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Bellass S, Lister J, Kitchen CEW, Kramer L, Alderson SL, Doran T, Gilbody S, Han L, Hewitt C, Holt RIG, Jacobs R, Prady SL, Shiers D, Siddiqi N, Taylor J. Living with diabetes alongside a severe mental illness: A qualitative exploration with people with severe mental illness, family members and healthcare staff. Diabet Med 2021; 38:e14562. [PMID: 33772867 DOI: 10.1111/dme.14562] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023]
Abstract
AIMS Diabetes is two to three times more prevalent in people with severe mental illness, yet little is known about the challenges of managing both conditions from the perspectives of people living with the co-morbidity, their family members or healthcare staff. Our aim was to understand these challenges and to explore the circumstances that influence access to and receipt of diabetes care for people with severe mental illness. METHODS Framework analysis of qualitative semi-structured interviews with people with severe mental illness and diabetes, family members, and staff from UK primary care, mental health and diabetes services, selected using a maximum variation sampling strategy between April and December 2018. RESULTS In all, 39 adults with severe mental illness and diabetes (3 with type 1 diabetes and 36 with type 2 diabetes), nine family members and 30 healthcare staff participated. Five themes were identified: (a) Severe mental illness governs everyday life including diabetes management; (b) mood influences capacity and motivation for diabetes self-management; (c) cumulative burden of managing multiple physical conditions; (d) interacting conditions and overlapping symptoms and (e) support for everyday challenges. People living with the co-morbidity and their family members emphasised the importance of receiving support for the everyday challenges that impact diabetes management, and identified barriers to accessing this from healthcare providers. CONCLUSIONS More intensive support for diabetes management is needed when people's severe mental illness (including symptoms of depression) or physical health deteriorates. Interventions that help people, including healthcare staff, distinguish between symptoms of diabetes and severe mental illness are also needed.
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Affiliation(s)
- Sue Bellass
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Jennie Lister
- Department of Health Sciences, University of York, Heslington, York, UK
| | | | - Lyndsey Kramer
- Department of Sociology, Wentworth College, University of York, Heslington, York, UK
| | | | - Tim Doran
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Lu Han
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Richard Ian Gregory Holt
- Faculty of Medicine/Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, 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, Manchester, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Heslington, York, UK
- Bradford District Care NHS Foundation Trust, Shipley, Bradford, UK
- Hull York Medical School, University of York, Heslington, York, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, Heslington, York, UK
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Arnott B, Kitchen CEW, Ekers D, Gega L, Tiffin PA. Behavioural activation for overweight and obese adolescents with low mood delivered in a community setting: feasibility study. BMJ Paediatr Open 2020; 4:e000624. [PMID: 32399504 PMCID: PMC7204816 DOI: 10.1136/bmjpo-2019-000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mood and weight problems are common in young people, yet few treatments address both conditions concurrently. Behavioural activation (BA) has shown promise as a treatment for adults with comorbid obesity and depression. This study aimed to examine the feasibility and acceptability of a manualised BA treatment targeting weight and mood problems in young people. METHODS Young people with low mood and weight difficulties were identified via a school-based screening process. Following a diagnostic interview, young people with clinically significant mood problems and concurrent overweight/obesity were invited to participate. A total of 8-12 sessions of BA were delivered by a graduate therapist to eight adolescents (four male) aged 12-15 years. Weight, mood and functioning were assessed before, during and after treatment, and a semistructured qualitative interview was conducted, along with selected outcome measures at 4 months' follow-up. RESULTS Low attrition and positive qualitative feedback suggested the intervention was acceptable. Trends towards a reduction in reported depression symptoms and improved functioning scores were observed at follow-up, with more mixed results for change in body mass index. Of those attending the 4-month follow-up, 57% (4/7) no longer met the screening threshold for major depressive disorder. However, low screening and baseline recruitment rates would pose challenges to executing a larger trial. CONCLUSIONS BA delivered by a graduate therapist in a British community setting is an acceptable, feasible treatment for comorbid mood and weight problems in adolescence, and its effectiveness should be evaluated in an adequately powered randomised controlled trial.
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Affiliation(s)
- Bronia Arnott
- Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | | | - David Ekers
- Department of Health Sciences, University of York, York, North Yorkshire, UK.,Tees Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Lina Gega
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Paul Alexander Tiffin
- Department of Health Sciences & the Hull York Medical School, University of York, York, North Yorkshire, UK.,Tees Esk and Wear Valleys NHS Foundation Trust, Teesside, UK
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Kitchen CEW, Lewis S, Tiffin PA, Welsh PR, Howey L, Ekers D. A focused ethnography of a Child and Adolescent Mental Health Service: factors relevant to the implementation of a depression trial. Trials 2017; 18:237. [PMID: 28545545 PMCID: PMC5445271 DOI: 10.1186/s13063-017-1982-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior to commencing a randomised controlled trial, we conducted a focused ethnography to ensure that the trial was well suited to the proposed setting. METHODS A six-month observation of a Child and Adolescent Mental Health Service site in the North-East of England was undertaken to observe the site procedures, staff culture and patient care pathways. During this period, documentary data were collected and interviews were conducted with key informants to provide insight into staff perceptions of the proposed trial. The data were coded using thematic analysis and the resulting themes were verified by a second coder. RESULTS Seventeen documents were collected, 158 h of observation and six formal staff interviews were undertaken. Four themes emerged from the data; non-clinically orientated variation in practice, diagnosis, capacity and staff economy. Non-clinically orientated variation in practice occurred when staff decisions were based upon resource availability rather than on clinical judgement. Diagnosis demonstrated differing staff confidence in making diagnoses and in the treatment of patients who had received a diagnosis. Capacity consisted of the time to attend training and the psychological capacity to consider or incorporate learning into practice. Staff economy was characterised by staff changes and shortages. There was significant interaction between the themes, with staff economy emerging as a central barrier to research. The results directly informed adaptations to the trial protocol. CONCLUSIONS An ethnographic approach has provided important insights into the individual, practical and organisational boundaries into which a trial would need to be implemented.
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Affiliation(s)
- C E W Kitchen
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK.
| | - S Lewis
- Department of Geography, Durham University, Durham, UK
| | - P A Tiffin
- Department of Health Sciences, University of York, York, UK
| | - P R Welsh
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - L Howey
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - D Ekers
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
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