Reducing diabetes distress and improving self-management with mindfulness.

Stress associated with diabetes makes managing diabetes harder. We investigated whether mindfulness-based stress reduction (MBSR) could reduce diabetes distress and improve management. We recruited 38 participants to complete an MBSR program. Surveys and lab values were completed at baseline and post-intervention. Participants showed significant improvement in diabetes-related distress (Cohen's d -.71, p < .002), psychosocial self-efficacy (Cohen's d .80, p < .001), and glucose control (Cohen's d -.79, p < .001). Significant improvements in depression, anxiety, stress, coping, self-compassion, and social support were also found. These results suggest that MBSR may offer an effective method for helping people better self-manage their diabetes and improve mental health.

Clinician burnout and satisfaction with resources in caring for complex patients.

OBJECTIVE: To describe primary care clinicians' self-reported satisfaction, burnout and barriers for treating complex patients. METHODS: We conducted a survey of 1554 primary care clinicians in 172 primary care clinics in 18 health care systems across 8 states prior to the implementation of a collaborative model of care for patients with depression and diabetes and/or cardiovascular disease. RESULTS: Of the clinicians who responded to the survey (n=709; 46%), we found that a substantial minority (31%) were experiencing burnout that was associated with lower career satisfaction (P<.0001) and lower satisfaction with resources to treat complex patients (P<.0001). Less than 50% of clinicians rated their ability to treat complex patients as very good to excellent with 21% rating their ability as fair to poor. The majority of clinicians (72%) thought that a collaborative model of care would be very helpful for treating complex patients. CONCLUSIONS: Burnout remains a problem for primary care clinicians and is associated with low job satisfaction and low satisfaction with resources to treat complex patients. A collaborative care model for patients with mental and physical health problems may provide the resources needed to improve the quality of care for these patients.

National prevalence of receipt of antidepressant prescriptions by persons without a psychiatric diagnosis.

OBJECTIVE: The study addressed recent concerns regarding increasing prescription of antidepressant drugs to patients with no recorded psychiatric diagnosis. METHODS: Records from ten large integrated health systems in the Mental Health Research Network were used to examine diagnoses received by 1,011,946 health plan members who filled at least one antidepressant prescription in 2010. RESULTS: Among individuals filling antidepressant prescriptions, psychiatric diagnoses recorded during the year were depressive disorders (48%), anxiety disorders (27%), bipolar disorders (3%), and attention deficit disorders (3%). The proportion of those filling prescriptions who had no psychiatric diagnosis was 39%, which fell to 27% after the analysis excluded prescriptions for antidepressants often prescribed for nonpsychiatric indications (tricyclic antidepressants, trazodone, and bupropion). CONCLUSIONS: Prescription of antidepressants to patients without an appropriate diagnosis appears to be less common than previously reported.

Mindfulness-based stress reduction for family caregivers: a randomized controlled trial.

PURPOSE: Caring for a family member with dementia is associated with chronic stress, which can have significant deleterious effects on caregivers. The purpose of the Balance Study was to compare a mindfulness-based stress reduction (MBSR) intervention to a community caregiver education and support (CCES) intervention for family caregivers of people with dementia. DESIGN AND METHODS: We randomly assigned 78 family caregivers to an MBSR or a CCES intervention, matched for time and attention. Study participants attended 8 weekly intervention sessions and participated in home-based practice. Surveys were completed at baseline, postintervention, and at 6 months. Participants were 32- to 82-year-old predominately non-Hispanic White women caring for a parent with dementia. RESULTS: MBSR was more effective at improving overall mental health, reducing stress, and decreasing depression than CCES. Both interventions improved caregiver mental health and were similarly effective at improving anxiety, social support, and burden. IMPLICATIONS: MBSR could reduce stress and improve mental health in caregivers of family members with dementia residing in the community.

Recruiting and retaining family caregivers to a randomized controlled trial on mindfulness-based stress reduction.

Caregivers for a family member with dementia experience chronic long-term stress that may benefit from new complementary therapies such as mindfulness-based stress reduction. Little is known however, about the challenges of recruiting and retaining family caregivers to research on mind-body based complementary therapies. Our pilot study is the first of its kind to successfully recruit caregivers for a family member with dementia to a randomized controlled pilot study of mindfulness-based stress reduction. The study used an array of recruitment strategies and techniques that were tailored to fit the unique features of our recruitment sources and employed retention strategies that placed high value on establishing early and ongoing communication with potential participants. Innovative recruitment methods including conducting outreach to health plan members and generating press coverage were combined with standard methods of community outreach and paid advertising. We were successful in exceeding our recruitment goal and retained 92% of the study participants at post-intervention (2 months) and 90% at 6 months. Recruitment and retention for family caregiver interventions employing mind-body based complementary therapies can be successful despite many challenges. Barriers include cultural perceptions about the use and benefit of complementary therapies, cultural differences with how the role of family caregiver is perceived, the use of group-based designs requiring significant time commitment by participants, and travel and respite care needs for busy family caregivers.

Characteristics of adults who use prayer as an alternative therapy.

PURPOSE: To describe the demographics, health-related and preventive-health behaviors, health status, and health care charges of adults who do and do not pray for health. DESIGN: Cross-sectional survey with 1-year follow-up. SETTING: A Minnesota health plan. SUBJECTS: A stratified random sample of 5107 members age 40 and over with analysis based on 4404 survey respondents (86%). MEASURES: Survey data included health risks, health practices, use of preventive health services, satisfaction with care, and use of alternative therapies. Health care charges were obtained from administrative data. RESULTS: Overall, 47.2% of study subjects reported that they pray for health, and 90.3% of these believed prayer improved their health. After adjustment for demographics, those who pray had significantly less smoking and alcohol use and more preventive care visits, influenza immunizations, vegetable intake, satisfaction with care, and social support and were more likely to have a regular primary care provider. Rates of functional impairment, depressive symptoms, chronic diseases, and total health care charges were not related to prayer CONCLUSIONS: Those who pray had more favorable health-related behaviors, preventive service use, and satisfaction with care. Discussion of prayer could help guide customization of clinical care. Research that examines the effect of prayer on health status should adjust for variables related both to use of prayer and to health status.