‘I’ve put diabetes completely on the shelf till the mental stuff is in place’. How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. A qualitative study

Figures & data

Table 1.  An example of how GPs are expected to stratify patients with type 2 diabetes determining the level of chronic care.

		Disease regulation
		Well	Poor
Self-care	High	I	III
		General practice	General practice
			Specialist care
	Low	II	IV
		General practice	General practice
		Self-care support	Specialist care
			Self-care support

Table 2. shows the process for analyzing our data using systematic text condensation.

Theme	Meaning units (relevant quotes)	Condensation	Synthesis
Understanding the significance of severe mental disorders in combination with diabetes and other somatic conditions.	My biggest wish is to get my nut under control. I can live with my diabetes and the pain in my leg, but getting rid of these bad thoughts would broaden my horizons and help me to relax in what I do (Patient 4).	Relief from mental symptoms is prioritized first	Severe mental disorders overrule attention to somatic conditions.
	My mind takes up most space, while the diabetes is easy to forget… This night, I didn’t sleep. Then I spend all day speculating about the past (Patient 9).	Mental symptoms are ever present
	My back takes up much space, when it hurts and the mental stuff takes up extremely much space… We have heard so much about the diabetes, but I have put it completely on the shelf until the mental stuff is in place, because if I cannot survive mentally, then it doesn’t bloody matter how much diabetes I’ve got (Patient 10).	Somatic conditions can be overshadowed by mental disorders.
	It hurts me that neither my family, the GP nor the nurses have taken my anxiety seriously. They probably think that I use it as an excuse for being allowed to smoke. But it certainly is not; these attacks are very, very serious. When I get them, I must be alone and I think so much about why I have to live like this (Patient 12).	Mental symptoms can be neglected by the surrounding network and thereby block the care of somatic conditions.

Figure 1. The shifting perspectives model of chronic illness with modification.

Table 3.  Shows the profiles of the interviewed patients and the GP-identified case patients.

	Interview sample n = 13	All case patients n = 36
Age, years
Mean	59.2	62.5
Range	37–72	37–81
Gender, number (percentage)
Male	8 (62%)	21 (58%)
Female	5 (38%)	15 (42%)
Chronic Conditions, number (percentage)
Diabetes	13 (100%)	36 (100%)
Heart disease	6 (46%)	18 (50%)
Mental disorder	5 (38%)	16 (44%)
Obesity	5 (38%)	14 (39%)
Addiction	5 (38%)	9 (25%)
Musculoskeletal disorders	4 (31%)	8 (22%)
Respiratory disease	1 (8%)	4 (11%)