Table 1.

Perceived Barriers and Strategies to Address Psychological Conditions in Primary Care and Specialty Settings

	Perceived barriers	Strategies to address barriers
Patient level	Stigma about mental health conditions Denial of depression or diabetes distress Lack of knowledge about depressive symptomatology or diabetes distress	Educate patients with diabetes about depression and diabetes distress Inform patients about educational resources for depression and diabetes distress and mental health services available
Provider level	Lack of or inadequate mental health training Workload demands or time constraints Managing physical condition (e.g., diabetes) takes up providers’ time Perception of mental health issues being out of providers’ area of expertise or responsibility Perception that patients may not follow through with mental health referral	Identify and participate in mental health trainings available for primary care providers Identify ways to incorporate evidence-based guidelines into clinical practice Explore ways to effectively manage and address mental health conditions during diabetes clinic visits
Practice level	Lack of access to mental health specialists Lack of access to diabetes distress, depression, and other mental health assessment tools Lack of a reminder system	Explore opportunities to assess patients’ mental health concerns in regular diabetes clinic visits Identify ways to develop alert systems in electronic health records for depression and diabetes distress screenings