Enhancing Diabetes Self-Management Education and Psychological Services for Veterans With Comorbid Chronic Health and Mental Health Conditions

BACKGROUND: Veterans experience a higher prevalence of type 2 diabetes mellitus (T2DM) compared with the rate of their civilian counterparts. Veterans may experience vulnerability to chronic stress, in particular comorbid mental health conditions, and may not benefit from traditional diabetes education. METHODS: This study evaluated clinical and psychological measures among veterans engaged in health psychology services. Individualized motivational interviewing and cognitive behavioral interventions were provided to address T2DM distress and promote veterans' diabetes self-management. Pre-/postobjective and self-report measures were evaluated for clinical relevancy and statistically significant changes. RESULTS: The sample consisted of 13 older adults: mean age 62.8 years; 12 were male and 9 were prescribed insulin. More than half had comorbid hypertension, hyperlipidemia, and/or a diagnosis of chronic pain. Eleven participants were diagnosed with a mental health disorder. Baseline measures indicated mild depressive symptoms, mild anxiety symptoms, and moderate levels of T2DM distress. Postintervention reductions were shown for T2DM distress; emotional burden, and regimen-related distress, depressive symptoms, and enhanced diabetes empowerment. CONCLUSIONS: Veterans with comorbid conditions may benefit from individualized psychology services that offer cognitive behavioral strategies for self-management of T2DM-related distress, integrated with traditional primary care and diabetes education.