Research Article|Articles in Press

Association between mental health and self-care behavior among older adults with diabetes according to Behavioral Risk Factor Surveillance System 2019

  • Jenny Zhou
    University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Ln, Chapel Hill, NC 27599, United States
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  • Christina H. Sherrill
    High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States
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  • Andrew Y. Hwang
    Corresponding author at: MCPHS University School of Pharmacy, 179 Longwood Ave, Boston, MA 02115, United States.
    High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States

    MCPHS University School of Pharmacy, 179 Longwood Ave, Boston, MA 02115, United States
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  • Sun Lee
    High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States

    Analysis Group, 111 Huntington Ave, Boston, MA 02199, United States
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Published:March 08, 2023DOI:


      • Optimal diabetes management includes several self-care behaviors.
      • One in four people with diabetes reported occasional-to-frequent mental health burden.
      • Mental health burden was associated with less self-care behavior participations.
      • Mental health screening could target interventions to improve self-care behaviors.



      To assess the association of mental health burden with diabetes-related self-care behaviors and healthcare utilization among older adults.


      This cross-sectional 2019 Behavioral Risk Factor Surveillance System (BRFSS) study included ≥ 65 years old adults with self-reported diabetes. Three groups were used based on the number of days in the past month affected by mental health: 0 days (no burden), 1–13 days (occasional burden), and 14–30 days (frequent burden). Primary outcome was performing ≥ 3 of 5 diabetes-related self-care behaviors. Secondary outcome was performing ≥ 3 of 5 healthcare utilization behaviors. Multivariable logistic regression was used in Stata/SE 15.1.


      Of 14,217 included individuals, 10.2 % reported frequent mental health burden. Compared to ‘no burden’, ‘occasional’ and ‘frequent burden’ groups included more female, obese, not married persons with younger age of diabetes diagnosis, and reported more comorbidities, insulin use, cost-related barriers to see doctors, and diabetes-related eye issues (p < 0.05). ’Occasional/frequent burden’ groups reported less self-care and healthcare utilization behaviors, except 30 % higher healthcare utilization was observed in the ‘occasional burden’ group compared to no burden (aOR 1.30, 95 %CI 1.08–1.58, p = 0.006).


      Overall, mental health burden was associated with reduced participation in diabetes-related self-care and healthcare utilization behaviors in a stepwise manner, except occasional burden was associated with higher healthcare utilization.


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