Whom should we target? A brief report on a prospective study to identify predictors of mental health and self-care worsening in patients with diabetes mellitus during the COVID-19 pandemic

• Published in: Archives of endocrinology and metabolism Vol. 68; p. e2300073
• Main Authors: Alessi, Janine, Erthal, Isadora Nunes, Teixeira, Julia Belato, Schaan, Beatriz D, Telo, Gabriela H
• Format: Journal Article
• Language: English
• Published: Brazil 2024
• Subjects: Adult; Aged; Brazil - epidemiology; COVID-19 - psychology; Diabetes Mellitus, Type 1 - psychology; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Female; Humans; Male; Mental Disorders - epidemiology; Mental Health; Middle Aged; Pandemics; Prospective Studies; SARS-CoV-2; Self Care; Brazil; anxiety; Depression; outbreak; diabetes; health care
• ISSN: 2359-4292

To identify predictors of mental health disorders and self-care worsening in patients with diabetes through 15 months of COVID-19 pandemic.
Prospective study following patients with type 1 and type 2 diabetes during the COVID-19 pandemic in Southern Brazil. Participants were evaluated through phone calls in two moments: first three months of the outbreak, and 15 months later. The outcomes were the assessment of worsening in mental health disorders (increase ≥ 10% in the total score of the Self-Report Questionnaire), the assessment of emotional distress related to diabetes (increase ≥ 10% in the total score of the Brazilian version of the Problem Areas in Diabetes), and worsening in self-care parameters (reduction ≥ 3 points in the Self-Care Inventory-Revised). Logistic regression models were used to determine the odds ratio (OR) and their respective confidence intervals. Point-biserial correlation coefficients (r
) were used to measure the relationship between the variation in scores and patient characteristics.
In total, 150 adults were enrolled (54.6 ± 13.9 years old, 58.7% female, 85.9% white), out of which 118 remained during follow up. After 18 months, 34,7% of them (52.2 ± 14.8 years old, 53.7% female, 87.5% white) worsened mental health scores. An increase in mental health disorders was experienced by patients with lower middle-income [OR 4.2 (1.2-15.0)], and those who reported greater difficulty managing diabetes [OR 3.2 (1.4-7.1); r
0.32, P < 0.01]. In contrast, those who perceived an improvement in diabetes control showed a reduction in their mental health scores [OR 0.3 (0.1-0.8)]. For self-care, there was a score worsening in patients with longer duration of diabetes [OR 1.1 (1.0-1.1)] and in those using insulin [OR 8.3 (1.7-41.4); r
0.23, P = 0.01]. Conversely, those who followed the social distancing guidance had an improvement in self-care [OR 0.4 (0.1-0.9); r
0.18, P = 0.05].
Some clinical and socioeconomic characteristics may be suitable for identifying patients at higher risk of mental health and self-care worsening, signaling who needs to be monitored more closely during crisis situations.