The Geography of Mental Health and Diabetes

Aug 28, 2013
The states with the highest usage rates of mental health medications are the same states found within the "Diabetes Belt." Is it more than just coincidence?
  • Depression
  • Diabetes
  • Mental/Neurological Disorders

Throughout the United States, the number of people using medications to treat mental health conditions has been rising over the past decade. While increases have been seen nationwide, there are geographical hot spots where the use of these treatments is particularly prevalent. As we reported in our Childrens Mental Health Woes, the highest rates of mental health medication use are in the country's East South Central region, which includes Kentucky, Tennessee, Mississippi and Alabama. Among that population, nearly one in four adults (23.3%) has taken medications commonly used to treat mental health conditions. Medications included in this analysis included antidepressants, antipsychotics, attention deficit hyperactivity disorder (ADHD) medications and anti-anxiety medications.

mental health medications by region

The Correlation Between Depression and Diabetes

What could be producing higher rates of mental strife in this area of the country? Interestingly, these also are some of the very same states that make up the “Diabetes Belt,” the part of the nation where the highest diabetes rates are found. While the connection between diabetes and mental health disorders is not obvious, it’s real.

Both depression and anxiety are more common among those with diabetes than the rest of the population:

It’s not yet clear what links these conditions, but there is evidence that both depression and diabetes share some of the same physiological mechanisms.

The Compounded Impact of Depression and Diabetes

Of particular concern is that people who suffer from both diabetes and depression tend to have more difficulty managing their diabetes and taking medications as prescribed to treat their diabetes. Medication nonadherence can aggravate diabetes and can result in disease-related complications, such as heart disease, stroke, blindness, limb amputations and kidney disease. The negative impact of depression outcomes in diabetes care is enormous considering the added human suffering and economic burden of disease.

So while use of mental health medications and diabetes rates may be particularly high in the East South Central region of the U.S., it’s also quite likely that medication nonadherence is significant among this population. Identifying and addressing nonadherence is critical to improving outcomes for these patients.

Express Scripts Encourages Better Decisions and Healthier Outcomes

At Express Scripts, insights learned from the behavioral sciences and our clinical specialization allow us to act on patient data and offer tailored solutions to help patients stay on track with their medications, including those used to treat diabetes and depression. Recognizing geographical patterns and variations, such as those noted here, can make us smarter about how we engage with patients to help them make better decisions and achieve healthier outcomes.

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