School of Public Health

New study links preventable diabetes hospitalizations to underlying behavioral health


Published: March 18, 2019

By Sally Crocker

Erica Stockbridge 0005

Dr. Erica Stockbridge

A new study by UNTHSC public health researchers points to important information that may help health care providers, policymakers and insurance payers reduce the risk of preventable hospitalizations for diabetes patients by providing insight into the relationship between these hospitalizations and behavioral health conditions like schizophrenia, bipolar disorder, depression, anxiety and drug or alcohol abuse.

“An estimated 30.3 million people in the U.S. are living with diabetes, which accounted for about $237 billion in direct medical costs for the year 2017,” said Dr. Erica Stockbridge, Assistant Professor of Health Behavior and Health Systems at the UNTHSC School of Public Health, and lead author of a new article published by PLOS ONE. “Costs for diabetes patients are approximately 2.3 times higher than for other patients, often from complications that could be prevented through timely, high-quality, ongoing outpatient care.”

To analyze the impact of mental health conditions and substance use disorders on these types of potentially preventable hospitalizations, the researchers reviewed the medical and pharmacy claims data of 229,039 commercially insured, working age persons with diabetes from across the U.S. In total, 3,246 of those persons experienced a total of 4,521 preventable hospitalizations between 2011 and 2013.

Diabetes patients with a co-occurring behavioral health condition were at disproportionately high risk for diabetes-related potentially preventable hospitalizations; the 20.8% of persons with both diabetes and behavioral health conditions experienced 43.6% of all diabetes preventable hospitalizations.

The research team found that schizophrenia and alcohol use disorder increased the potential for hospitalization but not repeat admissions. In contrast to previous studies, the UNTHSC researchers did not find a significant link between anxiety disorders and preventable diabetes hospitalizations.

The researchers recommend additional, future study into the unique challenges facing diabetes patients who also suffer from substance abuse, as their hospitalizations and repeat health relapses may be due in large part to “neglect of other areas of their life while spending a significant amount of time obtaining, using or recovering from their substance(s) of choice.”

The groups at greatest risk for experiencing recurring preventable admissions were those with depression, those with drug use disorder and those with multiple behavioral health conditions.

More than one third of persons with co-occurring diabetes and behavioral health conditions were diagnosed with multiple behavioral health conditions, emphasizing the importance of looking at the patient’s total health picture, rather than each mental or physical health concern separately.

“Our findings point to the importance of integrating how diabetes patients’ complex physical and underlying behavioral health needs are screened, diagnosed and addressed,” Dr. Stockbridge said. “When physical and mental health providers and insurance payers are aligned as one team, there are opportunities to develop more encompassing and effective treatment plans that deliver quality care and behavioral interventions outside the hospital.”