Psychological Care Needs and Mental Health Service Use Among Adults with Diabetes: Evidence from the Diabetes, Distress, and Disparities (3D) Study

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BACKGROUND/OBJECTIVES: Mental disorders and diabetes-related distress (DRD) are under-addressed aspects of person-centered diabetes care. This study examines the burden of depression, anxiety, and DRD among adults with type 1 (T1D), latent autoimmune diabetes in adults (LADA), type 2 (T2D), and gestational diabetes (GD), and explores their experiences and barriers in receiving mental health services. METHODS: This study uses quantitative data from the 2023/24 Diabetes, Distress, and Disparities (3D) Study, which is based at a large US medical center. The 3D Study consists of 573 adults with diabetes (51.3% with T1D or LADA, 43.5% with T2D, and 4.4% with current/past GD). Mental health assessments included the Patient Health Questionnaire-9 (depression), Generalized Anxiety Disorder-7 (anxiety), and Problem Areas in Diabetes-11 (DRD). Logistic regression was used to examine the prevalence of mental health concerns and behavioral service use. RESULTS: Overall, 14.5% had clinically significant depression, 8.0% had anxiety, and 23.6% had elevated DRD. Symptoms of depression, anxiety, and DRD had a positive, non-linear relationship with poor glycemic control. Approximately 30% of those with clinically significant emotional health concerns did not receive any behavioral health services in the past 12 months. Black adults were less likely to receive behavioral health treatment than non-Hispanic Whites (Odds Ratio = 0.24, 95% CI: 0.07-0.77). Common reasons for not receiving behavioral health services included not knowing where to go, cost, and lack of accessible providers. CONCLUSIONS: Gaps in addressing the emotional health needs of people with diabetes persist. Healthcare systems need to integrate addressing psychosocial factors as part of person-centered diabetes care.

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