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Type 1 Diabetes, Public Health Insurance, and Suicidal Ideation: Surprising Links

By August 12, 2017June 24th, 2025No Comments5 min read

Janet L. Cummings, Psy.D.
Chairman of the Board and Faculty 
Cummings Graduate Institute for Behavioral Health Studies

According to a recent article by Buckley (2017) that appeared this month on the Medscape website, two factors that increase suicidality in teens with type 1 diabetes have recently been identified.  These two factors are:  (1) Teens who reveal depression during routine depression screening, and (2) Teens who are on public health insurance.

Matlock, et al. (2017) reviewed medical records for 473 teenagers with type 1 diabetes.  These patients had all been screened for depression (using the Children’s Depressive Inventory, or CDI) at medical visits during 2011 and 2012.  Of these 473 teens, 27% screened positive for moderate or severe depression, and 8% admitted to suicidal ideation (Buckley, 2017).  The teens who reported suicidal ideation were matched with teens who did not as a control group.  The teens with suicidal ideation were twice as likely as controls to have public health insurance as opposed to private insurance (Buckley, 2017).

The teens in the study who reported suicidal ideation were given appropriate mental health intervention and treatment (Buckley, 2017; Matlock, et al., 2017).  Therefore, it is unknown whether or not any of these teens would have attempted suicide as a result of their suicidal ideation, had their depression been left untreated.  The study showed that twice as many teens with type 1 diabetes who were on public health insurance had suicidal ideation as teens on private insurance (Buckley, 2017; Matlock, et al., 2017).  However, more research is needed to understand the link between public health insurance and depression with suicidal ideation.

The Matlock, et al. (2017) study clearly shows that teens with type 1 diabetes who screen positive for depression are more like than non-depressed teens to progress to suicidal ideation.  It also suggests that public health insurance for these teens may be a risk factor for suicidal ideation.  However, these links are not yet well understood, and more research is needed in order to understand these complex relationships.

Some things, however, are very clear.  It is critical that we screen adolescents with type 1 diabetes for depression when they first receive the medical diagnosis, and that we continue to screen them routinely at diabetes-related medical visits.  In integrated care settings, these depressed adolescents can seamlessly receive intervention and treatment for their depression by on-site behavioral care providers, whether or not the depression has progressed to suicidal ideation.  Ideally, depressed patients should be identified and treated early, preferably before their depression worsens and leads to suicidal ideation.

It is also clear that researchers (and policy-makers) need to take a closer look at the relationship between public health insurance and depression, and to assess whether or not the link seen in type 1 diabetic teens holds true for other demographic groups.  Americans are experiencing uncertainty about the future of healthcare in general, and the future of their own healthcare, as our President, Senators, and Representatives decide the fate of Obamacare and many other healthcare policies.  This uncertainty about healthcare may be contributing to the incidence of depression in Americans, especially for those who have a serious or chronic medical diagnosis.

In the Biodyne Model, we value prevention and early intervention for mental health problems, and advocate for routine screening for depression in medical settings, especially for populations at greater risk for depression, such as teens with type 1 diabetes.  At the Cummings Graduate Institute for Behavioral Health Studies, our students are taught to use a wide array of screening tools that have been developed for use in medical settings.  Our Doctor of Behavioral Health graduates are able to screen for anxiety, depression, obsessive-compulsive disorder, thought disorders, dementia, and other psychosocial problems in medical settings, even when these conditions are mild and in the early stages.  More importantly, Doctors of Behavioral Health are able to appropriately treat these conditions in the same medical settings where these patients are identified.

Our Doctor of Behavioral Health students are also taught to be aware of healthcare disparities, including the disparities between consumers with public health insurance and those with private insurance.  Our graduates are able to help patients become their own healthcare advocates and to navigate healthcare systems that may seem very daunting to them.

References

Buckley, R. (2017, August 7). Which adolescents with type 1 diabetes are most at risk for      suicidal ideation?   Retrieved August 8, 2017

Matlock, K. A., Jones, N. Y., Corathers, S. D., & Kichler, J. C. (2017). Clinical and psychosocial       factors associated with suicidal ideation in adolescents with type 1 diabetes. Retrieved   August 8, 2017

 

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As a member of the AAPI community, I’m very familiar with the barriers to mental health services and the need to break through the glass wall of cultural stigma that prevents many from receiving potentially life–saving treatment. I was the only Asian American person in my master’s cohort, the only Asian American person in many of my clinical work settings, the only Asian American person to walk into many of the professional settings that I pushed myself to show up to. In my current practice, I’m constantly reminded by my patients of how difficult it is to find an Asian American mental health provider, though this reminder constantly informs me that more needs to be done for my community. Day after day, I read stories of Asian American people who die by suicide as a consequence of our culture’s avoidance of mental health topics. As a DBH, my biggest goal is to use my expertise in whole–person care to amplify the conversation around mental health and help my community understand that mental healthcare is not a privilege that we are not entitled to, it is a crucial part of our healthcare that will manifest differently in us than what many Western psychology or psychiatry textbooks will describe, and that our unique experience of mental health issues are valid, important, and is time to be part of the larger conversation.

Willam Chum, LMHCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 16, 2022

The Doctor in Behavioral Health (DBH) program has changed my understanding of the subject and career path. Before this academic journey, my knowledge of behavioral health was primarily theoretical, including essential ideas and methods. However, the DBH curriculum combined intense academic research with practical application, helping me understand behavioral health from multiple angles. Recognizing mental health as part of total health changed my perspective. The biopsychosocial model, which showed how biological, psychological, and social variables affect mental health, was stressed in the DBH curriculum. This comprehensive approach made me realize how complex human behavior is and how important it is to address mental health issues. Effective interventions must target the individual’s surroundings, relationships, and life experiences, not just symptoms. The curriculum also gave me enhanced evidence-based practice training to execute successful solutions. Studies methods and data analysis classes improved my critical thinking and allowed me to evaluate and apply behavioral health studies. This gave me the confidence to contribute to the field’s knowledge base through practice and research.

Dr. Rhea Hill, DBH, LPCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - February 17, 2025

This program will change how you present to the world, not just as a professional but as an individual. Understand this is work but the work is worth it and the journey is undeniably transformative. If you are seeking a doctorate for the title, this is not the program for you. If you are seeking a doctorate to interrupt and disrupt the course of healthcare, then this is the program for you. You won’t find a more supportive program with professors who are dedicated to your success and your education. This program is not about the regurgitation of information. It is about the appropriate applied application of knowledge and information to push forward and become an advocate for equitable and quality care for all.

Brandy K. Biglow LMHC, CCTP, QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 5, 2024

The Doctor of Behavioral Health (DBH) program has definitely transformed my understanding of behavioral health. Understanding the links between physical and mental health has taught how to make better treatment decisions. The DBH program has also given me insights that otherwise would not be possible and allows me to view individuals through a lens that I was previously ignorant of. This program has helped me grow into a more confident individual, provider, and parent.

Cory H. Cannady, BCBA, LBADBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 13, 2024

The DBH program has reinforced my vision of viewing behavioral health (BH) as an integrated component of the healthcare system rather than a siloed service. As a practitioner in the focused BH realm of substance use disorder (SUD) treatment, I observe on a regular basis how identifying and serving SUD patients is often missed, ignored and stigmatized in primary healthcare, despite the fact that early intervention at these check-points often has the potential to intervene earlier and lessen the negative SUD outcomes frequently seen by the time a patient reaches specialty SUD services. Reinforcement received in my DBH program has motivated me to promote integration as a leader in my workplace and is a primary factor in considering the long-term trajectory of my individual career path.

Kenneth L. Roberts, MPS, LPCC, LADCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - November 5, 2024

Graduating from the DBH program has influenced and enhanced my approach to addressing behavioral health challenges and making a difference in the field by preparing me to become a serious business owner. Through the DBH program, I understand now that becoming a business owner not only assists me in reaping the financial benefits of working for myself, but the program also offers me a sense of freedom to make a difference in an individual’s life.

Dr. Rebecca K. Wright, DBH, LBA, BCBA, QBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - December 18, 2024

I have always wanted to pursue a higher degree but never found a program that met my needs. When I investigated the DBH program, I can honestly say I was excited. It was a program that would expand my knowledge in behavioral health but also how it relates to physical health. The philosophy of treating the whole person was exactly what I was looking for.

Elizabeth Nekoloff, M.Ed., LPCC-S, NCCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - January 16, 2025

Prior to obtaining my DBH, I practiced behavioral health within the boundaries of behavior analysis. The DBH degree has given me the ability to broaden my scope of competence allowing me to provide a higher quality of care to my clients through a person-centered approach, while still staying within my scope of practice. I was in the beginning stages of opening my business when I enrolled in the DBH program which set my trajectory towards being a stronger leader. The program equipped me with essential healthcare leadership and entrepreneurial skills, allowing me to ensure high-quality services for my clients and foster a supportive work environment for our staff. It has also given me the confidence to expand my business and pursue other healthcare ventures, reaching a broader range of patients in need.

Dr. Pauline Tolentino Pablo, DBH, BCBA, IBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - January 21, 2025

Although I have worked with many patients who have mental health diagnoses, or behaviors which make managing their medical diagnoses and day to day life difficult, the DBH program at CGI is broadening that knowledge and providing a deeper understanding of behavioral health and how best to help these individuals manage their health and improve their quality of life. This will allow me to provide and advocate for more meaningful and seamless integrated care, providing new tools for my intervention toolbox, and the confidence and skills to collaborate within and lead whole person focused interdisciplinary teams. I also anticipate building upon my knowledge as a nurse case manager and long time caregiver, as well as my personal passions and professional vision, learning about processes and operations, to be in position to start up and lead my own company one day, offering the services and care I know every person should have access to.

Hollie Wilson, MSN, RN, CCMDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 11, 2025

The DBH program will open opportunities for me to contribute to healthcare system innovation, particularly through trauma-informed care and integrated behavioral health settings. I will be better positioned to advocate for and implement holistic care models that improve health outcomes for underserved populations. Ultimately, this program will help me transition into higher-level roles, such as a director or consultant in behavioral health, where I can influence broader system changes and contribute to the future of healthcare delivery.

DeKyn Rashad Peters, MPH-CHES,BSW/BA,APCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 4, 2025

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