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Living with diabetes alongside a severe mental illness: a qualitative exploration with people with severe mental illness, family members and healthcare staff

Living with diabetes alongside a severe mental illness: a qualitative exploration with people with severe mental illness, family members and healthcare staff
Living with diabetes alongside a severe mental illness: a qualitative exploration with people with severe mental illness, family members and healthcare staff

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.

bipolar and related disorders, co-morbidity, delivery of healthcare, diabetes mellitus, schizophrenia spectrum and other psychotic disorders, self management
0742-3071
Holt, Richard
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Bellass, Sue
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Lister, Jennie
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Wray Kitchen, Charlotte Emma
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Kramer, Lyndsey
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Alderson, Sarah Louise
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Doran, Tim
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Gilbody, Simon
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Han, Lu
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Hewitt, Catherine
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Jacobs, Rowena
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Prady, Stephanie Louise
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Shiers, David
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Siddiqi, Najma
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Taylor, Johanna
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Holt, Richard
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Bellass, Sue
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Lister, Jennie
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Wray Kitchen, Charlotte Emma
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Kramer, Lyndsey
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Alderson, Sarah Louise
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Doran, Tim
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Gilbody, Simon
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Han, Lu
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Hewitt, Catherine
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Jacobs, Rowena
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Prady, Stephanie Louise
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Shiers, David
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Siddiqi, Najma
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Taylor, Johanna
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Holt, Richard, Bellass, Sue, Lister, Jennie, Wray Kitchen, Charlotte Emma, Kramer, Lyndsey, Alderson, Sarah Louise, Doran, Tim, Gilbody, Simon, Han, Lu, Hewitt, Catherine, Jacobs, Rowena, Prady, Stephanie Louise, Shiers, David, Siddiqi, Najma and Taylor, Johanna (2021) Living with diabetes alongside a severe mental illness: a qualitative exploration with people with severe mental illness, family members and healthcare staff. Diabetic Medicine, 38 (7), [e14562]. (doi:10.1111/dme.14562).

Record type: Article

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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SUBMITTED R2_EMERALD Qualitative Paper_Diabetic Medicine_2nd_Resubmission_230221_clean - Accepted Manuscript
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Published date: July 2021
Additional Information: Funding Information: SLA has received funding from the Wellcome Institutional Strategic Support Fund and a National Institute of Health Research (NIHR) Clinical Trials Fellowship. SLA is a member of the Health Services & Delivery Research funding committee. SG is a deputy chair of the NIHR Health Technology Assessment (HTA) Commissioning Board, and a member of the HTA Commissioning Committee, the HTA Funding Committee Policy Group and the HTA Post‐Funding Committee teleconference. CH is a member of the NIHR HTA Commissioning Board (2015‐current). RIGH has received honoraria for speaker engagement, conference attendance or advisory boards from AstraZeneca, Boehringer‐Ingelheim, European Association for the Study of Diabetes, Eli Lilly, Janssen, Menarini, Mylan, Novo Nordisk and Omniamed, Otsuka. RIGH was a member of the HTA Prioritisation Committee C (Mental Health, Women and Children's Health) until July 2019. DS is an expert advisor to the National Institute for Health and Care Excellence (NICE) centre for guidelines and a member of the current NICE guideline development group for Rehabilitation in adults with complex psychosis and related severe mental health conditions; a Board member of the National Collaborating Centre for Mental Health (NCCMH); a Clinical Advisor (paid consultancy basis) to the National Clinical Audit of Psychosis (NCAP); these are the personal views of DS and not those of NICE, NCCMH or NCAP. DS has received personal fees from Wiley Blackwell publication ‘Promoting Recovery in Early Psychosis’ 2010, ISBN 978–1–4051–4894–8, joint editor in receipt of royalties, outside the submitted work; personal fees received as member of the current NICE guideline development group for Rehabilitation in adults with complex psychosis and related severe mental health conditions. SB, JL, CEWK, LK, TD, LH, RJ, SLP, NS and JT declare no conflicts of interest. Funding Information: This publication presents independent research funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (ref 15/70/26). SG, NS, SLP and RJ were also funded by the NIHR Yorkshire and Humber Applied Research Collaboration (NIHR YH‐ARC), https://www.arc‐yh.nihr.ac.uk/ . The views expressed are those of the authors and not necessarily those of the HS&DR programme, the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
Keywords: bipolar and related disorders, co-morbidity, delivery of healthcare, diabetes mellitus, schizophrenia spectrum and other psychotic disorders, self management

Identifiers

Local EPrints ID: 447876
URI: http://eprints.soton.ac.uk/id/eprint/447876
ISSN: 0742-3071
PURE UUID: 31326b4d-a2dd-4f8f-812e-16ca35661259
ORCID for Richard Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 25 Mar 2021 18:19
Last modified: 17 Mar 2024 06:26

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Contributors

Author: Richard Holt ORCID iD
Author: Sue Bellass
Author: Jennie Lister
Author: Charlotte Emma Wray Kitchen
Author: Lyndsey Kramer
Author: Sarah Louise Alderson
Author: Tim Doran
Author: Simon Gilbody
Author: Lu Han
Author: Catherine Hewitt
Author: Rowena Jacobs
Author: Stephanie Louise Prady
Author: David Shiers
Author: Najma Siddiqi
Author: Johanna Taylor

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