Are Healthcare Professionals Promoting Adoption of a Healthy Lifestyle Among Patients with Mental Health Problems and Comorbid Diabetes or Elevated Risk for Diabetes?

Background/Purpose: Mental health problems are associated with increased rates of smoking, sedentarism, and unhealthy dietary intake. It is hypothesized that these behaviors subsequently lead to poor physical health outcome, particularly in the context of chronic illnesses such as Type 2 diabetes.

The American Diabetes Association (ADA) recommends that healthcare providers, such as social workers, counsel patients with diabetes or at high-risk for diabetes about nutrition and physical activity. Little is known about how often this recommendation is practiced with patients experiencing comorbid mental health problems. Because patients with mental health problems face significant barriers in the healthcare system, there is concern that they are not consistently receiving recommended counseling on diabetes risks.

The objectives of the study were to determine the lifetime prevalence of healthcare provider’s advice related to exercise and low-fat diet and examine the correlates of provider advice to persons with mental health problems and diabetes or elevated diabetes risk.

Methods: Adults with mental health problems (n=9,859) were selected from the Household Component of Medical Expenditure Panel Survey (MEPS-HC) series of 2004-2011. Mental health problems were defined as a score of ≥13 on the Kessler Psychological Distress Scale (K6), a standard screener for past-year of mental health problems such as anxiety and mood disorders. Receipts of low-fat dietary advice and exercise were ascertained if respondents reported ever being advised to eat fewer high-fat or high-cholesterol foods and/or to exercise more by a healthcare provider. Diabetes diagnosis was determined if respondents reported being told by a healthcare provider that they had diabetes. ADA standards were used to classify individuals into categories of diabetes risk through consideration of the following factors: age of 45 or older, non-Caucasian ethnicity, overweight, physical inactivity, hypertension, hyperlipidemia, and a history of cardiovascular disease. All measures were self-report. Multivariate logistic regression was conducted using Stata 11.2 to account for the complex survey design of the MEPS.

Results: Less than half of adults with mental health problems had ever been counseled to exercise more (48%) and reduce dietary fat intake (44%). The prevalence of provider advice increased in a linear fashion as the number of risk factors for diabetes increased (ranged from 13% to 71%), eventually reaching a similar level to that among patients with diabetes (71-72%). In multivariate analysis adjusted for sociodemographic, healthy behaviors and other clinical factors, the strongest correlates of receiving advice were BMI, hyperlipidemia and other physical comorbidities rather than patients’ current health behaviors. There were sociodemographic disparities in the likelihood of receiving provider advice after adjusting for healthy behaviors and clinical factors.

Conclusions/Implications: Healthcare providers are missing opportunities to provide exercise and low-fat dietary advice to patients with mental health problems before they manifest physical risk factors associated with diabetes. Given the substantial higher risk for diabetes and associated mortality among patients with mental health problems, it is important that providers counsel them as early as possible about exercise and nutritional changes that reduce the risks associated with diabetes.