title: Psychosocial Features of Clinically Relevant Patient Subgroups With Serious Mental Illness and Comorbid Diabetes.
abstract: Care for people with serious mental illness and diabetes is complicated by clinical heterogeneity. This cross-sectional analysis of 200 individuals with comorbid serious mental illness and diabetes explored differentiation between patient subgroups that were characterized on the basis of selected dimensions within a biopsychosocial framework.
  
  
  
  Relationships between self-efficacy, treatment expectation, social support, and depression were first assessed via bivariate Spearman correlations among 200 individuals participating in a randomized controlled trial who had diabetes along with major depression, bipolar disorder, or schizophrenia. Next, latent profile analyses were conducted to determine underlying subgroups on the basis of these variables. The resultant groups were compared on diabetes control, function, and symptoms.
  
  
  
  Two subgroups emerged. One had more severe psychiatric symptoms, low scores on other psychosocial variables, and worse diabetes control. The other had low levels of psychiatric symptoms, better scores on other variables, and better diabetes control.
  
  
  
  Symptom presentation and internal and external resources appeared to be related to diabetes control for people with comorbid diabetes and serious mental illness. Care approaches need to go beyond standard education and consider biopsychosocial variables.
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Douglas
authors.initials: D
authors.lastname: Gunzler
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Richard
authors.initials: R
authors.lastname: McCormick
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Adam
authors.initials: A
authors.lastname: Perzynski
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Charles
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kanuch
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Edna
authors.initials: E
authors.lastname: Fuentes-Casiano
authors.affiliation: Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Mr. Thomas, Ms. Kanuch, and Dr. Dawson are with the Center for Health Care Research and Policy, Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Ms. Kanuch, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland. Dr. Sajatovic, Ms. Cassidy, and Ms. Fuentes-Casiano are with the Department of Psychiatry, Case Western Reserve University. Send correspondence to Dr. Sajatovic (e-mail: martha.sajatovic@uhhospitals.org ).
authors.forename: Neal
authors.initials: N
authors.lastname: Dawson
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000453:epidemiology / Q000503:physiopathology*; D020377:Self Efficacy; D012944:Social Support
keywords: Depression; Heterogeneity; Latent profile analysis; Research/psychiatric; Schizophrenia; Social support networks