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5 Questions for…Esti Iturralde

Clinical psychologist and mental health services researcher aims to improve the overall health of people with mental illness


After completing her training as a clinical psychologist, Esti Iturralde, PhD, joined the Division of Research in 2017 as a delivery science fellow to pursue postdoctoral research at the intersection of behavioral and psychological health. Two years later, as her fellowship was drawing to a close, the Division of Research offered Iturralde a research scientist position. She quickly accepted.

Today, as a member of the Behavioral Health, Aging, and Infectious Diseases Section, Iturralde studies evidence-based behavioral health interventions that can improve the physical and emotional well-being of people with mental illness. She is currently completing a pilot study, funded by the National Institute of Diabetes and Digestive and Kidney Diseases, that will allow her to learn firsthand from people with severe mental illness about the types of health interventions they believe can best help them prevent or manage diabetes.

We caught up with Iturralde right before she headed off with her husband and two young daughters for a socially-distanced week outside of Yosemite.

How did you begin looking at connections between mental health and chronic disease prevention and management?

During my clinical training, I worked with individuals with diabetes, and I learned how strenuous and difficult it is to care for this disease. At the Division of Research, I was able to broaden my focus to also look at cardiovascular disease. I also got to know psychiatrists who were interested in the metabolic health of people with severe mental illness. I am now collaborating with them on a series of studies that will help us identify potential gaps in care that put people with certain types of severe mental illness at higher risk for developing diabetes and cardiovascular disease in the future.

Iturralde and her family at Lake Tahoe.

How does diabetes intersect with mental illness?

People with mental illness have a lot of different contributors that make their metabolic health an issue. One example is the antipsychotics used to treat mental illness. They can be life changing if they work for you. But they can also cause people to develop a really intense appetite and gain a lot of weight, and they can sap you of energy to be physically active. These side effects don’t happen to everyone, but when they do people can face a difficult decision: Do you stay on this medication that is helping you control your suicidal ideation and helping with your depression, even though it means you will face a really serious risk for obesity and then, possibly, diabetes?

What kinds of interventions may help patients?

One option may be to switch medications. There is also the possibility of adding metformin to people’s regimens. This is a very well-known medication that people take to prevent type 2 diabetes, and there is nice clinical trial evidence showing that it helps people on antipsychotic medications gain less weight. People with mental illness die 15 to 30 years earlier than their peers without mental illness, and more than 90% of these individuals are dying of chronic disease, such as cardiovascular disease and cancer. It is very important to address the potential long-term health issues these patients are facing.

What advice would you give to young researchers looking for a postdoc position?

There are a lot of different kinds of postdocs out there, and every postdoc is unique. My advice would be to think about what the strengths are of the particular postdoc that you are pursuing, and what the mentors’ objectives and backgrounds are. Different mentors have different areas of strength, and it’s great if you can match up with somebody who is going to offer you some training that fills a particular gap or area where you want to grow. What was really exciting to me about the Division of Research, and doing a fellowship here, is that I had access to all of this great experience related to how to test and implement new kinds of interventions in a real health system.

How do you like to spend your free time?

I have a delightful family and I enjoy spending time with my husband and two daughters, ages 6 and 3, and our little dog, Roscoe. We garden and cook together and go bicycling around town as a family. I also like to do dance classes with my daughters. Another passion of mine is drinking fancy coffee. That is something the pandemic has not been able to take away from me.

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