Psychological Care Needs and Mental Health Service Use Among Adults with Diabetes: Evidence from the Diabetes, Distress and Disparities (3D) Study

Background/Objectives: Mental disorders and diabetes-related distress (DRD) are under-addressed aspects of person-centered diabetes care. This study examines the burden of depression, anxiety, and DRD among adults with type 1 or 1.5 (T1D/T1.5D), type 2 (T2D), and gestational diabetes (GD), and explores their experiences and barriers in receiving mental health services. Methods: This study uses quantitative data from the 2023/24 Diabetes, Distress, and Disparities (3D) Study, which consists of 573 adults with diabetes (51.3% with T1D/T1.5D, 43.5% with T2D, and 4.4% with current/past GD). Mental health assessments included the Patient Health Questionnaire-9 (depression), Generalized Anxiety Disorder-7 (anxiety), and Problem Areas in Diabetes-11 (DRD). Logistic regression was used to examine the prevalence of mental health concerns and behavioral service use. Results: Overall, 14.5% had clinically-significant depression, 8.0% had anxiety, and 23.6% had elevated DRD. Symptoms of depression, anxiety, and DRD had a positive, non-linear relationship with poor glycemic control. Approximately 30% of those with clinically-significant emotional health concerns did not receive any behavioral health services in the past 12 months. Black adults were less likely to receive behavioral health treatment than non-Hispanic Whites (Odds ratio=0.24, 95% CI: 0.07- 0.77). Common reasons for not receiving behavioral health services included not knowing where to go, cost, and lack of accessible providers. Conclusions: Gaps in addressing emotional health needs of people with diabetes persist. Healthcare systems need to integrate addressing psychosocial factors as part of person-centered diabetes care.