title: Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes.
abstract: OBJECTIVE
  While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden.
  
  
  METHODS
  Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score.
  
  
  RESULTS
  Anxiety disorders were seen in 33.1% (N=52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden.
  
  
  CONCLUSIONS
  One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are needed to better understand the relationship between depression, anxiety, and health management in people with serious mental illness and diabetes mellitus type II.
authors.affiliation: VA Boston Healthcare Center, USA Harvard Medical School, USA laura_bajor@hms.harvard.edu.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bajor
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Gunzler
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Einstadter
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: McCormick
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Perzynski
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA.
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Kanuch
authors.affiliation: School of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, USA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA.
authors.forename: Neal V
authors.initials: NV
authors.lastname: Dawson
authors.affiliation: Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000097:blood / Q000453:epidemiology*; D015897:Comorbidity; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged
chemical_list: D006442:Glycated Hemoglobin
keywords: Serious mental illness; anxiety; bipolar disorder; comorbidity; diabetes mellitus; schizophrenia