Significance of fostering the mental health of patients with diabetes through critical time intervention

Table 2 Studies concerning the mental health challenges associated with homeless diabetic patients and impact of critical time intervention in enhancing mental health of homeless individuals during the time of transition

Authors	Location/population	Objectives	Mental health disorder/CTI/management of diabetes	Method/sample	Results
Lennox et al[25]	Britain, 14	CTI model was adapted to reflect the stages of transition for prisoners in England	CTI	Mixed method of qualitative and quasi-experimental	CTI intervention groups showed a lower level of anxiety regarding release and more support in terms of housing, access to services, and reintegration into the community as compared to previous imprisonment
Wiens et al[35]	Ontario, & Toronto, 6944	To create a population cohort of people with diabetes with a history of homelessness to understand their unique demographic and clinical characteristics and improve long-term health outcomes	Psychotic disorder, Bipolar disorder	Descriptive	Patients with a history of homelessness were more likely to be diagnosed with mental illness (49% vs 2%) and be admitted to a designated inpatient mental health bed (37% vs 1%). A suitable match was found for 5219 (75%) diabetic people with documented homelessness after the intervention. The derived matched cohort was balanced on important demographic and clinical characteristics
Davachi and Ferrari[36]	CDIRC in Canada, 524	To develop an accessible and effective diabetes management support for the homeless population especially those at risk or already diagnosed with diabetes	chronic disease self-management disorder	Survey study	There was a reduction in participants FBG and their HbA1c levels. Although the low numbers of follow-up data collected, the mean reductions in FBG of 4 mmol/L and HbA1c of 1.1% is significant for this population. Baseline results and results captured at the 3 to 12 mo follow-ups were only available for 10 patients with pre-existing diabetes
Thompson et al[37]	Canada, 52	Group medical visits, GMV in primary care for patients with diabetes and low socioeconomic status and low perception of life: users' perspectives and lessons for practitioners	Low perception of life	Qualitative research design	The GMV as a CTI promotes group identification and cohesion against the Diabetes mellitus disease process. The relationships made within the group were found to be supportive and therapeutic. It may also improve individuals' perception of diabetes management from problem solving, modelling, information and education, emotional support, accountability, and social competition
Campbell et al[38]	Canada, 28	To report the experiences of co-researchers with lived experience of homelessness and diabetes, giving voice to patients	Community-based participatory research approach	Qualitative	Many participants felt that the study provided them with intangible benefits, including feeling respected, valued, and heard; feeling accomplished and purposeful, resulting in improved self-efficacy in other areas; and building a sense of community with others who shared many of their life experiences
Campbell et al[39]	Canada, 96	The study documented the innovations in providing diabetes care for individuals experiencing homelessness	Management of diabetes	Survey	Among homeless individuals, this study identified five innovative and unique approaches to diabetes care. Among these approaches are the provision of in-shelter care, the provision of peer outreach, the provision of diabetes specialty outreach clinics, and the provision of diabetes group care specific to this population
Mayberry et al[40]	TN United States, 9	Explore acceptability of engaging family/friends in patients’ T2D self-management using text messaging	Depressive symptoms	Qualitative	A majority of participants (48%) cited needing assistance and seeing the benefits of engaging others as reasons for inviting a support person, while reasons for not inviting one included being an unnecessary "burden" or being unable to text. As a result of the texts, support persons reported an increase in awareness, a creation of dialogue, and an improvement in their own health and behavior
Elder and Tubb[41]	United States, 15	Seeks to understand barriers and enablers to health for homeless people with diabetes as perceived by homeless persons and providers	Management of diabetes	Survey	Despite being regarded as peripheral to diabetes care, all social service providers considered their primary roles to be important
Kasprow and Rosenheck[42]	United States, 484	evaluate an effort to disseminate a program of CTI case management for homeless veterans with mental illness being discharged from veteran psychiatric inpatient units	CTI	Randomized controlled trial	A higher proportion of CTI clients spent more time at home and fewer days in institutional settings than those receiving typical VA services. Clients of CTI case management also reported a reduction in alcohol consumption, drug use, and psychiatric disorders
Clark et al[43]	United States, 230	examine two the CTI management for people with co-occurring disorders and histories of chronic homelessness and to better understand their roles in permanent supported housing	CTI	Descriptive	A significant decrease in alcohol consumption, drug use, and psychological symptoms was also observed in participants of the CTI program
Shinn et al[44]	United States, 200	compared effects of a FCTI to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problem	CTI	Randomized trial	In children 6-10 and in adolescents 11-16, referrals to FCTI resulted in fewer internalizing and externalizing problems, as well as self-reported school troubles
Tomita and Herman[45]	New York City, 150	Evaluated the impact of CTI in reducing rehospitalization among formerly homeless individuals with severe and persistent mental illness after discharge from inpatient psychiatric treatment	CTI	Randomized control trial	The study revealed that CTI is effective in lowering psychiatric rehospitalization and efficient in reducing the likelihood of recurrent of homelessness
Asgary et al[46]	New York City, 418	This study assesses diabetes control and rates and predictors of diabetes that is not well-managed among patients experiencing homelessness compared with those of domiciled patients who receive medical care at New York City's shelter-clinics	Mental illness, substance abuse	Retrospective evaluative of T2D measurement	Homeless patients were more likely to have inadequately managed diabetes than other patients. The average HBA1c of homeless individuals was greater than that of domiciled individuals. There was a significant association between diabetic patients with mental illness and a lower HBA1c, as a result of better living conditions in their shelters
Keene et al[47]	United States, 5	Examine transitions into rent-assisted housing as they relate to diabetes self-management behaviors	Management of diabetes	Survey	Participants were able to reduce financial stress and offset diabetes-related expenses as a result of affordable housing and rental assistance
Yamamoto et al[48]	Japan, 106	survey of the prevalence of diabetes and prediabetes among homeless men in Nagoya, Japan	Cognitive disability	Descriptive survey	Prevalence of prediabetes differed significantly between groups with and without a history of social support. The prevalence of prediabetes was lower in the group with social support than in others. Early intervention for preventing diabetes and social support focused on diabetes management is imperative for homeless people
Shaw et al[49]	Britain, 150	Establish effectiveness of CTI in improving engagement of prisoners with mental illness	CTI	Parallel group randomized controlled trial	Participants engaged more fully with CTI than their counterparts. However, the difference was not substantial. Furthermore, the intervention group demonstrated better continuity of care and improved access to services
Jarrett et al[50]	United Kingdom, 60	This study aimed to see whether a CTI in the 1st week’s post-release effectively connects mentally ill prisoners with social, clinical, housing, and welfare services on leaving prison	CTI	Randomized Controlled	The CTI program significantly increased the number of prisoners receiving medication and being registered with their general practitioner
de Vet et al[51]	Dutch, 183	Examined the evidence base in Europe for effective interventions that improve the wellbeing of homeless people	CTI	Parallel-group randomized controlled trial	The CTI significantly enhanced the social support of individuals experiencing low levels of social support and psychological distress
Lako et al[52]	Europe, 136	To examine the effectiveness of CTI—an evidence-based intervention—for abused women transitioning from women’s shelters to community living	CTI	A randomized controlled trial	There is evidence that CTI is effective in reducing post-traumatic stress symptoms and unmet care needs in a population of abused women

CDIRC: Calgary drop-in & rehab centre; CTI: Critical time intervention; FBG: Fasting blood glucose; FCTI: Family critical time intervention; GMV: Group medical visit; T2D: Type 2 diabetes; HBA1c: Hemoglobin A1c.