Health care utilisation and quality of life in individuals with diabetes and comorbid mental disorders

Objective: To investigate the association of comorbid mental disorders with health care utilisation and quality of life (QoL) in persons with diabetes (PWD). Method: Data were drawn from the German National Health Interview and Examination Survey (GNHIES). Mental disorders in PWD (n-146) were assessed by means of a standardised clinical interview for mental disorders (M-CIDI). Health care utilisation was assessed by using self-report questionnaires and QoL by using the SF-36. Results: Controlling for age and sex, mental comorbidity was significantly associated with reduced QoL scores on all SF-36 subscales, except for "bodily pain". The frequency of physician visits was (insignificantly) higher in PWD with mental disorders compared to PWD Without (20.7 vs. 14.4). Among PWD with mental disorders (n=40), only seven individuals reported mental health specialist visits. Mental comorbidity was not associated with hospitalisation days, disability days or utilisation of diabetes-related preventive services. Conclusions: Comorbid mental disorders were found to be associated with lowered psychosocial and physical aspects of QoL in a nationally representative sample of PWD. Associations with health care utilisation were less consistent. The low rate of mental health specialist visits in PWD with comorbid mental disorders may indicate an under-use of appropriate health care services. (C) 2009 Elsevier Inc. All rights reserved.