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Barriers to Self-management of Serious Mental Illness and Diabetes

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Objectives: Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices. Methods: We conducted 20 indepth interviews with persons who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. Results: Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care). Conclusions: Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care are needed to help these vulnerable individuals avoid health complications and premature mortality.
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Keywords: DIABETES; HEALTHCARE BARRIERS; SELF-MANAGEMENT; SERIOUS MENTAL ILLNESS

Document Type: Research Article

Affiliations: 1: Senior Scholar, Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH;, Email: [email protected] 2: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH 3: Assistant Professor of Medicine, Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH 4: Professor of Medicine, Epidemiology & Biostatistics, Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH 5: Professor of Psychiatry and Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH

Publication date: March 1, 2016

More about this publication?
  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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