Disclosures: Kitchen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
April 26, 2021
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Greater support, interventions key to diabetes care for adults with severe mental illness

Disclosures: Kitchen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Adults with severe mental illness and diabetes need more intensive interventions and greater support to overcome barriers to diabetes self-management, according to a study published in Diabetic Medicine.

“This study adds to growing evidence that diabetes management is overshadowed by the many competing mental and physical health needs experienced by people with severe mental illness, which when experienced together can be overwhelmingly pervasive,” Charlotte Kitchen, PhD, a postdoctoral research fellow in the department of health sciences at the University of York, United Kingdom, and colleagues wrote.

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Researchers conducted a qualitative study aimed at exploring the experiences of adults with severe mental illness and diabetes and understanding the circumstances influencing their diabetes care. Participants were adults aged at least 18 years with a recorded diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder or depression with psychosis, as well as either type 1 or type 2 diabetes. They were recruited from six general practices, six mental health trusts in north and northwest England, and a research database of adults with severe mental illness and diabetes who previously consented to be contacted for research studies.

Adults with mental illness and diabetes were asked to identify family members and friends who provide support to also participate in the study. Health care staff members involved in mental or diabetes care for people with severe mental illness also participated. Semi-structured interviews were conducted from April to December 2018 with all participants using topic guides developed with reference to existing literature. Interviews took place in the homes of those with severe mental illness and their family members, and at work or by telephone for health care staffers.

Of the 78 participants in the study, 39 were people with severe mental illness and diabetes, nine were family members and 30 were health care staff members. Of the 39 adults with mental illness and diabetes, 56% were diagnosed with schizophrenia and 33% had bipolar disorder.

Barriers to diabetes management

Several themes emerged from the interviews. Participants from all three subgroups said severe mental illness overshadowed the importance of diabetes, especially during periods of poor mental health. Most participants said fluctuating moods were part of daily life. Some feelings, such as low mood, depression, stress or anxiety, were linked to concerns about diabetes and derailed attempts at diabetes self-management.

Nearly all participants with severe mental illness and diabetes were also challenged by the burden of managing other health problems other than their mental illness and diabetes. Some participants said the lack of immediate consequences from diabetes caused them to pay less attention to diabetes self-management. Many participants across all three groups also said there was an overlap of mental illness and diabetes symptoms, making it difficult to identify the underlying cause. These symptoms occasionally had a negative impact on diabetes management.

More support, interventions needed

Adults with mental illness and diabetes said support from family members, friends and health care staff was highly valued, but most claimed they did not feel well supported. A few participants also expressed the desire for more intensive support.

“Approaches to tackle the systemic overshadowing of diabetes are needed to ensure that it is afforded appropriate priority in the context of severe mental illness,” the researchers wrote. “In particular, more intensive and tailored support is needed to help people overcome the multiple barriers to self-management, especially when their mental or physical health deteriorates.”

Researchers also suggested diabetes education tailored specifically for adults with severe mental illness may help address some of the barriers they face.

“For example, introducing strategies to manage the impact of low and fluctuating mood and the side effects of severe mental illness medication, and helping people to distinguish between overlapping mental illness and diabetes symptoms, may contribute to improvements in diabetes self-management,” the researchers wrote.