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Ter Braake JG, Fleetwood KJ, Vos RC, Blackbourn L, McGurnaghan SJ, Wild SH, Jackson CA. Cardiovascular risk management among individuals with type 2 diabetes and severe mental illness: a cohort study. Diabetologia 2024; 67:1029-1039. [PMID: 38409440 PMCID: PMC11058755 DOI: 10.1007/s00125-024-06111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024]
Abstract
AIMS/HYPOTHESIS The aim of this study was to compare cardiovascular risk management among people with type 2 diabetes according to severe mental illness (SMI) status. METHODS We used linked electronic data to perform a retrospective cohort study of adults diagnosed with type 2 diabetes in Scotland between 2004 and 2020, ascertaining their history of SMI from hospital admission records. We compared total cholesterol, systolic BP and HbA1c target level achievement 1 year after diabetes diagnosis, and receipt of a statin prescription at diagnosis and 1 year thereafter, by SMI status using logistic regression, adjusting for sociodemographic factors and clinical history. RESULTS We included 291,644 individuals with type 2 diabetes, of whom 1.0% had schizophrenia, 0.5% had bipolar disorder and 3.3% had major depression. People with SMI were less likely to achieve cholesterol targets, although this difference did not reach statistical significance for all disorders. However, people with SMI were more likely to achieve systolic BP targets compared to those without SMI, with effect estimates being largest for schizophrenia (men: adjusted OR 1.72; 95% CI 1.49, 1.98; women: OR 1.64; 95% CI 1.38, 1.96). HbA1c target achievement differed by SMI disorder and sex. Among people without previous CVD, statin prescribing was similar or better in those with vs those without SMI at diabetes diagnosis and 1 year later. In people with prior CVD, SMI was associated with lower odds of statin prescribing at diabetes diagnosis (schizophrenia: OR 0.54; 95% CI 0.43, 0.68, bipolar disorder: OR 0.75; 95% CI 0.56, 1.01, major depression: OR 0.92; 95% CI 0.83, 1.01), with this difference generally persisting 1 year later. CONCLUSIONS/INTERPRETATION We found disparities in cholesterol target achievement and statin prescribing by SMI status. This reinforces the importance of clinical review of statin prescribing for secondary prevention of CVD, particularly among people with SMI.
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Affiliation(s)
- Jonne G Ter Braake
- Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, the Netherlands
| | | | - Rimke C Vos
- Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, the Netherlands
| | - Luke Blackbourn
- MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Mikkelsen TJ, Agerskov H, Jensen DM, Stenager E, Rothmann MJ. Living with schizophrenia and type 2 diabetes and the implication for diabetes self-care: A qualitative study. J Clin Nurs 2024; 33:1862-1874. [PMID: 38356190 DOI: 10.1111/jocn.17001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
AIM To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care. DESIGN The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews. METHODS Data were collected during 2020-2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. RESULTS Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment. CONCLUSION Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. IMPLICATIONS FOR PATIENT CARE The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.
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Affiliation(s)
- Tanja Juhl Mikkelsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Family Focused Health Care Research Centre, University of Southern Denmark, Odense, Denmark
| | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Psychiatric Research Unit, Aabenraa, Department of Regional Health Services Research, University of Southern Denmark, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Stenov V, Willaing I, Joensen LE, Knudsen L, Andersen GS, Hansen DL, Cleal B. Which self-reported measures are useful to explore diabetes support needs among adults with diabetes and severe mental illness? Chronic Illn 2024:17423953241241762. [PMID: 38584462 DOI: 10.1177/17423953241241762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVES To construct and test patient-reported outcome measures (PROMs) for identifying diabetes support needs of adults with co-existing diabetes and severe mental illness (SMI) provided by mental health professionals at psychiatric outpatient clinics. METHODS Design thinking was used to identify, select, and modify PROMs in collaboration with 18 adults with type 1 or type 2 diabetes and SMI and 10 healthcare experts. The PROMs were then tested with 86 adults with diabetes and SMI recruited from eight psychiatric outpatient clinics in Denmark. Data were analysed using systematic text condensation (questionnaire construction) and descriptive statistics (testing). RESULTS Four principles for PROMs were identified: (a) be modified to be relevant for the target group, (b) be concise and simple to complete, (c) have a clear and unambiguous wording, and (d) be designed to measure topics that are perceived as meaningful. Test of the questionnaire contained 49 items in four domains. Missing response rates in the test were 1.2-4.7% in three domains and 4.7-11.6% in a domain addressing potential sources of diabetes support. DISCUSSION PROMs can successfully be constructed in collaboration with this vulnerable population that yield low rates of missing responses.
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Affiliation(s)
- Vibeke Stenov
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ingrid Willaing
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lene Eide Joensen
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Section of Health Services Research, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Lenette Knudsen
- Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Gregers Stig Andersen
- Clinical Epidemiological Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Dorte Lindqvist Hansen
- Department of Diabetes Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Bryan Cleal
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Ojo O, Kalocsányiová E, McCrone P, Elliott H, Milligan W, Gkaintatzi E. Non-Pharmacological Interventions for Type 2 Diabetes in People Living with Severe Mental Illness: Results of a Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:423. [PMID: 38673334 PMCID: PMC11049919 DOI: 10.3390/ijerph21040423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND People with serious mental illnesses (SMIs) such as schizophrenia and bipolar disorder die up to 30 years younger than individuals in the general population. Premature mortality among this population is often due to medical comorbidities, such as type 2 diabetes (T2D). Being a disease directly related to diet, adverse lifestyle choices, and side effects of psychotropic medication, an effective approach to T2D treatment and management could be non-pharmacological interventions. This systematic review and meta-analysis (1) summarise the current evidence base for non-pharmacological interventions (NPI) for diabetes management in people living with SMI and (2) evaluate the effect of these interventions on diverse health outcomes for people with SMI and comorbid diabetes. METHODS Six databases were searched to identify relevant studies: PubMed (MEDLINE), PsycINFO, Embase, Scopus, CINAHL, and Web of Science. Studies were included if they reported on non-pharmacological interventions targeted at the management of T2D in people living with SMI. To be eligible, studies had to further involve a control group or report multiple time points of data in the same study population. Whenever there were enough interventions reporting data on the same outcome, we also performed a meta-analysis. RESULTS Of 1867 records identified, 14 studies were included in the systematic review and 6 were also eligible for meta-analysis. The results showed that there was a reduction, although not significant, in glycated haemoglobin (HbA1c) in the NPI group compared with the control, with a mean difference of -0.14 (95% CI, -0.42, 0.14, p = 0.33). Furthermore, NPI did not significantly reduce fasting blood glucose in these participants, with a mean difference of -17.70 (95% CI, -53.77, 18.37, p = 0.34). However, the meta-analysis showed a significant reduction in psychiatric symptoms: BPRS score, -3.66 (95% CI, -6.8, -0.47, p = 0.02) and MADRS score, -2.63 (95% CI, -5.24, -0.02, p = 0.05). NPI also showed a significant reduction in the level of total cholesterol compared with the control, with a mean difference of -26.10 (95% CI, -46.54, -5.66, p = 0.01), and in low-density lipoprotein (LDL) cholesterol compared with control, with a standardised mean difference of -0.47 (95% CI, -0.90, -0.04, p = 0.03). NPI did not appear to have significant effect (p > 0.05) on body mass index (BMI), health-related quality of life (HRQL), triglycerides, and high-density lipoprotein cholesterol compared with control. CONCLUSIONS This systematic review and meta-analysis demonstrated that NPI significantly (p < 0.05) reduced psychiatric symptoms, levels of total cholesterol, and LDL cholesterol in people with type 2 diabetes and SMI. While non-pharmacological interventions also reduced HbA1c, triglyceride, and BMI levels and improved quality of life in these people, the effects were not significant (p > 0.05).
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Affiliation(s)
- Omorogieva Ojo
- School of Health Sciences, Avery Hill Campus, University of Greenwich, London SE9 2UG, UK;
| | - Erika Kalocsányiová
- Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, Old Royal Naval College, University of Greenwich, Park Row, London SE10 9LS, UK; (E.K.); (P.M.); (E.G.)
| | - Paul McCrone
- Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, Old Royal Naval College, University of Greenwich, Park Row, London SE10 9LS, UK; (E.K.); (P.M.); (E.G.)
| | - Helen Elliott
- King’s Academy, 1-5 Hinton Road, London SE24 0HU, UK;
| | - Wendy Milligan
- School of Health Sciences, Avery Hill Campus, University of Greenwich, London SE9 2UG, UK;
| | - Evdoxia Gkaintatzi
- Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, Old Royal Naval College, University of Greenwich, Park Row, London SE10 9LS, UK; (E.K.); (P.M.); (E.G.)
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Seeman MV. Women with Schizophrenia Have Difficulty Maintaining Healthy Diets for Themselves and Their Children: A Narrative Review. Behav Sci (Basel) 2023; 13:967. [PMID: 38131823 PMCID: PMC10740554 DOI: 10.3390/bs13120967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Severe psychiatric disorders such as schizophrenia are inevitably linked to unemployment, meagre per capita income, and residence in disadvantaged, poorly resourced neighbourhoods. This means difficult access to healthy food and is particularly problematic for pregnant women and mothers with children to feed. The necessity of taking antipsychotic drugs is an additional barrier to healthy eating because these drugs are associated with serious cognitive, psychological, behavioural, and metabolic sequelae. Being ill with psychosis makes it extremely difficult to maintain a healthy diet; nutritional deficiencies result, as do medical complications. The results of present literature review confirm the gravity of the problem and suggest a number of potentially useful clinical interventions.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 3G4, Canada
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Tzeng WC, Feng HP. Dietary Management in Individuals With Serious Mental Illness and Comorbid Diabetes: A Focused Ethnography Study. J Nurs Res 2023; 31:e292. [PMID: 37522625 DOI: 10.1097/jnr.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Patients with serious mental illness (SMI) are more likely to have Type 2 diabetes mellitus (T2DM). However, studies that discuss the eating habits of patients with both T2DM and SMI are lacking. PURPOSE This study was designed to explore the beliefs and experiences of Taiwanese patients with SMI who also have T2DM. METHODS Fieldwork for this study included 2 years of participant observation and individual interviews with 13 patients with SMI. Data from transcripts of observational field notes and interviews were transcribed verbatim and analyzed. RESULTS The participants described their experiences and concerns regarding dietary management during the period after receiving their T2DM diagnosis. The results of the data analysis were distinguished into three categories, including (a) increased difficulty in life, (b) positive view of dietary control, and (c) inability to abide by dietary restrictions. CONCLUSIONS The findings suggest that healthcare professionals should work to better understand the challenges faced by patients with SMI and T2DM in implementing changes and resisting the temptation to eat unhealthy food and provide suggestions tailored to their cultural background, lifestyle, and eating characteristics.
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Affiliation(s)
- Wen-Chii Tzeng
- PhD, RN, Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Hsin-Pei Feng
- PhD, RN, Assistant Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, ROC
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Zabell V, Arnfred SM, Rønne ST, Berring LL, Lerbaek B, Jørgensen R. Combining diabetes and mental health care: An ethnographic exploration of user involvement in combined care. J Clin Nurs 2023; 32:6622-6633. [PMID: 37166281 DOI: 10.1111/jocn.16703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To explore and describe the enactment of user involvement and combined care in a Danish clinic that aimed at providing integrated diabetes and mental health care. DESIGN An ethnographic study. DATA SOURCES AND METHODS Data consisted of field notes from 96 hours of participant observations and field notes from 32 informal conversations with healthcare providers, users and relatives as well as 12 semistructured interviews with users. Data were analysed using a thematic analysis. This study reports to the SRQR guidelines. RESULTS Treatment was not combined as intended if only one healthcare provider handled the consultations. Here, the healthcare providers' focus was often on their own area of expertise-either mental health or diabetes. If more than one healthcare provider handled consultations, the consultations were often divided between them, focussing on one condition at the time. Healthcare providers noted, that learning from peer colleagues was a way to increase the possibility for combined care. Furthermore, combined care was highly dependent on the healthcare providers' ability to involve users' illness experiences in their own care planning. Here, a high level of user involvement increased the levels of combined care during consultations. CONCLUSION This study set out to explore and describe user involvement and combined care in a specialised diabetes and mental health outpatient clinic. Combined care is complexed and requires that healthcare providers are well-equipped to manage the complexity of delivering care for people with both conditions. The degree of combined care was linked with the healthcare providers' ability to involve users and their knowledge on the condition outside there are of expertise. RELEVANCE TO CLINICAL PRACTICE A peer-learning environment in combination with clinical guidelines and joint display could support healthcare providers in involving users in own care and when delivering care outside their area of expertise. PUBLIC CONTRIBUTION No patient or public contribution. Due to the COVID-19 pandemic, the original user council withdraw their consent to participate due to health-related worries and anxiety concerning the pandemic. The user council consisted of three members diagnosed with diabetes and severe mental illness. They were invited to participate in physical meetings, phone or online meetings. Presenting findings from the study to the study participants were also hindered by the second lockdown. This influenced the possibility for data triangulation.
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Affiliation(s)
- Vicki Zabell
- Psychiatric Research Unit, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sidse Marie Arnfred
- Psychiatric Research Unit, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina Trappaud Rønne
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Lauge Berring
- Psychiatric Research Unit, Slagelse, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Birgitte Lerbaek
- Clinic for International and Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University, Aalborg, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Winarsunu T, Utami LA, Fasikhah SS, Anwar Z. Hope therapy: Can it treat hopelessness and internal locus of control on diabetes mellitus patients? PLoS One 2023; 18:e0286418. [PMID: 37310950 DOI: 10.1371/journal.pone.0286418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/16/2023] [Indexed: 06/15/2023] Open
Abstract
Patients with diabetes mellitus (DM) are always required to be able to control a healthy lifestyle throughout their life to avoid various diseases that can accompany the previous illness. However, psychological factors in the form of despair due to lack of hope make people with diabetes more depressed and less able to control behavior and maintain blood sugar stability, so an excellent internal locus of control is needed to be stronger. This study aimed to determine the effect of hope therapy in reducing hopelessness and increasing internal locus of control in people with DM. The research design used a experimental study with ten randomly selected respondents divided into two groups, namely the control group and the experimental group. Data retrieval using the locus of control scale and the beck hopelessness scale. Data analysis used non-parametric analysis, namely the Mann Whitney test, Wilcoxon test, and Spearman's Rank Correlation test. The results of the Mann-Whitney U test on the internal locus of control variable show a value of 0.000 and a p score of 0.008 (p <0.05), it can be concluded that there are differences in the internal locus of control in the experimental group compared to the internal locus of control in the control group. The hopelessness variable shows a value of 0.000 and a p score of 0.008 (p <0.05), this indicates that there is a difference in hopelessness in the experimental group and the control group. There is a decrease in hopelessness and an increase in internal locus of control in people with DM given hope therapy.
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Affiliation(s)
- Tulus Winarsunu
- Department of Psychology, University of Muhammadiyah Malang, Malang, Indonesia
| | - Lintang Aulia Utami
- Department of Psychology, University of Muhammadiyah Malang, Malang, Indonesia
| | | | - Zainul Anwar
- Department of Psychology, University of Muhammadiyah Malang, Malang, Indonesia
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Green CR, Elwyn R, Hill N, Johnston-Ataata K, Kokanović R, Maylea C, McLoughlan G, Roberts R, Thomas SDM. A critical review of research into mental health consumers' perspectives on their physical health: Is there an absence of consumers in the design, conduct, analysis and reporting of this research? Front Public Health 2023; 10:982339. [PMID: 36814954 PMCID: PMC9939465 DOI: 10.3389/fpubh.2022.982339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/28/2022] [Indexed: 02/08/2023] Open
Abstract
We conducted a critical review, using systematic methods, of the literature examining mental health consumer perspectives on their physical and mental health in academic research published between 2005 and 2021. This review examined the inclusion, extent, type and centrality of consumer perspectives regarding their mental and physical health. The search produced 1,865 papers from which 116 met the inclusion criteria. Studies predominantly focused on consumers' individual experiences of their physical and mental health, including but not limited to their understandings and experiences of medication and associated risk factors. They also captured some social aspects of mental health consumers' physical health, including factors that impacted individual agency, stigma, and social and interpersonal factors. Structural factors affecting physical and mental health, such as accessibility of services and financial constraints, were also identified. The review revealed that in comparison to clinician perspectives, the direct representation of consumer perspectives was lacking. Similarly, while clinician and carer perspectives on structural factors were investigated, the consumer perspective in this area was missing. The review also found few genuine codesigned or coproduced research studies. To better identify and respond to the health needs as prioritized by consumers, this paper argues it is imperative that future studies prioritize codesigned and coproduced research. It is argued that a focus on "services as provided" rather than "services as received" has contributed to a lack of progress in addressing the life expectancy gap for consumers. It is recommended that journals, ethics committees and research policy organizations develop guidelines and standards to inform best practice in research on consumer perspectives and experience and to support the implementation of codesigned and/or coproduced approaches in future research. Respecting and including consumers as equal partners in the research process will lead to more meaningful insights to inform policy and practice and reduce the life expectancy gap for people living with mental health concerns.
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Affiliation(s)
- Chloe R. Green
- School of Law, La Trobe University, Melbourne, VIC, Australia
| | - Rosiel Elwyn
- Psychology and Social Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Nicholas Hill
- School of Social and Political Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Kate Johnston-Ataata
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
| | - Renata Kokanović
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
| | - Chris Maylea
- School of Law, La Trobe University, Melbourne, VIC, Australia
| | - Grace McLoughlan
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
| | - Russell Roberts
- School of Business, Charles Sturt University, Bathurst, NSW, Australia
| | - Stuart D. M. Thomas
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
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Wang HI, Han L, Jacobs R, Doran T, Holt RIG, Prady SL, Gilbody S, Shiers D, Alderson S, Hewitt C, Taylor J, Kitchen CEW, Bellass S, Siddiqi N. Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink. Br J Psychiatry 2022; 221:402-409. [PMID: 35049484 DOI: 10.1192/bjp.2021.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. AIMS To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. METHOD This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. RESULTS There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. CONCLUSIONS Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
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Affiliation(s)
- Han-I Wang
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Lu Han
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | | | - Tim Doran
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK; and Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, UK
| | - Stephanie L Prady
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Simon Gilbody
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK; and Hull York Medical School, University of York, UK
| | - David Shiers
- Division of Psychology and Mental Health/Greater Manchester Mental Health NHS Trust/Primary Care and Health Sciences (Keele University), University of Manchester, UK
| | - Sarah Alderson
- Leeds Institute for Health Sciences, University of Leeds, UK
| | - Catherine Hewitt
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | - Jo Taylor
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK
| | | | - Sue Bellass
- Leeds Institute for Health Sciences, University of Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Seebohm Rowntree Building, University of York, UK; Hull York Medical School, University of York, UK; and Bradford District Care NHS Foundation Trust, UK
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11
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Ohueri CW, García AA, Zuñiga JA. Counting, Coping, and Navigating the Flux: A Focused Ethnographic Study of HIV and Diabetes Self-Management. QUALITATIVE HEALTH RESEARCH 2022; 32:399-412. [PMID: 34928736 PMCID: PMC8923063 DOI: 10.1177/10497323211064231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Approximately 10-15% of people living with HIV are also diagnosed with diabetes. To manage their two chronic conditions, people must undertake certain activities and adopt behaviors. Due to overlapping symptoms, complex medication regimens, and heavy patient workloads, implementing these self-management practices can be difficult. In this focused ethnography, data were collected from semi-structured interviews and limited participant-observation with a selected subset of participants to gain insight into self-management challenges and facilitators. We conducted interviews and multiple observations with 22 participants with HIV+T2DM over the period of 9 months. Participants experienced numerous barriers to self-management in the areas of diet, medication adherence, and mental health. Social and familial support, as well as consistent access to care, were facilitators for optimal self-management. At the same time participants' lives were in a unique flux shaped by the dual diagnoses, and therefore, required constant mental and physical adjustments, thus illustrating challenges of managing chronicity.
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Affiliation(s)
- Chelsi W Ohueri
- Department of Slavic and Eurasian Studies, 12330The University of Texas at Austin, Austin, TX, USA
| | - Alexandra A García
- School of Nursing, 12330The University of Texas at Austin, Austin, TX, USA
| | - Julie A Zuñiga
- School of Nursing, 12330The University of Texas at Austin, Austin, TX, USA
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12
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Oral Health Status of Children Living with Type 1 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010545. [PMID: 35010805 PMCID: PMC8744624 DOI: 10.3390/ijerph19010545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 02/04/2023]
Abstract
Background: Diabetes is a well-known predisposing factor for oral diseases, so prevention in an early age is mandatory. Objective: To provide oral screening for children living with type 1 diabetes. We aimed to investigate the oral and general health indexes of T1DM children and compare these data to healthy siblings and controls. Methods: In this cross-sectional study, 120 DM patients and 78 siblings, thereafter 80 DM children and 95 controls, took part. A detailed questionnaire, panoramic radiographs, and lateral cephalograms were obtained in every orthodontic consultation. We used Pearson’s chi-square test for statistical analysis and compared the data of the study and control groups. Results: The oral health values of DM children were significantly better (DMF-T 0.83–1.3) than the national average (3.8–4.5). A total of 75% (n = 60) of the children needed orthodontic treatment for orthodontic or skeletal anomalies. The prevalence of skeletal anomalies was significantly (p < 0.05) higher among patients with diabetes mellitus (DM) than in the control group. The frequency of coeliac disease was significantly elevated compared to any literature data (1–3.5%) in the study (15%) and in the control sibling group (13%). Conclusions: Co-morbidities such as CD should get more attention as a prognostic factor for a future higher incidence of diabetes. T1DM children can be motivated and health-conscious patients with excellent oral hygiene and dental status. Orthodontic treatment can help eliminate the oral complications of DM. Special diabetes ambulances may help provide oral care for patients with DM.
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Balogun-Katung A, Carswell C, Brown JVE, Coventry P, Ajjan R, Alderson S, Bellass S, Boehnke JR, Holt R, Jacobs R, Kellar I, Kitchen C, Lister J, Peckham E, Shiers D, Siddiqi N, Wright J, Young B, Taylor J. Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis. PLoS One 2021; 16:e0258937. [PMID: 34699536 PMCID: PMC8547651 DOI: 10.1371/journal.pone.0258937] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND People living with severe mental illness (SMI) have a reduced life expectancy by around 15-20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI. AIM To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions. METHODS CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised. RESULTS Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning. CONCLUSIONS The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.
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Affiliation(s)
- Abisola Balogun-Katung
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Claire Carswell
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Peter Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ramzi Ajjan
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sue Bellass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jan R. Boehnke
- Department of Health Sciences, University of York, York, United Kingdom
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Richard Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Charlotte Kitchen
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jennie Lister
- Department of Health Sciences, University of York, York, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Ben Young
- Department of Health Sciences, University of York, York, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jo Taylor
- Department of Health Sciences, University of York, York, United Kingdom
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14
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Gelhorn H, Balantac Z, Shinde S, Thieu VT, Boye KS. The Burden of Type 2 Diabetes and the Value of Achieving Near Normoglycemia from the Patient Perspective. Diabetes Ther 2021; 12:1821-1837. [PMID: 34043162 PMCID: PMC8155797 DOI: 10.1007/s13300-021-01054-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) is extremely burdensome to people with T2D and associated with impaired health-related quality of life. This study explores the impact of T2D and potentially relevant outcomes for new therapies using a unique approach to in-depth qualitative interviews where people with T2D are asked to think about their future with T2D. METHODS A cross-sectional qualitative interview study among people with T2D from the USA and UK. Interviews explored their treatment journey, perceptions of their future with T2D, and the value of achieving normoglycemia (explored through presentation of two vignettes with hypothetical medications that reduced hemoglobin A1c [HbA1c] levels < 7% and < 5.7%). RESULTS Patients with T2D (N = 50; US n = 25; UK n = 25) were 66.0% male, had a mean body mass index (BMI) of 30.8 ± 6.3 kg/m2, and had a mean of 13.0 ± 10.0 years since diagnosis. Current diabetes treatments included diet and exercise only (8.0%), oral medications only (62.0%), oral plus injections (24.0%), and insulin only (6.0%). Despite being treated, participants reported over 25 different unmet needs related to their T2D across a broad range of domains. The most common concerns were diet, diabetes-related complications, weight changes, and psychological and emotional issues. A large majority of participants indicated that achieving lower HbA1c values would change their life. When reflecting on the value of improved glycemic control, patients primarily anticipated physical improvements and improved psychological well-being. When presented with two hypothetical treatments, about 70% of participants preferred the < 5.7% treatment option over the < 7% HbA1c treatment option. CONCLUSIONS People with T2D have a high disease burden, a broad range of unmet needs, and extremely varied experiences and expectations on the impacts of T2D on their lives and future. Many patients indicated that achieving near normoglycemia would substantially change their lives primarily in terms of their physical and emotional health.
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Affiliation(s)
- Heather Gelhorn
- Evidera Inc., 7101 Wisconsin Ave, Suite 1400, Bethesda, MD USA
| | - Zaneta Balantac
- Evidera Inc., 7101 Wisconsin Ave, Suite 1400, Bethesda, MD USA
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15
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Lister J, Han L, Bellass S, Taylor J, Alderson SL, Doran T, Gilbody S, Hewitt C, Holt RIG, Jacobs R, Kitchen CEW, Prady SL, Radford J, Ride JR, Shiers D, Wang HI, Siddiqi N. Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background
People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap.
Objectives
The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness.
Design
Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews.
Setting
The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber).
Participants
The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff.
Data sources
The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation.
Results
People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’).
Limitations
Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices.
Conclusions
People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone.
Future work
These findings can inform the development of targeted interventions aimed at addressing inequalities in this population.
Study registration
National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jennie Lister
- Department of Health Sciences, University of York, York, UK
| | - Lu Han
- Department of Health Sciences, University of York, York, UK
| | - Sue Bellass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jo Taylor
- Department of Health Sciences, University of York, York, UK
| | - Sarah L Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Richard IG Holt
- Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | | | | | - John Radford
- Patient and public involvement representative, Keighley, UK
| | - Jemimah R Ride
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Primary Care and Health Sciences, Keele University, Keele, UK
| | - Han-I Wang
- Department of Health Sciences, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
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16
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Rønne ST, Zabell V, Joensen LE, Jørgensen R, Gaede PH, Hemmingsen Arnfred SM. Perceptions and experiences of living with coexisting type 2 diabetes and severe mental illness: a scoping review. Diabet Med 2020; 37:1627-1639. [PMID: 32421884 DOI: 10.1111/dme.14322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Abstract
AIMS To map existing research-based knowledge of everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness, and to identify study designs, aims, populations and themes. METHODS A systematic literature search was performed on 16 April 2019 using Medline, Embase, PsycINFO, Cinahl, the Cochrane Library, and the Web of Science to conduct a scoping review. Included studies were summarized with regard to the quantity of research, the study designs, aims, populations and themes RESULTS: From 3406 records, we included 23 studies about everyday life and illness management among people with coexisting type 2 diabetes and severe mental illness. Four studies were qualitative (observations, interviews and focus groups), and 19 were quantitative (observational and interventions) and used questionnaires. Five themes emerged in the findings: (1) diet and exercise, but not other diabetes self-care activities, are consistently compromised in the target group; (2) psychiatric exacerbation diminishes diabetes self-care; (3) social support and high self-efficacy improve diabetes self-care; (4) use of healthcare services is compromised; and (5) quality of life and well-being is poor. CONCLUSIONS The limited research into the studied population's experiences with coexisting type 2 diabetes and severe mental illness is characterized by its heterogeneity in aims and methods and a strong focus on diabetes management and treatment. Further research focusing on the management of both conditions in everyday life is needed to improve specialized and integrated care targeting the population.
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Affiliation(s)
- S T Rønne
- Psychiatric Research Unit West, Slagelse, Region Zealand, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - V Zabell
- Psychiatric Research Unit West, Slagelse, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L E Joensen
- Health Promotion, Steno Diabetes Centre Copenhagen, Copenhagen, Denmark
| | - R Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - P H Gaede
- Department of Internal Medicine Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Region Zealand, Denmark
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - S M Hemmingsen Arnfred
- Psychiatric Research Unit West, Slagelse, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Stenov V, Joensen LE, Knudsen L, Lindqvist Hansen D, Willaing Tapager I. “Mental Health Professionals Have Never Mentioned My Diabetes, They Don’t Get Into That”: A Qualitative Study of Support Needs in Adults With Type 1 and Type 2 Diabetes and Severe Mental Illness. Can J Diabetes 2020; 44:494-500. [DOI: 10.1016/j.jcjd.2020.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
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18
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Wu LC, Lai CY, Huang CJ, Chou FHC, Yu ET, Yu CY. Psychological distress and diabetes self-management in patients with type 2 diabetes and comorbid serious mental illness. Arch Psychiatr Nurs 2020; 34:218-223. [PMID: 32828352 DOI: 10.1016/j.apnu.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/18/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Lin-Chuan Wu
- Department of Nursing, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd Rd., Lingya Dist., Kaohsiung City 802, Taiwan.
| | - Chien Yu Lai
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-Te Road, Peitou District, Taipei City 807, Taipei, Taiwan.
| | - Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist, Kaohsiung City 807, Taiwan; Department of Psychiatry, Faculty of medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung City 807, Taiwan.
| | - Frank Huang-Chih Chou
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd Rd., Lingya Dist., Kaohsiung City 802, Taiwan
| | - Erica TengYuan Yu
- Department of Undergraduate Studies, Jane and Robert Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX 77030-3901, USA.
| | - Ching-Yun Yu
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanming District, Kaohsiung City 807, Taiwan.
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Exploring the Outcomes of a Pilot Education Program Tailored for Adults With Type 2 Diabetes and Mental Illness in a Community Mental Health Care Setting. Can J Diabetes 2020; 44:461-472.e1. [PMID: 32792101 DOI: 10.1016/j.jcjd.2020.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES People with mental illness and type 2 diabetes are more likely to experience diabetes complications than the general population. Diabetes management can be improved with tailored lifestyle intervention content. The purpose of this pilot study was to investigate diabetes insights of mental health-care patients after participation in a tailored education intervention. METHODS A 12-session diabetes education program was created to address the learning needs and challenges that people with mental illness may experience. The program was assessed through conducting interviews with 6 participants combined with quantitative data to describe the population. Interviews were transcribed verbatim, assessed for quality and coded to identify relationships and meanings between identified themes. RESULTS Throughout the year of participation, blood sugar control and physical activity level improved for some and worsened for others. Weight remained stable and dietary intake patterns appeared to improve overall. Participants described the appropriateness of the teaching strategies and program structure developed, and all improved their understanding about diabetes and gained practical self-management knowledge. Opportunities for program improvement included extending care beyond the counselling room to address financial limitations, incorporating a practical activity component and creating opportunities for social support. Additionally, leaving some sessions as patient directed would further individualize education care. CONCLUSIONS Our study offers a concrete education program strategy that aligns with Diabetes Canada's self-management education guidelines to support the provision of diabetes care for people with mental illness. Modifying program delivery may help to curtail the increasing rates of morbidity and mortality currently observed in this population.
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20
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Lee HM, Yang YC, Chen SF, Hsu CY, Shen YC. Risk of hyperglycemic crisis episode in diabetic patients with depression: A nationwide population-based cohort study. J Diabetes Complications 2020; 34:107509. [PMID: 31864898 DOI: 10.1016/j.jdiacomp.2019.107509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/28/2019] [Accepted: 12/07/2019] [Indexed: 11/15/2022]
Abstract
AIMS This study aims to investigate the risk of hyperglycemic crisis episode (HCE) in diabetic patients with depression and to examine the relationship between the duration of antidepressants use and the risk of HCE. METHODS In all, 26,746 diabetic patients with depression and 106,853 controls (without depression) matched by gender, age, index year, and Charlson Comorbidity Index (CCI) score were included between 1999 and 2010, then followed until the end of 2013. During the follow-up period, participants who developed HCE were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the HCE incidence rate between the two groups studied. RESULTS Diabetic patients with depression had a significantly increased risk of HCE compared to unaffected controls after adjusted for gender, age, CCI score, and duration of antidepressants use (2.87 versus 2.50 per 1000 person-years, HR: 1.78, 95% CI: 1.56-2.03). Also, long-term use of antidepressants in diabetic patients with depression showed a significantly reduced risk of HCE compared to non-users after adjusting for the above-mentioned variables (HR: 0.44, 95% CI: 0.35-0.55). CONCLUSIONS This study shows diabetic patients with depression have an increased risk of HCE, and the use of antidepressants may reduce its risk.
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Affiliation(s)
- Haw-Ming Lee
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Fen Chen
- Center of Medical Genetics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yu-Chih Shen
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Risk of hyperglycemic crisis episode in diabetic patients with bipolar disorder: A nationwide population-based cohort study. J Affect Disord 2019; 257:281-286. [PMID: 31302516 DOI: 10.1016/j.jad.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/05/2019] [Accepted: 07/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suboptimal management of diabetes can lead to a hyperglycemic crisis episode (HCE), which could be further enhanced in the presence of bipolar disorder (BD) and the prescription of antipsychotics. This study aims to investigate the risk of HCE in diabetic patients with BD. Additionally, the duration of antipsychotic prescription on HCE risk is examined. METHODS Using the Taiwan National Health Insurance Research Database, 6099 diabetic patients with BD and 24,378 diabetic patients without BD matched by gender, age, index year, and Charlson Comorbidity Index score were enrolled between 1999 and 2010 and followed to the end of 2013. Participants who developed HCE during the follow-up period were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the HCE incidence rate between two groups studied. RESULTS Diabetic patients with BD were associated with an increased risk of HCE compared with unaffected controls after adjusted for baseline demographics and duration of antipsychotic prescription (3.84 versus 2.71 per 1,000 person-years, HR: 1.41, 95% CI: 1.15-1.71). Also, this study revealed that male gender, more comorbidities, and a longer duration of antipsychotic prescription were potential risk factors for developing HCE. LIMITATIONS This study only deals with data on the duration of antipsychotic prescription, without showing the effects of different antipsychotics on HCE risk. CONCLUSION This study highlights the need to pay attention to the risk of HCE in diabetic patients with BD and the importance of careful prescription of antipsychotics to reduce the HCE incident.
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Tailoring Diabetes Education to Meet the Needs of Adults With Type 2 Diabetes and Mental Illness: Client and Health-Care Provider Perspectives From an Exploratory Pilot Study. Can J Diabetes 2019; 43:421-428.e3. [DOI: 10.1016/j.jcjd.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/14/2018] [Accepted: 09/18/2018] [Indexed: 12/17/2022]
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Abu-Ghname A, Clementi M, Marton S, Schwarzwald H, Giwa E, Hollier L, Chapman S. Behavioral health service utilization: Trends in utilization within a patient-centered medical home for low-income children and women. J Family Med Prim Care 2019; 8:3983-3989. [PMID: 31879647 PMCID: PMC6924215 DOI: 10.4103/jfmpc.jfmpc_412_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 11/04/2022] Open
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