabetes who may be experiencing emotional or mental health challenges.

7 As model

  • Be aware: Recognise signs of emotional or mental health challenges.
  • Ask: Explore concerns using open-ended, non-judgemental questions.
  • Assess: Use discussion and validated questionnaires to understand support needs.
  • Advise: Discuss findings and possible next steps.
  • Assist: Work with the person to develop an achievable plan and provide support.
  • Assign: Refer when additional expertise or support is needed.
  • Arrange: Plan follow-ups and ongoing reviews to reassess support needs and goals.

For more information about applying the 7 As model in practice, including toolkits for common emotional health concerns in diabetes, visit the NDSS Enhance your skills in supporting mental health resource.

Common emotional health concerns and questionnaires

When emotional health concerns are identified through conversations, validated questionnaires can help assess the nature and severity. The questionnaire selected should reflect the concerns raised during the discussion.

Common emotional health concerns in diabetes include:

  • Diabetes distress: The emotional burden of living with and managing diabetes. The Problem Areas in Diabetes Scale (PAID) questionnaire assesses diabetes-specific emotional distress and identifies areas of concern6.
  • Depression: Persistent low mood, loss of interest or reduced motivation that may affect day-to-day function and diabetes management. The Patient Health Questionnaire Nine (PHQ-9) screens for symptoms of depression and indicates severity.
  • Anxiety: Excessive worry related to diabetes or other life circumstances. The Generalised Anxiety Disorder Seven (GAD-7) measures anxiety symptoms and their severity.
  • Fear of hypoglycaemia: concerns about experiencing a hypo that may influence diabetes management decisions. The Hypoglycaemia Fear survey version II Worry Scale (HFS-11 W) assesses worries or concerns about experiencing hypoglycaemia.
  • Psychological barriers to using insulin: Concerns about starting, using or increasing insulin. The Insulin Treatment Appraisal Scale (ITAS) measures a person’s positive and negative perceptions of insulin use.

The NDSS mental health questionnaires webpage provides links to the validated questionnaires and information about when and how these tools can be used in practice. For more information about understanding and responding to these emotional health concerns, see Chapters 3-8 of Diabetes and emotional health – a practical guide for health professionals.

Using questionnaires to support conversations

Discussing emotional health can feel challenging when consultation time is limited. However, emotional wellbeing often underpins a person’s ability and motivation to engage in diabetes management, making these conversations an important part of routine diabetes care.

Questionnaires are most effective when used to support conversations about emotional health rather than as standalone assessments. They can help identify concerns that may not emerge through routine discussion, guide care planning and provide a benchmark for monitoring emotional wellbeing over time.

Questions that may help guide discussions include:

  • “How did you feel about answering these questions?”
  • “How have you been feeling about your diabetes management recently?”
  • “What would help you feel more supported to manage your diabetes?”

When reviewing results, focus on the person’s experiences rather than the score alone. Normalising emotional health discussions as part of routine diabetes care can help build trust and encourage more open conversations about emotional wellbeing.

What happens next

When concerns are identified, discuss the results with the person and consider appropriate support based on their needs, preferences and the severity of symptoms. Emotional health needs can change over time, so ongoing review may be required.

This may include:

  • providing additional diabetes education or support
  • arranging follow-up appointments to review concerns
  • connecting the person with peer support or community resources
  • referral to a GP, psychologist or other mental health professional for further assessment or support.

Key takeaway

Questionnaires do not replace conversations; they support them. When they are used alongside person-centred communication and the 7 As framework they can help identify emotional health concerns, guide meaningful discussion and connect people living with diabetes with the support they need.

Further resources and information

For health professionals

For people living with diabetes

References

  1. American Diabetes Association Professional Practice Committee. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes – 2026. Diabetes Care. 2026; 49 (Suppl 1): S89-S130. Available from: https://diabetesjournals.org/care/article/49/Supplement_1/S89/163932/5-Facilitating-Positive-Health-Behaviors-and-Well ↩︎
  2. Speight J, Hermanns N, Jensen W, Kanc K, Karagiannis T, Law M, et al. 2026 EASD evidence-based clinical practice guideline for assessing and managing diabetes distress among adults with type 1 diabetes or type 2 diabetes. Diabetologia. Epub 2026 Sep 15. Available from: https://pubmed.ncbi.nlm.nih.gov/42744915/ ↩︎
  3. Speight J, Holmes-Truscott E, Hendrieckx C, Skovlund S, Cooke D, Browne JL. Diabetes MILES-2: Diabetes Management and Impact for Long-term Empowerment and Success. Survey report 2016. Melbourne (VIC): Australian Centre for Behavioural Research In Diabetes; 2016. Available from: https://acbrd.org.au/diabetes-miles-study/ ↩︎
  4. Hendrieckx C, Halliday JA, Beeney LJ, Speight J. Diabetes and emotional health: a practical guide for health professionals supporting adults with type 1 or type 2 diabetes. Canberra (ACT): National Diabetes Services Scheme, 3rd edition, 2025. Available from: https://www.ndss.com.au/about-diabetes/resources/find-a-resource/diabetes-and-emotional-health/ ↩︎
  5. National Diabetes Services Scheme. Enhance your skills in supporting mental health [Internet]. Canberra (AU): NDSS; [cited 2026 Sep 29]. Available from: https://www.ndss.com.au/health-professionals/supporting-emotional-health/enhance-your-skills/ ↩︎
  6. National Diabetes Services Scheme. Mental health questionnaires [Internet]. Canberra (ACT). NDSS; [cited 2026 Sep 21]. Available from: https://www.ndss.com.au/health-professionals/supporting-emotional-health/mental-health-questionnaires/ ↩︎