WITHDRAWN: Profiles and Predictors of Co-Occurring Substance Abuse, Mental Health, and Health-Related Quality of Life Conditions Among American Indian Adults Living with Type 2 Diabetes

Background:

American Indians have among the highest rates of type 2 diabetes and associated comorbid risks of any racial/ethnic groups in the United States. Mental and physical health comorbidities are common among people living with type 2 diabetes, and are often associated with poorer behavioral, psychological, and physiological diabetes outcomes. Less is known, however, about the role of substance use problems among people living with type 2 diabetes, its possible comorbid associations with mental and physical health conditions, and its relation to diabetes-specific outcomes.

Purpose:

The purpose of the study is to examine the overlap among substance abuse, mental health problems and physical health-related quality of life, and their associations with diabetes-related outcomes among a sample of American Indian adults recently diagnosed with type 2 diabetes.

Method:

Data are from a four-wave longitudinal study of five tribal reservation communities in Minnesota and Wisconsin (N = 191). Substance use (i.e., daily cigarette smoking, alcohol and other substance use problems), mental health (i.e., depressive symptoms, anxiety symptoms), and physical health-related quality of life (i.e., functional limitations, self-rated physical health) indicators at baseline were examined within a latent class analysis framework to identify subgroups of individuals who share common comorbidity patterns. Latent classes were used as predictors of distal diabetes-related outcomes at six-month follow-up.

Results:

Three classes were identified: low health-related comorbidities (52.8%), moderate mental and physical health-related comorbidities (32.5%), and high mental health symptoms/moderate physical health-related comorbidities (14.1%). Being female increased the odds, whereas age and per capita family income decreased the odds of high mental health/moderate physical health limitations class membership compared to the other two classes. Compared to the low health-related comorbidities class, individuals in the other two classes had lower mean levels of diabetes-related empowerment, diabetes-related social support, and healthy eating days. Compared to the moderate mental and physical health-related comorbidities class, individuals in the other two classes had higher mean levels of physical activity days and body mass index.

Implications:

Identifying distinct comorbidity patterns may aid in the development of targeted interventions aimed at improving quality of life among people living with T2D and improving long-term diabetes outcomes.