title: Barriers to Self-management of Serious Mental Illness and Diabetes.
abstract: OBJECTIVE
  Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices.
  
  
  METHODS
  We conducted 20 in-depth interviews with persons who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes.
  
  
  RESULTS
  Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care).
  
  
  CONCLUSIONS
  Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care are needed to help these vulnerable individuals avoid health complications and premature mortality.
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA. cxb28@cwru.edu.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Blixen
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kanuch
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, 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, Cleveland, OH, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Epidemiology & Biostatistics, Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
authors.forename: Neal V
authors.initials: NV
authors.lastname: Dawson
authors.affiliation: Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
mesh_terms: D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D048909:Diabetes Complications / Q000523:psychology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications / Q000628:therapy*; D012565:Schizophrenic Psychology; D012648:Self Care / Q000523:psychology*