Our expert answers 3 Questions
I’m thinking about how stress and mental health influence development, and management, of chronic health conditions like diabetes. I’m particularly interested in how mental health impacts social disparities in risk of diabetes and related conditions. I am leading a study that is recruiting a diverse cohort of adults at high risk of developing type 2 diabetes from high and low poverty neighborhoods to examine how stress exposure, stress reactivity, and self-regulation influence progression of hyperglycemia. Our goal is to understand the roles of stress and mental health in the emergence of racial and socioeconomic disparities in diabetes. I’m also thinking about points of intervention for addressing healthcare needs when individuals have both mental and physical health conditions. One of these locations is long-term care (assisted living facilities, nursing homes); residents of these facilities have complex health needs and are often physically frail. These settings may therefore be ideal places to develop interventions that specifically address the nexus of mental and physical health in later life. In line with this thinking, I am currently leading a study examining whether living in, or transitioning into, long-term care is related to suicide in later life using data from the National Violent Death Reporting System.
My research uses epidemiologic methods to investigate the intersection of mental and physical health. To me, there is no health without mental health. Mental health is more than behavior or how we feel about ourselves: it relates to almost every part of our lives, from how well we sleep, to our social relationships, to our jobs, to our physical health as we age. Numerous longitudinal studies have demonstrated that depression in young adulthood is associated with heart disease, diabetes, and onset of disability as people age. By understanding the mechanisms linking depression to conditions like diabetes, we can hopefully identify ways to reduce the impact of depression on overall health. This kind of work is inherently interdisciplinary, which is why these problems are so interesting to me. I try to incorporate perspectives from multiple disciplines in both my research and mentoring.
We don’t need to wait until we know the specific mechanisms linking depression and diabetes to start addressing the burden of depression for people with diabetes. Large, well-controlled randomized trials have shown that the Collaborative Care Model, a patient-centered form of healthcare with a prominent role of nurse care managers, can effectively treat depression and improve management of diabetes. Moreover, treating depression among older primary care patients with diabetes actually reduces the risk of mortality. In line with this evidence, I am working with my community partners at the Greater Richmond YMCA to evaluate and improve their diabetes self-management program in a way that incorporates elements of brief interventions for mental health to help keep participants engaged. We are doing this in partnership with our Community Advisory Board. Because mental health touches so many elements of life it has implications across multiple sectors of life, including non-traditional healthcare settings like community-based organizations.