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Mental Health
Screening:
•Depression
is often sited as a reason for therapy
non-adherence.
•Grief
coping following diagnosis can continue
for years (setbacks or therapy changes
can exacerbate this grieving)
•Persons
with diabetes are 4x more likely to
experience depression and anxiety
•Screening
and referral for mental health services
Mental health is a major consideration in managing any chronic illness. The strain of daily management of a disease state with little observable benefit can become very tiring. Even patients who are maintaining good control of blood sugars can suffer from “burn out” or a loss of adherence due to the stress of maintaining control. It is important that health care supports educate patients on available mental health resources, and screen for referrals. Persons with diabetes are 4 times more likely than the general population to suffer from anxiety, depression, and stress related illness, not only related to their diabetes management, but the impact that the disease has on their energy levels, thought processes, social interactions and self image. Continuing to address therapy adherence and guideline goals without due treatment of mental health needs is not only unlikely to have any positive impact, but may continue to exacerbate the underlying stressors and lead to continued decline in adherence. Cost and insurance:
According to Daly et al, a survey of patients suggested that the most common barrier to self-care is cost, including expenses for following the recommended meal plan, medications, blood glucose monitoring, and exercising. High co-pays and deductibles, lack of adequate insurance, no insurance, and limited economic resources can lead to patients prioritizing and choosing to pay only for those therapies they see as immediately impacting their quality of life, such as symptoms. Meanwhile, the intangible benefits of controlling blood sugars may be neglected and lead to progression of the disease that will further lead to a reduction in quality of life and other complications.
Social workers that are members of the health care team can assist with referrals for medication assistance programs, applications for public assistance programs, and working toward other economic assistance that can free up funding for medications and other therapy costs. In some cases, free services and other resources may be available in a community setting. Support groups can also help to identify local resources that may be helpful to reduce economic barriers to adherence. The National Diabetes Information Clearinghouse has a number of links to resources for economic support. Summary
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