Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes
Open accessAbstract
Objective: While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden. Methods: Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score. Results: Anxiety disorders were seen in 33.1% ( N = 52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden. Conclusion: One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are needed to better understand the relationship between depression, anxiety, and health management in people with serious mental illness and diabetes mellitus type II.
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In patients with chronic medical conditions, behavioural health issues are even more common and costly.
“In the subset of patients with chronic medical conditions, behavioural health issues are even more common and costly.6–8”
From A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive-behavioural programme with integrated coaching for anxious adults in primary care (2018) · cites this paper as [6]
The Discussion (page not provided) reports elevated anxiety among people with type 2 diabetes, and the Conclusions describe potentially costly outcomes for people with both serious mental illness and diabetes. The paper does not establish that behavioural health issues are more costly across patients with chronic medical conditions generally; its cost statement concerns possible outcomes in a narrower population. (LLM, conf=0.85)
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- Authors
- Bajor, L. A., Gunzler, D., Einstadter, D., Thomas, C., McCormick, R., Perzynski, A. T., Kanuch, S. W., Cassidy, K. A., Dawson, N. V., & Sajatovic, M.
- Affiliations
- Harvard University (US)
- MetroHealth Medical Center (US)
- University Hospitals Cleveland Medical Center (US)
- Corresponding author
- Bajor, Laura A
- ORCID
- Venue
- The International Journal of Psychiatry in Medicine
- Publisher
- SAGE Publications
- Published
- 2015-05
- Volume
- 49
- Issue
- 4
- Pages
- 309-320
- ISSN
- 0033-278X (ISSN-L)
- 0091-2174
- 1541-3527
- PMC
- PMC4698974
- OpenAlex
- W2253308244
- Cited by
- 30
- References
- 55
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 4 · 2016: 5
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The International Journal of Psychiatry in Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Case Western Reserve University
- Georgia Clinical and Translational Science Alliance
- National Institutes of Health (KL2TR000440, UL1TR000439)
- National Institute of Mental Health (R01MH085665)
- National Center for Research Resources (UL1RR024989)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- anxiety comorbidity, type 2 diabetes, severe mental illness, diabetes management, HbA1c, depressive symptoms, medical burden, Charlson Comorbidity Index, psychiatric comorbidity
- MeSH terms
- Adult, Aged, Anxiety Disorders, Mental Disorders, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Comorbidity, Cost of Illness
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