Patients with chronic diseases are often burdened with psychological distress. The overwhelming nature of living with a chronic disease can result in stress and other mental health comorbidities that negatively influence disease management. Patients with diabetes, for example, commonly experience depressive symptoms and in turn have difficulty adhering to treatment protocols. These individuals are less likely to engage in regular glucose self-monitoring and are therefore at increased risk of detrimental clinical outcomes, like nephropathy, retinopathy, hospitalization, and death.
Behavioral Health and Telehealth
Due to the high prevalence of diabetes with co-occurring depression, there is a public health need for programs that target the mental health comorbidities of diabetes. These types of programs also have the potential to reduce the cost of care by improving adherence to self-management protocols.
Advancements in telehealth have made it possible to offer these types of programs to a wide range of patients across the country. In 2016, a group of researchers conducted a retrospective observational study to examine the efficacy of an 8-week telebehavioral program for patients with diabetes. The program was designed to address the depressive symptoms that accompany diabetes and also to support treatment adherence and positive lifestyle changes.
Over the course of the 8-week program, participants in the study received behavioral health services through telephone or video conferencing. Sessions were administered by a clinical social worker (LCSW) or a behavioral coach and included components of cognitive behavioral therapy, acceptance and commitment therapy, mindfulness, and motivational interviewing.
Improving Mental Health and Diabetes Self-Care
The researchers used the Depression Anxiety Stress Scales (DASS-21) to measure depression, anxiety, and stress symptoms at the start of the program and upon completion of the program. They also compared the frequency of glucose self-testing and morning blood glucose levels before and after the program.
At baseline, over 30% of participants presented with elevated depression, anxiety, or stress. After completing the program, the participants demonstrated several mental health improvements, including:
80% of participants improved to less severe depression, anxiety, or stress categories on the DASS-21
67% of participants with elevated baseline depression transitioned to normal scores
59% of participants with elevated anxiety at baseline transitioned to normal scores
70% of participants with elevated stress at baseline transitioned to normal scores
In addition to demonstrating improved mental health, participants also presented with improved adherence to morning self-glucose testing, resulting in better overall health. Improvements included:
69% of participants reported glucose self-testing at least one time per week
Mean morning glucose dropped from 146.2 mg/dL to 135.8 mg/dL over the course of the program (mean absolute change was -12.3 mg/dL)
Among participants with above normal morning glucose ( > 100 mg/dL), there was an even greater absolute change from baseline to graduation of -15.8 mg/dL
The telebehavioral program for patients with diabetes not only resulted in significant mental health improvements, but also improved diabetes self-care outcomes. The results also demonstrate the efficacy and feasibility of a telehealth delivered behavioral health program.
The implications of this study reach far beyond the diabetes patient population. Patients with other chronic diseases also experience psychological distress and are therefore likely to benefit from behavioral health interventions. A study that outlined a 10-week pilot trial demonstrated that telebehavioral health interventions significantly reduced depression in US veterans with a variety of chronic conditions, including diabetes, hypertension, and chronic pain.
Adopting a Holistic View of Patient Care
Behavioral health is often missing from treatment programs for chronic diseases. By addressing co-occurring depression, anxiety, and stress, care providers can help patients improve their mental health and enhance disease management. Additionally, behavioral health programs result in health cost savings by improving patient adherence.
As our healthcare system transitions to quality based care, providers are increasingly incentivized to adopt a holistic view of patient care. By addressing the behavioral health needs of all chronic disease patients, providers can deliver more efficient and effective care that will benefit both the patients and the healthcare system as a whole.
Mochari-Greenberger H, Vue L, Luka A, et al. A Tele-Behavioral Health Intervention to Reduce Depression, Anxiety, and Stress and Improve Diabetes Self-Management. Telemed J E Health. 2016 Aug;22(8):624-30.
Piette JD, Richardson C, Himle J, et al. A randomized trial of telephone counseling plus walking for depressed diabetes patients. Med Care 2011;49:641–648.