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 In-depth interviews were conducted with 20 subjects 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.
Designing culturally relevant weight-reduction programs requires understanding of ethnic variations and illness beliefs. Preliminary data on the values and beliefs about obesity and weight reduction were obtained from women of different ethnic/racial backgrounds. Purposive sampling was used to recruit African American (AA) and Caucasian (C) women with a body mass index (BMI)>or= 30 from the general internal medicine clinics of a large tertiary care facility. Four focus groups (2 with AA women and 2 with C women) consisting of a total of 20 subjects were conducted in a 2-month period. AA women cited culture specific barriers to weight loss more so than did C women. AA women and C women also differed on how health care professionals could help them with weight loss. These findings have implications for nursing's role in the design of culturally relevant weight-loss programs.
Social support appeared to play an important role in moderating the effects of pain, functional limitation, and depression on these subjects' quality of life. Nurses who work with older adults are in a unique position to help them adjust to living with osteoarthritis by providing them the support needed to help them manage their disease.
Objectives Targeted Training in Illness Management (TTIM) addresses serious mental illness and diabetes (DM) concurrently and is designed to improve psychiatric symptoms, functioning, general health and DM control. This 60-week, randomized controlled trial assessed TTIM vs. treatment as usual in 200 individuals with serious mental illness and diabetes. Methods Clinical Global Impression (CGI), Montgomery Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS) assessed symptoms. Global Assessment of Functioning (GAF) and Sheehan Disability Scale (SDS) assessed functioning. Short-form 36 (SF-36) assessed general health and serum glycosylated hemoglobin (HbA1c) assessed DM. Results Average age was 52.7±9.5 years, 54% African-American. Psychiatric diagnoses were depression (48%), schizophrenia (25%) and bipolar disorder (28%). Baseline depressive severity was substantial while psychosis severity was modest. There was greater improvement at 60-weeks in TTIM for CGI (p=<.001) and MADRS (p=.016) and no difference on BPRS. There was greater TTIM improvement on GAF (p=.003) and an improvement trend on SDS (p=.086). There were no group differences on SF-36 or HbA1c means. Diabetes knowledge was significantly improved for TTIM vs. treatment as usual. In post-hoc analyses among individuals within recommended American Diabetes Association HbA1c targets adjusted for high comorbidity at baseline (53%), TTIM had minimal HbA1c 60-week change, while treatment as usual worsened. Conclusions TTIM was associated with improved psychiatric symptoms, functioning, and DM knowledge compared to treatment as usual. General health and DM did not significantly differ when analyzing the whole group, although there were post-hoc analysis differences among sub-groups based upon DM control at baseline.
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