Attitudes towards mental health, mental health research and digital interventions by young adults with type 1 diabetes: A qualitative analysis

Abstract

BackgroundYoung people with type 1 diabetes are at increased risk of mental disorders. Whereas treatment need is high, difficulty recruiting young people with type 1 diabetes into psychosocial studies complicates development, testing and dissemination of these interventions.ObjectiveInterviews with young adults with type 1 diabetes were conducted to examine attitudes towards mental health and mental health research, including barriers and motivators to participation in mental health studies and preferred sources of mental health support. The interviews were audio‐taped, transcribed and evaluated via thematic analysis.Setting and participantsYoung adults with type 1 diabetes were recruited via social media channels of 3 advocacy organizations. A total of 31 young adults (26 females and 5 males) with an average age of 22 years were interviewed between October 2015 and January 2016.ResultsParticipants were largely unaware of their increased vulnerability to common mental health problems and knew little about mental health research. Major barriers to participation included perceived stigma and lifestyle issues and low levels of trust in researchers. Opportunities to connect with peers and help others were described as key motivators. Psychological distress was considered normal within the context of diabetes. A need for some level of human contact in receiving psychosocial support was expressed.Discussion and conclusionFindings provide valuable insights into the complex dynamics of engaging young adults with type 1 diabetes in mental health studies. Interviewees provided practical suggestions to assist investigation and delivery of psychosocial interventions for this vulnerable group.

Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care

“…This echoes our experience with people with type I diabetes, suggesting that diabetes itself may pose a barrier to research participation for some people. Participants in a study by Clarke et al [38] expressed limited awareness of the link between mental health and diabetes and spoke about the double stigma of chronic mental and physical comorbidity. This suggests that providing further education around the bidirectional relationship between mental and physical health may have benefits in terms of both patient outcomes and the future of primary care research for people with T2D.…”

A Web-Based Cognitive Behavior Therapy Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial

“…Fisher and colleagues [24] have previously suggested that scores on depression screeners may be less reflective of mood disturbance than general emotional and diabetes-specific distress, that is, distress experienced in response to the daily challenges and demands of living with diabetes. In line with this, we have recently published data showing that mildly depressed adults with diabetes maintain a very nuanced conceptualization of their mental health symptoms in which low mood, anxiety, and stress are generally perceived as features of the diabetes diagnosis (and warranted by contextual stressors) and not separate or comorbid conditions to be managed [55]. Lack of differentiation of mild-to-moderate depression symptoms from adjustment to diabetes has potential to attenuate the personal relevance and clinical effectiveness of interventions targeting broad CBT skills and techniques.…”

Diabetes management experience of middle‐aged persons with type 1 diabetes

“…The participants made efforts to continue with diabetes management in the present and fulfill their responsibilities at home and in society rather than relying on the false hope that a complete cure for T1D may become available in the future. One study has reported that diabetes management in those with T1D is affected by their perceived responsibility (Clarke et al, 2018). This responsibility is best represented by their duty to take care of their diabetes (Miracle, 2011) and to not regard themselves as patients with disease (Kangasniemi, Halkoaho, Länsimies‐Antikainen, & Pietilä, 2012).…”

“…The participants in the present study felt responsible for themselves not only as middle‐aged persons and the heads of their families but also as role models for those with T1D who have not entered middle adulthood. The latter sense of responsibility reflects their altruism in being willing to help those who have the same disease (Clarke et al, 2018).…”