Are diabetes self-management programmes for the general diabetes population effective for people with severe mental illness?: a systematic review

Collaborative innovations in diabetes self-care for individuals with type 2 diabetes and schizophrenia: A Participatory Design study developing a diagnosis-specific educational manual

BACKGROUND AND AIMS

Individuals with schizophrenia are at high risk of developing type 2 diabetes. This study aimed to develop a tailored solution to address their complex diabetes care needs, based on insights from patients and healthcare professionals, to enhance self-care.

METHODS

Using a Participatory Design approach, we conducted three workshops and an evaluation, which included focus groups, interviews, and written feedback. Patients, healthcare professionals, and stakeholders actively participated in all stages of the process between May 2022 and December 2023. Iterative processes ensured comprehensive input in idea generation and concept development. Data analysis followed the steps of planning, acting, observing, and reflecting. The study is reported using SRQR framework.

RESULTS

Participants highlighted challenges such as navigating a fragmented healthcare system, undertreatment, and stigma. In response, a tailored educational manual for voluntary mentors was developed. This two-day training program equips mentors to support individuals with type 2 diabetes and schizophrenia, fostering collaboration and bridging the gap between psychiatric and somatic care.

CONCLUSIONS

A co-designed approach may enhance diabetes self-care and improve coordination between healthcare sectors.

Barriers to Access and Utilization of Diabetes Care Among Patients with Severe Mental Illness in Saudi Arabia: A Qualitative Interpretive Study

Background/Objectives: The prevalence of Diabetes Mellitus (DM) is a major concern in Saudi Arabia, making it a challenge for health delivery for those with severe mental illness (SMI). This study aims to explore the barriers to access and utilization of diabetes care among patients with diabetes and serious mental illnesses, their relatives, and healthcare providers to provide evidence-based recommendations for health policy improvement. Methods: A qualitative interpretive research design was used via Braun and Clarke's framework to analyze the data thematically. Semi-structured interviews were conducted with 35 participants, including patients, relatives, and healthcare providers between September and October 2023, in Jeddah city, Saudi Arabia. Results: The following four themes emerged from the qualitative data: (1) The status of integrated care, (2) Barriers to access to diabetes care at different levels, (3) Navigating obstacles to providing comprehensive diabetes care, and (4) Evidence-based recommendations for health policy improvement. Conclusions: This study underscores the necessity for a comprehensive and integrated approach to care, educational programs, specialized clinics, and improved healthcare logistics. Integrating mental health and diabetes management is needed to ensure better utilization.

Are diabetes self-management interventions delivered in the psychiatric inpatient setting effective? A protocol for a systematic review

INTRODUCTION

Diabetes is a major risk factor for cardiovascular disease, which is the most significant contributor to increased mortality due to natural causes in those with severe mental illness (SMI). Self-management interventions for diabetes have been shown to be effective in the general population, however, effects of these interventions in those with SMI is still unclear. Psychiatric admission could be used opportunistically to deliver interventions of this kind and help improve diabetes self-management. This review aims to assess whether interventions of this kind improve diabetes outcomes and have an effect on reducing cardiovascular risk.

METHODS AND ANALYSIS

This review will include studies assessing diabetes self-management interventions designed to be delivered to those aged 18 and over with comorbid type 2 diabetes and SMI during admission to psychiatric inpatient settings. Databases including the Cochrane Library, Medline, Psychinfo, CINAHL, Embase, WHO's International Clinical Trials Registry Platform, International Health Technology Assessment Database, UK Clinical Research Network and ClinicalTrials.gov will be searched from inception to September 2022. Where possible, meta-analysis of included studies will be conducted. If heterogeneity is high and meta-analysis is not possible, we will use other means of data synthesis and will include a narrative description of included studies.

ETHICS AND DISSEMINATION

Ethical approval is not required as the systematic review will only include data from existing studies. The results will be disseminated via peer-reviewed publication and presentation at relevant national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42022357672.

Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness

PURPOSE OF REVIEW

Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings.

RECENT FINDINGS

Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.

Catastrophic Health Expenditure and Poverty Impact Due to Mental Illness in India

Majority of people in low- and middle-income countries with mental illness do not receive healthcare, leading to chronicity, suffering and increased costs of care. This study estimated the out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and poverty impact due to mental illness in India. Data was acquired from the 76th round data of the National Sample Survey (NSS) on the theme ‘Persons with Disabilities in India Survey’, July–December 2018. Data of 6,679 persons who reported mental illness during the survey was included for analysis. OOPE, CHE, poverty impact and state differentials of healthcare expenditure on mental illness were analysed using standard methods. In total, 18.1% of the household’s monthly consumption expenditure was spent on healthcare on mental illness. About 59.5% and 32.5% of the households were exposed to CHE based on 10% and 20% thresholds, respectively. About 20.7% of the households were forced to become poor from non-poor due to treatment care expenditure on mental illness. Our study suggests the critical need to accelerate on various measures for early diagnosis and management of mental health issues along with financial risk protection for reducing financial impact of healthcare expenditure on mental illness among households in India.

Risk of Developing Type 2 Diabetes in Individuals With a Psychiatric Disorder: A Nationwide Register-Based Cohort Study

OBJECTIVE

Previous studies have investigated the incidence of type 2 diabetes in individuals with psychiatric disorders, but most studies have focused on a specific psychiatric disorder or a selected sample. More population-based studies are needed to determine these associations in representative samples. We therefore aimed to determine these associations in a nationwide, register-based dynamic cohort study.

RESEARCH DESIGN AND METHODS

We analyzed data from 5,005,612 adults living in Denmark between 1995 and 2018, without prior diabetes. We investigated 10 different categories of psychiatric disorders and a composite group with any psychiatric disorder. Individuals with a psychiatric disorder were compared with individuals without using multivariable-adjusted Poisson regression to estimate incidence rate ratios (IRR) of type 2 diabetes. We modeled age-specific incidence rates (IR) for individuals with and without the specific psychiatric disorder. All models were stratified by sex.

RESULTS

In total, 334,739 individuals developed type 2 diabetes during follow-up. For all investigated categories of psychiatric disorders, we found increased IR of type 2 diabetes for individuals with versus those without a psychiatric disorder (IRR: men, 1.47 [95% CI 1.45-1.50]; women, 1.65 [95% CI 1.62-1.68]). When we examined age-specific IR, the largest differences were found in the younger population (<50 years).

CONCLUSIONS

We found that the IR of type 2 diabetes was higher in individuals with a psychiatric disorder compared with individuals without a psychiatric disorder and particularly high in the younger people with a psychiatric disorder. New studies into the prevention and early detection of type 2 diabetes in these groups are warranted.

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

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.