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Malak MZ, Abualruz H, Shehadeh A. Psychosocial factors correlating self-care management among Jordanian adolescents with type 1 diabetes. J Pediatr Nurs 2025; 80:75-82. [PMID: 39579721 DOI: 10.1016/j.pedn.2024.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 11/15/2024] [Accepted: 11/16/2024] [Indexed: 11/25/2024]
Abstract
PURPOSE Few studies were conducted to examine the correlation between the anxiety symptoms, depressive symptoms, self-efficacy, and social support variables and type 1 diabetes in developing countries, including Jordan. Thus, this study was conducted to assess the correlation between these psychosocial factors and self-care management among Jordanian adolescents with type 1 diabetes. DESIGN & METHODS A cross-sectional, descriptive correlational design was used to perform a study among adolescents with type 1 diabetes (N = 351) aged 14-18 years who attended primary healthcare centers clinics, and diabetic clinics related to hospitals in Amman Governorate, Jordan. A convenience sampling method was used to recruit participants. The data were collected using self-reported questionnaire during the period from June to December 2023. FINDINGS The results revealed that around 61.0 % of the sample were males and 39 % female, and 74.9 % of the participants experienced type 1 diabetes for more than one year. Only, 4.3 % of the participants had the recommended HbA1c (< 7.5 %). The participants had high percentage anxiety and depressive symptoms, poor self-efficacy, moderate social support, and low self-care management. There was a correlation between self-efficacy, social support, and self-care management. Also, social support mediated the relationship between self-efficacy and self-care management. However, no relationship existed between anxiety and depressive symptoms and self-care management. CONCLUSION Screening for anxiety and depressive symptoms should be a significant element of care for adolescents with type 1 diabetes in outpatient clinics. Policymakers and healthcare professionals including pediatric nurses should develop strategies and education programs on self-care management to enhance self-care practices and management for adolescents with type 1 diabetes.
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Affiliation(s)
- Malakeh Z Malak
- Community Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan.
| | - Hasan Abualruz
- Mental Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
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O'Daffer A, Yi-Frazier JP, Roberts AJ, Lowry SJ, Pihoker C, Hirsch IB, Weaver KW, Zenno A, Malik FS. The association of resilience with HbA1c and key psychosocial factors in emerging adults with type 1 diabetes. J Pediatr Psychol 2024; 49:866-873. [PMID: 39394732 DOI: 10.1093/jpepsy/jsae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/14/2024] Open
Abstract
OBJECTIVE Emerging adults (EAs) with type 1 diabetes (T1D) have difficulty meeting glycemic targets and have a high prevalence of mental health comorbidities. Resilience, the ability to harness resources needed to sustain one's emotional and physical well-being, may be a key factor impacting poor mental health and glycemic outcomes. We aimed to (a) evaluate the association between resilience, HbA1c, and key psychosocial factors and (b) explore whether resilience moderates the relationship between psychosocial factors (depression, diabetes-related distress, anxiety) and HbA1c in EAs with T1D. METHOD EAs with T1D (N = 233) (mean age = 19.9 years (SD = 1.6), range 16.8-24.7) seen at an EA-specific diabetes clinic completed resilience, diabetes-related distress, depression, and anxiety measures and had their HbA1c level evaluated. We used linear regression models and conducted moderation analyses for the resilience factor. RESULTS Resilience was strongly associated with HbA1c, depression, diabetes-related distress, and anxiety in EAs with T1D. We did not find evidence that resilience moderates the relationship between depression, anxiety, or diabetes-related distress and HbA1c. CONCLUSIONS This study found that resilience is a highly relevant psychological factor associated with HbA1c and a key mental health factor for EAs with T1D. Novel interventions are needed to ameliorate high diabetes-related distress and HbA1c, and bolstering resilience may be one avenue to explore. Future research on resilience should longitudinally characterize and evaluate whether resilience may be a mechanism underlying the relationship between poor psychosocial outcomes and not meeting glycemic targets in EAs with T1D.
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Affiliation(s)
- Alison O'Daffer
- Joint Doctoral Program of Clinical Psychology, San Diego State University/University of California, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Joyce P Yi-Frazier
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Alissa J Roberts
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Sarah J Lowry
- Biostatistics Epidemiology and Analytics for Research Core, Seattle Children's Research Institute, Seattle, WA, United States
| | - Catherine Pihoker
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Irl B Hirsch
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Kathryn W Weaver
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Anna Zenno
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
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Glick BA, Chan Hong KM, Hoffman RP. Identifying depression, diabetes distress, and suicidality among adolescents with diabetes. SOCIAL WORK IN HEALTH CARE 2024; 63:489-500. [PMID: 39292600 DOI: 10.1080/00981389.2024.2400883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/26/2024] [Indexed: 09/20/2024]
Abstract
This study explored the frequency of adolescents with diabetes who endorse suicidality on the Patient Health Questionnaire (PHQ-9) with varying degrees of depression scores. Additionally, compared whether diabetes distress levels from the Problem Areas in Diabetes-Teen (PAID-T) assessment tool is associated with and without suicidal ideation. Χ2 analysis was used to assess differences in subjects with or without suicidal ideation based on depression severity. Since all the data were nonparametrically distributed (Shapiro-Wilk test, p < .05), Kruskal-Wallis test assessed differences in continuous variables. Overall, 27 of 355 adolescents screened endorsed suicidal ideation. Both PHQ-9 [13 (9-17.8) vs 1 (0-4.5)] and PAID-T [88 (61.8-104.5) vs 40 (30-58.8)] scores were significantly higher in patients with suicidal ideation. The frequency of suicidal ideation increased with the severity of depression. The frequency of severe depression was higher in adolescents with type 2 diabetes (n = 48) than in type 1, but there was no difference in suicidality. Adolescents with no demonstrable or minimal depression can still have potential suicidal ideation. Suicidality is a separate construct that should be screened routinely and apart from any measures screening for distress or adjustment disorders associated with adolescents experiencing life-long chronic conditions in a healthcare follow-up setting.
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Affiliation(s)
- Bethany A Glick
- Clinical Medical Social Work, Nationwide Children's Hospital, Columbus, OH, USA
| | - K Ming Chan Hong
- Clinical Medical Social Work, Nationwide Children's Hospital, Columbus, OH, USA
| | - Robert P Hoffman
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
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Albright D, Wardell J, Harrison A, Mizokami-Stout K, Hirschfeld E, Garrity A, Thomas I, Lee J. Screening for diabetes distress and depression in routine clinical care for youth with type 1 diabetes. J Pediatr Psychol 2024; 49:356-364. [PMID: 38647266 PMCID: PMC11098041 DOI: 10.1093/jpepsy/jsae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The purpose of this study is to examine diabetes distress as a potential mediator of the relationship between depression symptoms and diabetes outcomes, including hemoglobin A1c (hemoglobin A1c [HbA1c]) and diabetes management behaviors in a clinical sample of adolescents and young adults. METHODS In a pediatric diabetes clinic, 716 youth (ages 12-21 years) completed measures of diabetes distress (Problem Areas in Diabetes-Teen [PAID-T]), a single-item of diabetes distress, and depression (Patient Health Questionnaire [PHQ-9]) as part of standard care. Electronic health records were extracted for the "Six Habits" and glycemic management (HbA1c). RESULTS Overall, 3.6% (n = 26) of adolescents had clinically elevated diabetes distress and depression symptoms, 5.0% had diabetes distress alone, 8.7% had depression symptoms alone, and 82.7% had neither clinical elevation of diabetes distress nor depression symptoms. Results of mediation analysis demonstrated diabetes distress (both full and single-item measures) fully mediated the relationship between depression symptoms and HbA1c (p < .001). Also, mediation analysis results showcase incomplete mediation of the effect of the Six Habits score on HbA1c appears by PAID-T Diabetes Distress. CONCLUSIONS In a clinical sample of youth with type 1 diabetes, both depressive symptoms and diabetes distress are associated with HbA1c. Furthermore, diabetes distress fully mediates the relationship between depressive symptoms and HbA1c. As part of standard clinical care, the single-item screener for diabetes distress captured similar results as the full-scaled PAID-T. With limited clinical resources, providers may consider focusing assessment and interventions on the psychological factor of diabetes distress within the diabetes clinic to maximize the impact on glycemic control and consider the use of single-item screening to identify distress.
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Affiliation(s)
- Dana Albright
- Health Services and Informatics Research, Parkview Health, Fort Wayne, IN, United States
| | - Joseph Wardell
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Annalise Harrison
- Health Services and Informatics Research, Parkview Health, Fort Wayne, IN, United States
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Emily Hirschfeld
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Ashley Garrity
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
| | - Inas Thomas
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
| | - Joyce Lee
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
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Al Alshaikh L, Doherty AM. The relationship between diabetic ketoacidosis and suicidal or self-injurious behaviour: A systematic review. J Clin Transl Endocrinol 2023; 34:100325. [PMID: 37840692 PMCID: PMC10568420 DOI: 10.1016/j.jcte.2023.100325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Background It has been suggested that there may be an association between type 1 diabetes (T1DM) and suicide, with one study reporting a rate 11 times that of the general population The aim of this paper was to investigate the association between Diabetic ketoacidosis (DKA: a life-threatening acute complication of T1DM) and suicidal behaviours in people with T1DM. Methods We performed a search of the following databases: PubMed, PsychInfo, and Embase for papers which explored the association between suicidal behaviours and self-harm with DKA in T1DM. We excluded case reports and review papers. Results Only three papers explored the relationship between DKA and self-harm. One study found an association between DKA and self-harm in a national cohort of people with type 1 diabetes and schizophrenia. The second found a significant increase in psychiatric admissions for self-harm following an episode of DKA. The third study reported that patients with diabetes and a history of self-harm were at elevated risk of a range of diabetes complications including DKA. These findings indicate an association between DKA and self-harm and support the guidelines in recommending a psychosocial assessment where DKA cannot be explained. Conclusions This review suggests that DKA is associated with suicidal or self-injurious behaviours. The small number of studies and the seriousness of this issue highlight the importance of further research on this topic, to improve the evidence base for the identification and treatment of risk of suicidal behaviours in people with T1DM.
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Affiliation(s)
| | - Anne M. Doherty
- Department of Psychiatry, University College Dublin, 63 Eccles Street, Dublin 7, Ireland
- Department of Liaison Psychiatry, Mater Misericordiae University Hospital, 63 Eccles Street, Dublin 7, Ireland
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Marks KP, Pouwer F, Jensen MB, Ibfelt EH, Kristensen LJ, Thastum M, Birkebæk NH. Responses to the Strengths and Difficulties Questionnaire predict HbA1c trajectories in children and adolescents with type 1 diabetes: a population-based study. BMJ Open Diabetes Res Care 2023; 11:e003479. [PMID: 37914346 PMCID: PMC10626890 DOI: 10.1136/bmjdrc-2023-003479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION We aimed to determine whether caregiver responses to the Strengths and Difficulties Questionnaire (SDQ) are predictive of HbA1c trajectory membership in children and adolescents with type 1 diabetes, when adjusting for covariates. RESEARCH DESIGN AND METHODS For a Danish 2009 national cohort of children and adolescents with type 1 diabetes, we analyzed yearly HbA1c follow-up data during 2010-2020 including sociodemographic data from Danish national registries. Using group-based trajectory modeling and multinomial logistic regression, we tested whether caregiver SDQ scores predicted HbA1c trajectory membership when adjusting for sex, age at diabetes diagnosis, diabetes duration, family structure, and caregiver education. RESULTS In total, 835 children and adolescents (52% females) with a mean (SD) age of 12.5 (3.3) years, and a mean diabetes duration of 5.2 (3.1) years, were included. Based on 7247 HbA1c observations, four HbA1c trajectories were identified: (1) 'on target, gradual decrease' (26%), (2) 'above target, mild increase then decrease' (41%), (3) 'above target, moderate increase then decrease' (24%), and (4) 'well above target, large increase then decrease' (9%). Higher SDQ total difficulties scores predicted trajectories 3 and 4 (p=0.0002 and p<0.0001, respectively). Regarding the SDQ subscale scores, emotional symptoms predicted trajectories 3 and 4, and conduct problems and hyperactivity/inattention predicted trajectories 2, 3, and 4. Single-parent family and low caregiver education level both predicted trajectories 3 and 4. CONCLUSIONS Caregiver SDQ responses and sociodemographic information may help detect children and adolescents with type 1 diabetes, who need intensive multidisciplinary medical and psychological interventions.
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Affiliation(s)
- Kevin P Marks
- Department of Clinical Medicine - Paediatrics, Aarhus Universitet, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Else H Ibfelt
- Danish Clinical Quality Program-National Clinical Registries (RKKP), Frederiksberg, Denmark
- Steno Diabetes Center Copenhagen, The Capital Region, Denmark
| | - Lene J Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology, Centre for Psychological Treatment of Children and Adolescents, Aarhus University, Aarhus, Denmark
| | - Niels H Birkebæk
- Department of Clinical Medicine - Paediatrics, Aarhus Universitet, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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O'Donnell MB, Scott SR, Ellisor BM, Cao VT, Zhou C, Bradford MC, Pihoker C, DeSalvo DJ, Malik FS, Hilliard ME, Rosenberg AR, Yi-Frazier JP. Protocol for the Promoting Resilience in Stress Management (PRISM) intervention: A multi-site randomized controlled trial for adolescents with type 1 diabetes. Contemp Clin Trials 2023; 124:107017. [PMID: 36410689 PMCID: PMC9839528 DOI: 10.1016/j.cct.2022.107017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescents with type 1 diabetes (T1D) are at high risk for elevated diabetes distress, which greatly impacts diabetes management, glycemic outcomes and overall quality of life. Developing protective skills and "resilience resources" to navigate adversity and manage diabetes distress has high potential to help adolescents with T1D achieve optimal behavioral, psychological, and health outcomes. The "Promoting Resilience in Stress Management" (PRISM) program is a manualized, brief, skills-based intervention delivered over 6 months via two 45-60 min one-on-one sessions and a family meeting with a PRISM coach, and supplemented by booster calls and a digital app. This trial (PRISM versus usual care)is designed to:: (1) assess PRISM's impact on glycemic outcomes and diabetes distress among adolescents with T1D, and (2) explor PRISM's impact on resilience, self-reported adherence, and quality of life. METHODS We describe the protocol for a multi-site randomized controlled trial designed for adolescents ages 13-18 with elevated diabetes distress. The primary trial outcomes are glycemic outcomes and diabetes distress 6 months post-randomization. Secondary outcomes include resilience, self-reported adherence, and QOL 6 months post-randomization. Our hypothesis is that youth in the PRISM group will demonstrate better glycemic outcomes and improved diabetes distress, adherence, resilience, and QOL compared to usual care. CONCLUSIONS This study will provide methodologically rigorous data and evidence regarding a novel intervention to promote resilience among adolescents with T1D and elevated diabetes distress. This research has the potential to offer a practical, skills-based curriculum designed to improve outcomes for this high-risk group. TRIAL REGISTRATION Prospectively registered at Clinicaltrials.gov (NCT03847194).
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Affiliation(s)
- Maeve B O'Donnell
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America; University of Washington School of Medicine, Department of Pediatrics, Division of Diabetes/Endocrinology, Seattle, WA, United States of America; Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Samantha R Scott
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America; Department of Psychology, University of Denver, Denver, CO, United States of America
| | - Britney M Ellisor
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America
| | - Viena T Cao
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, TX, United States of America
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States of America; University of Washington, School of Medicine, Department of Pediatrics, Division of General Pediatrics, Seattle, WA, United States of America
| | - Miranda C Bradford
- Core for Biostatistics, Epidemiology and Analytics for Research (BEAR) Core, Seattle Children's Research Institute, Seattle, WA, United States of America
| | - Catherine Pihoker
- University of Washington School of Medicine, Department of Pediatrics, Division of Diabetes/Endocrinology, Seattle, WA, United States of America
| | - Daniel J DeSalvo
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, TX, United States of America
| | - Faisal S Malik
- University of Washington School of Medicine, Department of Pediatrics, Division of Diabetes/Endocrinology, Seattle, WA, United States of America; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States of America
| | - Marisa E Hilliard
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, TX, United States of America
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America; Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, United States of America.
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Alassaf A, Gharaibeh L, Zurikat RO, Farkouh A, Ibrahim S, Zayed AA, Odeh R. Prevalence of Depression in Patients with Type 1 Diabetes between 10 and 17 Years of Age in Jordan. J Diabetes Res 2023; 2023:3542780. [PMID: 36873812 PMCID: PMC9977551 DOI: 10.1155/2023/3542780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
METHODS The study was conducted by distributing the Center for Epidemiological Studies Depression Scale for Children (CES-DC) to adolescents with T1D seen at Jordan University Hospital between February 2019 and February 2020. Demographic, clinical, and socioeconomic data were collected using electronic clinical charts. Possible predictors of depression were assessed using logistic regression analysis. RESULTS A total of 108 children were enrolled in the study with mean age of 13.7 ± 2.3 years. Fifty-eight children (53.7%) had a CES depression score less than 15, and 50 children (46.3%) had a depression score of 15 or more. The number of diabetes-related hospital admissions and the frequency of self-monitoring of blood glucose (SMBG) were significantly different between the two groups. In the multivariable analysis, both gender and SMBG frequency were statistically significant. Girls were more likely to have a depression score ≥ 15 (OR = 3.41, p = 0.025) than boys. Patients who were rarely testing blood glucose levels were more likely to have a depression score ≥ 15 compared to those who were testing regularly (OR = 36.57, p = 0.002). CONCLUSION The prevalence of depressive symptoms is relatively high in adolescents with T1D, especially in those living in developing countries. Longer diabetes duration, higher glycated hemoglobin level, and less frequent blood glucose monitoring are associated with higher depression scores.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Rajai O. Zurikat
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Ala'a Farkouh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Ayman A. Zayed
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
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Takaike H, Miura J, Ishizawa K, Babazono T. High prevalence of depressive symptoms among people with pediatric-onset and adolescent-onset type 1 diabetes: A cross-sectional analysis of the Diabetes Study from the Center of Tokyo Women's Medical University. J Diabetes Investig 2022; 13:1626-1632. [PMID: 35587633 PMCID: PMC9434570 DOI: 10.1111/jdi.13835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS To investigate the prevalence of depressive symptoms by the age of onset of type 1 diabetes and its association with the condition of individuals with pediatric- and adolescent-onset type 1 diabetes. MATERIALS AND METHODS This single-center cross-sectional study enrolled Japanese participants with type 1 diabetes. All participants completed a questionnaire about their diabetes-related condition and the Patient Health Questionnaire-9, which was used to evaluate depression. Individuals with a Patient Health Questionnaire-9 score of ≥10 points were defined as having moderate depressive symptoms. RESULTS A total of 1,267 participants (mean age, 40 years; mean duration of type 1 diabetes, 21 years; 68% female; mean glycated hemoglobin, 7.8%) were included and classified according to the age of onset of type 1 diabetes to identify the proportion of moderate depressive symptoms in each group: 21% (0-12 years), 18% (13-19 years), and 13% (20-40 years). The prevalence of moderate depressive symptoms was significantly higher among participants with pediatric-onset type 1 diabetes (p<0.05). Moderate depressive symptoms were associated with increased glycated hemoglobin, neuropathy, and hypoglycemia unawareness. CONCLUSIONS Regular screening for depressive symptoms and hypoglycemia awareness is important. Healthcare professionals should provide appropriate psychosocial care for people with pediatric-onset and adolescent-onset type 1 diabetes from childhood through to adulthood.
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Affiliation(s)
- Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kaya Ishizawa
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Wigglesworth KR, Vigers T, Pyle L, Youngkin EM, Fay-Itzkowitz E, Tilden J, Raymond JK, Snell-Bergeon J, Sass A, Majidi S. Follow-Up Mental Health Care in Youth and Young Adults With Type 1 Diabetes After Positive Depression Screen and/or Suicidal Ideation. Clin Diabetes 2022; 40:449-457. [PMID: 36385972 PMCID: PMC9606559 DOI: 10.2337/cd21-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with type 1 diabetes have higher rates of depression and suicidal ideation than the general population, and symptoms of depression are often associated with higher A1C levels and complications. This study evaluated mental health follow-up rates in youth and young adults with type 1 diabetes who screened positive for depressive symptoms or suicidal ideation and identified differences between those who obtained follow-up mental health care and those who did not. Specifically, males were less likely to obtain follow-up, and those who had mental health follow-up had decreasing A1C over the following year. These findings suggest increased assistance and monitoring are needed to ensure follow-up mental health care is obtained.
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Affiliation(s)
- Kelly R.S. Wigglesworth
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Timothy Vigers
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Erin M. Youngkin
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ellen Fay-Itzkowitz
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer Tilden
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer K. Raymond
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Janet Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy Sass
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Children’s National Hospital, Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, DC
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Nguyen LA, Pouwer F, Lodder P, Hartman E, Winterdijk P, Aanstoot HJ, Nefs G. Depression and anxiety in adolescents with type 1 diabetes and their parents. Pediatr Res 2022; 91:188-196. [PMID: 33664478 DOI: 10.1038/s41390-021-01392-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Longitudinal studies including parental distress when examining adverse health outcomes in adolescents with type 1 diabetes are lacking. This study examined whether parental depression and anxiety predict adolescent emotional distress and glycated hemoglobin A1c (HbA1c) 1 year later and whether a relation between parental distress and HbA1c is mediated by the level of parental involvement in diabetes care and by treatment behaviors. METHODS Longitudinal path modeling was applied to data from 154 adolescents and parents from diabetes centers participating in the Longitudinal study of Emotional problems in Adolescents with type 1 diabetes and their Parents/caregivers (Diabetes LEAP). At baseline and 1-year follow-up, participants completed measures of depression and anxiety. HbA1c was extracted from medical charts. Responsibility and treatment behavior questionnaires were completed by adolescents at baseline. RESULTS Baseline parental depressive and anxiety symptoms were not associated with 1-year adolescent depressive symptoms, anxiety symptoms, and HbA1c. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. CONCLUSIONS Parental depressive and anxiety symptoms did not predict adolescent health outcomes 1 year later. Future studies may determine whether the link is present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress. IMPACT Adolescents with T1D are a vulnerable group in terms of psychological and health outcomes. Whether parental emotional distress (i.e., depressive and anxiety symptoms) is prospectively associated with adolescent emotional distress and/or HbA1c has been understudied. Our results show that parental distress was not related to adolescent distress or HbA1c 1 year later. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. Future studies could determine whether these links are present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress.
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Affiliation(s)
- Linh A Nguyen
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,STENO Diabetes Center Odense, Odense, Denmark.,School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Esther Hartman
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Per Winterdijk
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Henk-Jan Aanstoot
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands. .,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. .,National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands.
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12
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March CA, Siminerio LM, Muzumdar RH, Libman IM. Implications of the School Day on Health Behaviors for Children With Type 1 Diabetes: A Survey of Parent Perspectives During the COVID-19 Pandemic. Sci Diabetes Self Manag Care 2021; 47:447-456. [PMID: 34935539 DOI: 10.1177/26350106211051298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to survey parents of youth with type 1 diabetes during the COVID-19 pandemic with school closures to better understand the implications of the school day on health care behaviors. METHODS A cross-sectional, online survey was distributed to parents of youth with type 1 diabetes ≤19 years of age in a large, academic diabetes center. Questions encompassed perceived changes in management behaviors and plans for return to school. Subgroup analysis compared parent responses by child's age, reported stressors, and socioeconomic markers. RESULTS Parents reported a worsening in their child's diabetes health behaviors during school closures compared to what they perceived during a regular school day before the pandemic. More than half of parents reported feeling that their child was unable to maintain a normal routine, with particular implications for snacking between meals, daily physical activity, and sleep habits. Families with adolescents or those experiencing multiple pandemic-related stressors reported greater challenges. In open-ended responses, families highlighted difficulty in balancing school, work, and diabetes care and expressed concerns about the mental health repercussions of school closures for their children. Nearly half of parents reported being at least moderately worried about return to school, whereas only a minority reported seeking guidance from their diabetes provider. CONCLUSIONS Parent-reported disruptions of school-day routines frequently had adverse consequences for diabetes management in this population. These findings highlight the importance of a school-day routine for children with type 1 diabetes; during closures, families may benefit from mitigating strategies to maintain effective habits.
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Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linda M Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Radhika H Muzumdar
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ingrid M Libman
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
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13
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Hong KMC, Glick BA, Kamboj MK, Hoffman RP. Glycemic control, depression, diabetes distress among adolescents with type 1 diabetes: effects of sex, race, insurance, and obesity. Acta Diabetol 2021; 58:1627-1635. [PMID: 34213654 DOI: 10.1007/s00592-021-01768-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 01/09/2023]
Abstract
AIMS To determine whether diabetes distress or depression screening better predict increased hemoglobin A1c (HbA1c) and to assess interactions with age, sex, race, obesity, and insurance status. BACKGROUND Diabetes distress is a negative emotional reaction to diabetes, diabetes complications, self-management demands, unresponsive providers, and/or poor interpersonal relationships. Guidelines recommend annual depression screening, however diabetes distress may be mistaken for depression. METHOD Depression (PHQ-9) and diabetes distress (PAID-T) scores from self-administered tests were studied in 313 patients with type 1 diabetes (T1D) between the ages of 13-17. Spearman correlations and robust rank order multivariable regression analysis were used to assess relationships to age, duration, HbA1c. Kruskal-Wallis test was used to assess differences between sexes, races, and insurance status. Receiver operator curves (ROC) were constructed to see whether PAID-T or PHQ-9 scores more closely predicted HbA1c greater than 9%. RESULTS HbA1c was more strongly correlated with PAID-T (rs = 0.37, p < 0.01), than PHQ-9 (rs = 0.27, p < 0.01) scores. Area under ROC curve for poor HbA1c was 0.75 for PAID and 0.64 for PHQ-9. PAID-T and PHQ-9 scores were increased in females and subjects with public insurance and both were significantly related to HbA1c even when accounting for age, sex, race obesity, and insurance status. PHQ-9 and PAID-T scores correlated with BMI-Z scores in Blacks, but not Whites. CONCLUSIONS Both depression and diabetes distress are associated with increased HbA1c in adolescents with T1D, though distress is more so. Diabetes distress and depression should be routinely assessed in T1D adolescents, particularly those with public insurance.
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Affiliation(s)
- K Ming Chan Hong
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43105, USA
| | - Bethany A Glick
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43105, USA
| | - Manmohan K Kamboj
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43105, USA
| | - Robert P Hoffman
- Pediatric Endocrinology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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14
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Riveline JP, Vergés B, Detournay B, Picard S, Benhamou PY, Bismuth E, Bordier L, Jeandidier N, Joubert M, Roussel R, Sola-Gazagnes A, Bonnefond A, Clavel S, Velayoudom FL, Beltrand J, Hanaire H, Fontaine P, Thivolet C, Servy H, Tubiana S, Lion S, Gautier JF, Larger E, Vicaut E, Sablone L, Fagherazzi G, Cosson E. Design of a prospective, longitudinal cohort of people living with type 1 diabetes exploring factors associated with the residual cardiovascular risk and other diabetes-related complications: The SFDT1 study. DIABETES & METABOLISM 2021; 48:101306. [PMID: 34813929 DOI: 10.1016/j.diabet.2021.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is associated with a high risk of cardiovascular (CV) complications, even after controlling for traditional CV risk factors. Therefore, determinants of the residual increased CV morbidity and mortality remain to be discovered. This prospective cohort of people living with T1DM in France (SFDT1) will include adults and children aged over six years living with T1DM, recruited throughout metropolitan France and overseas French departments and territories. The primary objective is to better understand the parameters associated with CV complications in T1DM. Clinical data and biobank samples will be collected during routine visits every three years. Data from connected tools, including continuous glucose monitoring, will be available during the 10-year active follow-up. Patient-reported outcomes, psychological and socioeconomic information will also be collected either at visits or through web questionnaires accessible via the internet. Additionally, access to the national health data system (Health Data Hub) will provide information on healthcare and a passive 20-year medico-administrative follow-up. Using Health Data Hub, SFDT1 participants will be compared to non-diabetic individuals matched on age, gender, and residency area. The cohort is sponsored by the French-speaking Foundation for Diabetes Research (FFRD) and aims to include 15,000 participants.
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Affiliation(s)
- J P Riveline
- Department of Diabetology and Endocrinology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, 2 rue Ambroise Paré, Paris 75010, France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France.
| | - B Vergés
- Department of Endocrinology-Diabetology, INSERM LNC UMR1231, University of Burgundy, Dijon, France
| | - B Detournay
- CEMKA, 43 boulevard du Maréchal Joffre, Bourg-la-Reine, France
| | - S Picard
- Endocrinology and Diabetes, Point Medical, Rond-Point de la Nation, Dijon 21000, France
| | - P Y Benhamou
- INSERM U1055, LBFA, Endocrinologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - E Bismuth
- Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Université de Paris, Paris F-75019, France
| | - L Bordier
- Department of Diabetology and Endocrinology, Begin Military Hospital, Saint Mandé, France
| | - N Jeandidier
- Department of Endocrinology, Diabetes, Nutrition, Hospices Civils Strasbourg, UdS, Strasbourg 67000, France
| | - M Joubert
- Diabetes Care Unit - Caen University Hospital - UNICAEN, Caen, France
| | - R Roussel
- Department of Diabetology, Endocrinology, and Nutrition, Bichat-Claude Bernard Hospital, Paris,France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France
| | - A Sola-Gazagnes
- Department of Diabetology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - A Bonnefond
- Université de Lille, Inserm UMR1283, CNRS UMR8199, Institut Pasteur de Lille, CHU de Lille, Lille, France
| | - S Clavel
- Department of Diabetology Endocrinology Hotel Dieu Le Creusot, France
| | - F L Velayoudom
- Department of Diabetology and Endocrinology, University Hospital of Guadeloupe, Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, Lille University Hospital, Lille 59000, France
| | - J Beltrand
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, APHP Centre, Hôpital Universitaire Necker Enfants Malades, Université de Paris - Inserm U1016, Institut Cochin, Paris, France
| | - H Hanaire
- Department of Diabetology, University Hospital of Toulouse, University of Toulouse, France
| | - P Fontaine
- Department of Endocrinology, Diabetology and Nutrition University Hospital of Lille, University of Lille, France
| | - C Thivolet
- Center for Diabetes DIAB-eCARE, Hospices Civils de Lyon and Lyon 1 University, Lyon France
| | - H Servy
- e-health Services Sanoïa, 188 av 2nd DB, Gémenos 13420, France
| | - S Tubiana
- AP-HP, Hôpital Bichat, Centre de Ressources Biologiques, Paris F-75018, France
| | - S Lion
- Société Francophone du Diabète, Paris, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, 2 rue Ambroise Paré, Paris 75010, France; Unite INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Universite de Paris, Paris, France
| | - Etienne Larger
- AP-HP.Centre-Université de Paris, INSERM U1016, Institut Cochin Paris, France
| | - E Vicaut
- AP-HP, Hôpital F.Widal, Clinical Trial Unit, Paris 75010, France
| | - L Sablone
- Fondation Francophone Pour la Recherche sur le Diabète, 60 rue Saint Lazare, Paris 75009, France
| | - G Fagherazzi
- Department of Population Health, Deep Digital Phenotyping Research Unit, 1 AB rue Thomas Edison, Strassen, Luxembourg
| | - E Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Paris 13 University, Bobigny, France; UMR 557 INSERM/U11125 INRAE/CNAM / Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, Paris 13 University Sorbonne Paris Cité, Bobigny, France
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15
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Alaqeel A, Almijmaj M, Almushaigeh A, Aldakheel Y, Almesned R, Al Ahmadi H. High Rate of Depression among Saudi Children with Type 1 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111714. [PMID: 34770232 PMCID: PMC8583043 DOI: 10.3390/ijerph182111714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 01/09/2023]
Abstract
Saudi Arabia ranks among the top ten in type 1 diabetes (T1D) prevalence. The psychological burden, including depression, among T1D children, affects short-term and long-term outcomes. In Saudi Arabia, studies on depression among T1D children are limited. We determined the prevalence of depression among T1D children and adolescents in the Saudi Arabia-Qassim region and investigated risk factors for depressive symptoms. This quantitative cross-sectional study was conducted among T1D children and adolescents in the outpatient clinic of Maternity and Children Hospital, Buraydah, Saudi Arabia, between October 2020 and April 2021. Using a validated questionnaire translated into Arabic, we interviewed patients during clinic appointment. Questionnaires on sociodemographic characteristics, clinical data, and Clinical Depression Inventory scale were used to measure depression. There were 148 T1D respondents (children: 58.1%; adolescents: 41.9%). More than half were females (53.4%), with most Saudis (94.6%). Depression prevalence among children and adolescents was 27%. Mild, moderate, and severe depression occurred in 80%, 12.5%, and 7.5% of depressed patients, respectively. Factors significant for depression were female sex (p = 0.014), uncontrolled HbA1c level (p = 0.037), and longer diabetes duration (p = 0.013). Depression among children and adolescents was more prevalent in this study than in previous reports. Early detection of depression will improve diabetes control and quality of life.
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Affiliation(s)
- Aqeel Alaqeel
- Department of Pediatrics, College of Medicine, Qassim University, Qassim 51452, Saudi Arabia
- Correspondence:
| | - Muna Almijmaj
- Department of Pediatrics, Dr Suliman Al Habib Hospital, Riydah 13212, Saudi Arabia;
| | - Abdulaziz Almushaigeh
- Emergency Medicine Department, Riyadh Al khabra Hospital, Qassim 52714, Saudi Arabia;
| | - Yasser Aldakheel
- Department of Pediatrics, King Fahad Medical City, Riydah 12231, Saudi Arabia;
| | | | - Husam Al Ahmadi
- Maternity & Children Hospital, Al Qassim 52384, Saudi Arabia;
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16
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Rechenberg K, Koerner R. Cognitive Behavioral Therapy in Adolescents with Type 1 Diabetes: An Integrative Review. J Pediatr Nurs 2021; 60:190-197. [PMID: 34224937 DOI: 10.1016/j.pedn.2021.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/24/2021] [Indexed: 12/19/2022]
Abstract
PROBLEM Type 1 Diabetes (T1D) is a complex chronic condition that impacts physiologic and psychosocial outcomes in adolescents. Adolescents with T1D experience anxiety and depressive symptoms at 2 to 3 times the rate of the general adolescent population. Anxiety and depressive symptoms negatively impact disease management. Cognitive behavioral therapy (CBT) is considered the gold standard therapeutic technique for treating anxiety and depressive symptoms. The aim of this integrative review was to examine and synthesize the extant literature exploring the effect of CBT on physiologic and psychosocial outcomes in adolescents with T1D. ELIGIBILITY CRITERIA Electronic databases were searched with the terms "type 1 diabetes" and "cognitive behavioral therapy." Studies were included if they were published between 2000 and 2020, evaluated a pediatric population (≤18 years of age), and included individuals with diagnosed T1D. SAMPLE 475 articles were identified in our initial search, and after removal of duplicates 353 articles remained. 339 did not meet inclusion criteria. A total of 14 papers met inclusion criteria. RESULTS All studies included CBT, but differed in delivery methods. Several studies demonstrated evidence of the feasibility and acceptability; however, there were mixed results regarding improvement of physiologic and psychosocial outcomes. CONCLUSIONS CBT is a feasible and acceptable intervention in adolescents with T1D. It may be a method of improving psychologic and psychosocial outcomes for this high-risk population. IMPLICATIONS In adolescents with T1D, screening and treatment for psychosocial comorbidities should occur regularly at endocrinology visits. CBT can be operationalized to fill this gap.
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Affiliation(s)
- Kaitlyn Rechenberg
- University of South Florida College of Nursing, FL, United States of America.
| | - Rebecca Koerner
- University of South Florida College of Nursing, FL, United States of America.
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Bergmame L, Shaw S. Clinical Utility of Psychoeducational Interventions for Youth with Type 1 Diabetes: A Scoping Review. CONTINUITY IN EDUCATION 2021; 2:76-108. [PMID: 38774890 PMCID: PMC11104390 DOI: 10.5334/cie.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/03/2021] [Indexed: 05/24/2024]
Abstract
Adolescence is a challenging time for the medical management of type 1 diabetes. Thus, a range of psychoeducational interventions have been developed to improve diabetes management among youth. Systematic reviews of this literature have emphasized the effectiveness of interventions for improving patient outcomes. However, knowledge beyond what works is required for interventions to be adopted into routine clinical practice. The objective of this scoping review was to map the clinical utility of the literature based on a variety of indicators, including the problem base, context placement, information gain, transparency, pragmatism, and patient-centeredness of the research. This lens for reviewing research is consistent with the biopsychosocial model and an increasing focus on reducing disability, including activity limitation and participation restriction. PsycINFO, MEDLINE, and CINHAL databases were searched for evaluative psychoeducational intervention studies published between January 2005 and October 2020. Two cited reference searches and one reference list search were also performed. Fifty studies describing 46 different interventions were identified. The clinical utility of the interventions was highly variable. A detailed overview of the clinical utility of the literature is provided with an emphasis on current gaps and shortcomings to be addressed in future research. This work helps advance the translation of clinical knowledge into practice in schools, homes, and communities; and, ultimately, improve the health and well-being of adolescents with T1D.
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18
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Younes ZMH, Abuali AM, Tabba S, Farooqi MH, Hassoun AAK. Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates. Pediatr Diabetes 2021; 22:683-691. [PMID: 33745208 DOI: 10.1111/pedi.13204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/11/2021] [Accepted: 03/05/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Diabetes distress and depression have been shown to be prevalent among adolescents with type 1 diabetes and screening for these parameters should be a routine part of diabetes care. To assess the prevalence of diabetes distress and depression and their association with glycemic control in a sample of adolescents with type 1 diabetes attending a diabetes center in Dubai, United Arab Emirates. All adolescents aged 13 to 18 years with type 1 diabetes that were seeking treatment at the Dubai Diabetes Center from the period of September 1, 2018 to May 1, 2019. A total of 72 participants completed the study. RESEARCH DESIGN AND METHODS Adolescents were asked to fill in questionnaires assessing diabetes distress and depression. Multivariate linear regression analysis was used to assess the relationships between the subsets of socio-demographic and clinical characteristics, and the scores of the questionnaires. RESULTS The mean HbA1c of the study sample was 9.61% [82 mmol/mol] with higher levels found in females as compared with males (p<0.05). Females showed significantly greater levels of distress as compared with males. Although adolescents with HbA1c≥7.5% scored higher for diabetes distress and depression, the difference was not statistically significant to those with an HbA1c of <7.5%. Higher levels of diabetes distress were highly correlated with depressive symptoms, with distress and depression both being significant predictors of one another. CONCLUSIONS Our results highlight the importance of implementing and sustaining psycho-educational interventions to aid in alleviating diabetes distress and depression in this subgroup of the population.
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Affiliation(s)
| | - Alaa M Abuali
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
| | - Shadi Tabba
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
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19
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Jurgen B, Baker CN, Kamps JL, Hempe JM, Chalew SA. Associations Between Depressive Symptoms, Fear of Hypoglycemia, Adherence to Management Behaviors and Metabolic Control in Children and Adolescents with Type 1 Diabetes. J Clin Psychol Med Settings 2021; 27:385-395. [PMID: 31728880 DOI: 10.1007/s10880-019-09676-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined the relationship between two malleable risk factors, depressive symptoms and fear of hypoglycemia, in children and adolescents with Type 1 diabetes and their relationship to two important outcomes, adherence behaviors and metabolic control. To assess this relationship, we used a multidimensional measure of adherence, assessing frequency of both blood glucose monitoring and healthy behaviors including diet and exercise. We predicted that higher levels of depressive symptoms and higher levels of fear of hypoglycemia would be associated with worse metabolic control as mediated by poor adherence. Eighty-three children and adolescents ages 8 to 20 (M = 13.87, SD 3.21) were recruited from March 2014 to October 2014 at an outpatient diabetes clinic in a moderately sized Southeastern city within the USA. Nested models were evaluated using structural equation modeling. Adherence significantly mediated the relationship between depressive symptoms and metabolic control with more depressive symptoms leading to worse metabolic control. Adherence marginally mediated the relationship between fear of hypoglycemia and metabolic control; however, less fear of hypoglycemia was associated with worse metabolic control. In a combined model, adherence continued to significantly mediate the relationship between depressive symptoms and metabolic control, while also independently significantly mediating the relationship between fear of hypoglycemia and metabolic control. This finding was also contrary to the predicted relationship with less fear of hypoglycemia leading to worse metabolic control. The results indicate that youth with fewer depressive symptoms and more fear of hypoglycemia had better adherence to their treatment regimen, which was associated with better metabolic control. The results of this study highlight the importance of screening for depression and fear of hypoglycemia during routine clinic visits to optimize adherence and metabolic control.
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Affiliation(s)
- Brittney Jurgen
- Department of Psychology, Tulane University, New Orleans, LA, USA. .,, Boston, USA.
| | - Courtney N Baker
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Jodi L Kamps
- Department of Psychology, Children's Hospital of New Orleans, New Orleans, LA, USA.,Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Research Institute for Children, Children's Hospital, New Orleans, LA, USA
| | - Stuart A Chalew
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, LA, USA
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20
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Cyber School Is a Marker of Youth with High-Risk Diabetes. J Pediatr 2021; 230:167-173. [PMID: 33127366 PMCID: PMC7914142 DOI: 10.1016/j.jpeds.2020.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/13/2020] [Accepted: 10/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the health characteristics of youth with diabetes in cyber school compared with peers with diabetes in traditional brick-and-mortar schools. STUDY DESIGN This was a single-center cross-sectional study of youth with type 1 or type 2 diabetes in K-12 education during academic year 2017-2018. Youth enrolled in cyber school were matched with traditional school peers by age, sex, race, diagnosis, and diabetes duration. Comparisons included insurance status, hemoglobin A1c, treatment, coexisting conditions, screening, and healthcare use. RESULTS Of 1694 participants, 5% (n = 87) were enrolled in cyber school. Youth enrolled in cyber school were predominantly white (89%), female (60%), adolescents (median 15.2 years) with type 1 diabetes (91%). Youth with type 2 diabetes were excluded from analyses owing to the small sample (n = 7). Public insurance was more common among youth enrolled in cyber school (P = .005). Youth in cyber school had higher mean hemoglobin A1c, 9.1 ± 1.8% (76 ± 20 mmol/mol) vs 8.3 ± 1.2% (67 ± 13 mmol/mol) (P = .003), lower insulin pump use (OR, 0.36; 95% CI, 0.18-0.73), and more mental health conditions (OR, 4.48; 95% CI, 1.94-10.35) compared with peers in traditional schools. Youth in cyber school were less likely to have recommended vision (OR, 0.34; 95% CI, 0.15-0.75) and dental (OR, 0.33; 95% CI, 0.15-0.75) evaluations. The relationship between hemoglobin A1c and cyber school persisted after adjusting for insurance status, pump use, and mental health conditions (P = .02). Similar trends were observed for participants with type 2 diabetes. CONCLUSIONS Youth with diabetes in cyber school may be a high-risk population. Understanding the potential impact of cyber school-related factors on health may encourage additional provider/system/school supports for these patients.
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Schmitt A, McSharry J, Speight J, Holmes-Truscott E, Hendrieckx C, Skinner T, Pouwer F, Byrne M. Symptoms of depression and anxiety in adults with type 1 diabetes: Associations with self-care behaviour, glycaemia and incident complications over four years - Results from diabetes MILES-Australia. J Affect Disord 2021; 282:803-811. [PMID: 33601721 DOI: 10.1016/j.jad.2020.12.196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/28/2020] [Accepted: 12/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM). METHODS Data of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES-Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling. RESULTS Forty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (β = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (β = -0.67, P < 0.001), and this predicted microvascular complications (β = -0.38, P = 0.044); however, the indirect association via self-care was not significant (β = 0.25, P = 0.067). LIMITATIONS Participants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible. CONCLUSIONS Depressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.
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Affiliation(s)
- Andreas Schmitt
- Diabetes Center Mergentheim, Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764 Muenchen-Neuherberg, Germany.
| | - Jennifer McSharry
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Melbourne, Victoria, Australia
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark
| | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Adolescents with poorly controlled type 1 diabetes: Psychological flexibility is associated with the glycemic control, quality of life and depressive symptoms. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hamburger ER, Goethals ER, Choudhary A, Jaser SS. Sleep and depressive symptoms in adolescents with type 1 diabetes not meeting glycemic targets. Diabetes Res Clin Pract 2020; 169:108442. [PMID: 32941959 PMCID: PMC7736492 DOI: 10.1016/j.diabres.2020.108442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
AIMS Adolescents with type 1 diabetes (T1D) are at risk for problems with self-management and suboptimal glycemic control, and depressive symptoms and sleep disturbances predict poorer diabetes outcomes. Despite evidence for associations between adolescent depressive symptoms and sleep in the general population, few studies have investigated this link in the vulnerable group of adolescents with T1D not meeting glycemic targets. The current study sought to assess both depressive symptoms and sleep in relation to diabetes indicators in adolescents with T1D. METHODS 120 adolescents (ages 13-17 years) with above target glycemic control completed measures of depressive symptoms, sleep duration and quality, and self-management; parents also reported on adolescents' diabetes management. Clinical data (i.e., HbA1c) were extracted from medical records. RESULTS In our sample, 40% of adolescents reported at least mild depressive symptoms, and 26% reported clinically significant sleep disturbances. Adolescents with sleep disturbances were more likely to report at least mild symptoms of depression, and both depressive symptoms and sleep quality were associated with poorer diabetes management. No significant differences emerged regarding HbA1c or frequency of blood glucose monitoring. CONCLUSIONS The current findings highlight the importance of clinical assessment of both depressive symptoms and sleep in the vulnerable group of adolescents with T1D.
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Affiliation(s)
| | - Eveline R Goethals
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States; KU Leuven, Leuven, Belgium
| | - Arjun Choudhary
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, United States.
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Lanning MS, Tanenbaum ML, Wong JJ, Hood KK. Barriers to Continuous Glucose Monitoring in People With Type 1 Diabetes: Clinician Perspectives. Diabetes Spectr 2020; 33:324-330. [PMID: 33223770 PMCID: PMC7666603 DOI: 10.2337/ds19-0039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to determine clinician attitudes about the distinct barriers to uptake of continuous glucose monitoring (CGM) among people with diabetes. Survey data were collected measuring individual barriers, prerequisites to CGM, confidence in addressing barriers, and clinic staff resources. Results show that clinicians commonly report barriers to using CGM among people with diabetes in their clinic. Furthermore, clinicians who report a high number of barriers do not feel confident in overcoming the barriers to CGM. Interventions that attempt to empower clinicians to address concerns about CGM among people with diabetes may be warranted because low uptake does not appear to be directly related to available resources or prerequisites to starting CGM.
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Affiliation(s)
- Monica S Lanning
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Jessie J Wong
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Petit JM, Goueslard K, Chauvet-Gelinier JC, Bouillet B, Vergès B, Jollant F, Quantin C. Association between hospital admission for ketoacidosis and subsequent suicide attempt in young adults with type 1 diabetes. Diabetologia 2020; 63:1745-1752. [PMID: 32642808 DOI: 10.1007/s00125-020-05206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/14/2020] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the associations between hospitalisation for diabetic ketoacidosis and subsequent hospitalisation for suicide attempt in young adults with type 1 diabetes. METHODS This nationwide historical cohort study included hospital data on all young people hospitalised in France for type 1 diabetes in 2008. Epidemiological follow-up focused on hospitalisations (medical and psychiatric hospital data) from the index hospitalisation to 2017. Survival analyses were done using a Cox proportional hazards regression model to explore the association between hospitalisation for ketoacidosis and subsequent hospitalisation for a suicide attempt. RESULTS In 2008, 16,431 people aged 18-35 years had a hospitalisation mentioning type 1 diabetes. Among them, 1539 (9.4%) had at least one hospitalisation for ketoacidosis between 2008 and 2010. At 9 years, 7.2% of the group hospitalised for ketoacidosis had been hospitalised for a suicide attempt vs only 2.5% in the group not hospitalised for ketoacidosis. The association between hospitalisation for ketoacidosis and suicide attempt decreased over time and was no longer significant after 5 years. CONCLUSIONS/INTERPRETATION We found that young adults admitted to hospital for diabetic ketoacidosis have an increased risk of being admitted to hospital for a subsequent suicide attempt. The risk of a suicide attempt was the highest in the 12 months following the ketoacidosis episode. Our findings support the recommendation that screening for depression and suicide risk should be part of the routine clinical assessment of individuals with type 1 diabetes and ketoacidosis.
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Affiliation(s)
- Jean-Michel Petit
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France.
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France.
| | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | | | - Benjamin Bouillet
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Bruno Vergès
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Fabrice Jollant
- Paris-Descartes University and Sainte-Anne Hospital, Paris, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
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Wolfgram P, Zhang L, Simpson P, Fiallo-Scharer R. Clinical associations of quarterly Patient Health Questionnaire-9 depression screening results in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:871-877. [PMID: 32277561 DOI: 10.1111/pedi.13017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/06/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Awareness of comorbid depression in type 1 diabetes (T1D) patients is necessary to optimize health and diabetes care. Depression can occur or recur requiring regular review for depression symptoms. A validated tool to screen adolescents for symptoms of depression is the Patient Health Questionnaire (PHQ)-9 Modified for Teens (PHQ91-9 ). METHODS PHQ91-9 depression screen results, depression-related ICD-codes, demographic data, and information on complications and comorbidities of adolescents ≥11 years old with T1D were obtained. Longitudinal and single observation multivariable analyses identified associations of covariates with positive PHQ91-9 depression screens. RESULTS 5032 PHQ91-9 surveys were completed by 1225 unique participants. Overall, 6% (286/5032) of the PHQ91-9 depression screens were positive, and 60% (171/286) of the positive screens occurred in 107 unique patients without documented depression. In the longitudinal analysis, positive PHQ91-9 screens were associated (P < .05) with a diagnosis of depression listed in the medical record (OR 9.8), diabetic retinopathy (OR 4.3), female sex (OR 1.9), and use of an insulin pump (OR 0.5), while the single observation analysis at the time of a positive PHQ91-9 indicated presence of depression in the medical record (odds ratio 12.1), female sex (OR 1.9), and obesity (OR 1.8) were significantly (P < .05) associated with positive PHQ91-9 results. CONCLUSION Quarterly PHQ91-9 depression screening of adolescents with T1D during routine clinic visits can immediately inform care, and previous diagnosis of depression is the most strongly associated covariate, highlighting the importance of documenting depression in the medical record. Additionally, awareness for higher odds of positive PHQ91-9 depression screens in females, obese adolescent, and patients on insulin injections is important.
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Affiliation(s)
- Peter Wolfgram
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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KARDAŞ B, KARDAŞ Ö, DÜNDAR M, DEMİRAL M, ÖZBEK MN. Bir Diyabet Kampı: Öncesi ve Sonrası? DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.706124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Papadakis JL, Anderson LM, Garza K, Feldman MA, Shapiro JB, Evans M, Thompson LG, Weissberg-Benchell J. Psychosocial Aspects of Diabetes Technology Use: The Child and Family Perspective. Endocrinol Metab Clin North Am 2020; 49:127-141. [PMID: 31980113 DOI: 10.1016/j.ecl.2019.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article offers a systematic review of the literature on psychosocial aspects of technology use in children and adolescents with type 1 diabetes and their families, searching for relevant articles published the past 5 years. Topics included continuous subcutaneous insulin infusion, continuous glucose monitoring, predictive low-glucose suspend, and artificial pancreas systems. The review indicates there are positive and negative psychosocial aspects to diabetes technology use among youth and their families. Although consistent findings were revealed, contradictions exist. Discussed are recommendations for future research and implications for how health care providers can collaborate with families to discuss and manage diabetes technology.
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Affiliation(s)
- Jaclyn Lennon Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA.
| | - Lindsay M Anderson
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Kimberly Garza
- Department of Anthropology, University of Illinois at Chicago, 1007 West Harrison Street, M/C 027, Chicago, IL 60607, USA
| | - Marissa A Feldman
- Child Development and Rehabilitation Center, Johns Hopkins All Children's Hospital, 880 6th Street South, #170, Saint Petersburg, FL 33701, USA
| | - Jenna B Shapiro
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Street, #7-200, Chicago, IL 60611, USA
| | - Laurie Gayes Thompson
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Street, #7-200, Chicago, IL 60611, USA
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Street, #7-200, Chicago, IL 60611, USA
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Majidi S, O'Donnell HK, Stanek K, Youngkin E, Gomer T, Driscoll KA. Suicide Risk Assessment in Youth and Young Adults With Type 1 Diabetes. Diabetes Care 2020; 43:343-348. [PMID: 31822488 PMCID: PMC6971783 DOI: 10.2337/dc19-0831] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe sociodemographic and clinical characteristics of youth and young adults with type 1 diabetes who endorsed suicidal ideations as part of routine depression screening and the results of their suicide risk assessments. RESEARCH DESIGN AND METHODS The Patient Health Questionnaire-9 was used to assess depressive symptoms and suicide/death ideation in 550 youth and young adults with type 1 diabetes ages 10-24 years. Only individuals who endorsed suicidal/death ideations (n = 49) completed a standardized suicide risk assessment protocol and safety planning. RESULTS Nine percent of individuals endorsed suicidal/death ideation and of those, 83.4% reported clinically elevated depressive symptoms; 16% made a previous suicide attempt. No youth (n = 39) or young adults (n = 11) disclosed current plans or preparations for suicide, but five who expressed suicidal ideation acknowledged the lethality of insulin for an attempt. Three previously used insulin to attempt suicide. The overwhelming majority of individuals were classified as being low risk for future suicide attempt/completion. None were hospitalized as a part of the suicide risk assessment, and no suicide completions have occurred. CONCLUSIONS The findings of this study provide initial insight into the behaviors and cognitions of youth and young adults with type 1 diabetes who experience suicidal and death ideations. Comprehensive suicide risk assessment and safety planning are feasible during routine type 1 diabetes clinic appointments.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Holly K O'Donnell
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kelly Stanek
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Erin Youngkin
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tara Gomer
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kimberly A Driscoll
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO .,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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30
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Corathers SD, DeSalvo DJ. Therapeutic Inertia in Pediatric Diabetes: Challenges to and Strategies for Overcoming Acceptance of the Status Quo. Diabetes Spectr 2020; 33:22-30. [PMID: 32116450 PMCID: PMC7026749 DOI: 10.2337/ds19-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite significant advances in therapies for pediatric type 1 diabetes, achievement of glycemic targets remains elusive, and management remains burdensome for patients and their families. This article identifies common challenges in diabetes management at the patient-provider and health care system levels and proposes practical approaches to overcoming therapeutic inertia to enhance health outcomes for youth with type 1 diabetes.
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Affiliation(s)
- Sarah D. Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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31
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Indelicato L, Calvo V, Dauriz M, Negri A, Negri C, Trombetta M, Bonora E. Depressive symptoms and glycaemic control in adults with type 1 diabetes: an exploratory study on the role of family functioning. Acta Diabetol 2020; 57:23-30. [PMID: 31119455 DOI: 10.1007/s00592-019-01356-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
AIMS Psychological distress and family functioning have a considerable impact on diabetes self-management and glycaemic control in individuals with type 1 diabetes (T1D). However, the influence of both individual and family factors on glycaemic control has not been adequately investigated yet. This study aimed at examining the relationship between perceived family functioning and depressive symptoms with the frequency of capillary self-monitoring of blood glucose (SMBG) and glycaemic control (HbA1c) in a large sample of adults with T1D. METHODS In a cross-sectional study design, we consecutively enrolled 90 adults with T1D diagnosis from at least 1 year and currently living in their family of origin or conjugal family from at least 1 year before the enrolment. Questionnaires were administered to assess family functioning and depressive symptoms. The SMBG frequency over the past 3 months and the most recent HbA1c measurement were also collected in each individual. Correlation and mediation analyses were carried out. RESULTS Glycaemic control showed a positive relationship with depressive symptoms and family balanced cohesion, while SMBG frequency was correlated with family balanced flexibility and rigidity, but not with depressive symptoms. Mediation analyses showed that family rigidity mediates the effect of depressive symptoms on glycaemic control. CONCLUSIONS This exploratory study highlighted the significance of a cohesive family context to facilitate the achievement of individual glycaemic goals in individuals with T1D. These observations, if confirmed in larger data sets, would timely call for a comprehensive family care assessment as part of the evaluations routinely carried out in the ambulatory care of these individuals.
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Affiliation(s)
- Liliana Indelicato
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Vincenzo Calvo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padua, Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Arianna Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Carlo Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
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Liu X, Boogaard L, Erasmus V, Sybrands E, Buijks H, Mackenbach JP, Polinder S. Assessing screening instruments and thresholds to detect risk of depression in diabetes patients, a brief report. Prim Care Diabetes 2019; 13:380-383. [PMID: 30581071 DOI: 10.1016/j.pcd.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022]
Abstract
Over the last decades several self-report instruments have been developed to identify diabetes at risk for depression. In a sample of diabetes outpatients, we assessed the accuracy of three widely-used instruments, and recommend the instruments with the best sensitivity and specificity for identifying diabetes in need of early treatment for depression.
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Affiliation(s)
- Xiaona Liu
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Laura Boogaard
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Sybrands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hanneke Buijks
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Corathers S, Mara CA, Chundi PK, Kichler JC. Depression Screening of Adolescents With Diabetes: 5-Years of Implementation and Outcomes. J Am Acad Child Adolesc Psychiatry 2019; 58:628-632. [PMID: 30802493 DOI: 10.1016/j.jaac.2019.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/15/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
As part of a quality improvement (QI) initiative, Cincinnati Children's Hospital Diabetes Center established a model of reliable, feasible, routine depression screening in a subspecialty clinic for adolescents with diabetes.1 On the occasion of the special section of the journal focusing on screening for, detection of, and treatment of depression in diverse settings, the purpose of this correspondence is to describe the evolution of an in-clinic, pragmatic approach to depression and suicidal ideation (SI) screening, and to evaluate depression screening scores and glycemic control across age groups over time.
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Affiliation(s)
- Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH.
| | - Constance A Mara
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH
| | - Pavan K Chundi
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH
| | - Jessica C Kichler
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH
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Iturralde E, Rausch JR, Weissberg-Benchell J, Hood KK. Diabetes-Related Emotional Distress Over Time. Pediatrics 2019; 143:e20183011. [PMID: 31043453 PMCID: PMC6564058 DOI: 10.1542/peds.2018-3011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many adolescents with type 1 diabetes experience diabetes-related distress (DRD; the negative emotional reactions specific to managing diabetes), but most research on DRD among adolescents relies on cross-sectional data. We assess adolescents' longitudinal DRD patterns and predictors of chronic DRD. METHODS This secondary analysis of data from a depression prevention clinical trial included 264 adolescents with type 1 diabetes randomly assigned to a resilience or education intervention (mean age: 15.7 ± 1.1 years; 59.8% female). Youth reported their DRD at 5 assessments over 16 months. Using latent class growth analysis, we classified adolescents into trajectory groups according to baseline starting point (intercept) and rate of change (slope) of DRD. We examined bivariate associations between trajectory group membership and demographic and clinical factors. Baseline predictors of chronic DRD were assessed via multiple logistic regression. RESULTS Participants were classified into 4 groups: stable high DRD (7.2%; high intercept, flat slope), stable moderate DRD (28.0%; above-average intercept, flat slope), improving DRD (33.7%; average intercept, downward slope), and low DRD (31.1%; below-average intercept, downward slope). Lower hemoglobin A1c, greater adherence, fewer socioemotional difficulties, and more adaptive coping distinguished the improving and low DRD trajectories. Chronic DRD patterns were associated with female sex and higher depressive symptoms and hemoglobin A1c. CONCLUSIONS In this study of adolescents' DRD trajectories during and after a psychoeducational intervention, one-third of youth were classified as having chronic, elevated DRD. Links with multiple clinical factors support efforts for routine DRD screening and comprehensive interventions for distressed youth.
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Affiliation(s)
- Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Joseph R Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus Ohio; and
| | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, California;
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Picozzi A, DeLuca F. Depression and glycemic control in adolescent diabetics: evaluating possible association between depression and hemoglobin A1c. Public Health 2019; 170:32-37. [DOI: 10.1016/j.puhe.2019.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/10/2019] [Accepted: 02/02/2019] [Indexed: 01/09/2023]
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Dempster KW, Liu A, Nansel TR. Depression and parenting in youth with type 1 diabetes: Are general and diabetes-specific parenting behaviors associated with depressive symptoms over a 2-year period? J Behav Med 2019; 42:842-850. [PMID: 30694403 DOI: 10.1007/s10865-019-00011-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 01/12/2019] [Indexed: 12/31/2022]
Abstract
To examine cross-sectional and longitudinal associations of general parenting style and diabetes-specific parenting behaviors with depression in youth with type 1 diabetes. Participants (n = 390) completed self-report measures of depression at baseline and 2-year follow-up, general parenting style at baseline, and diabetes-specific parenting (conflict, task involvement, and collaborative involvement) at baseline and every 6 months. Logistic regression examined associations of parenting with depression at baseline and 2-year follow-up. A less authoritative parenting style, lower parent collaborative involvement, and greater diabetes-related conflict were associated with baseline depression in the model simultaneously including all parenting variables and covariates. Lower parent collaborative involvement and higher diabetes-related conflict were associated with depression at 2-year follow-up, adjusting for baseline depression and covariates. Parent task involvement was not associated with depression at either time. Findings suggest a protective role of parenting in reducing the risk of depression in youth with type 1 diabetes.
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Affiliation(s)
- Katherine W Dempster
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Aiyi Liu
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Tonja R Nansel
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
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Baucom KJW, Turner SL, Tracy EL, Berg CA, Wiebe DJ. Depressive symptoms and diabetes management from late adolescence to emerging adulthood. Health Psychol 2018; 37:716-724. [PMID: 30024228 DOI: 10.1037/hea0000645] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine changes in depressive symptoms as well as between- and within-person associations between depressive symptoms and Type 1 diabetes (T1D) management across the transition from late adolescence to emerging adulthood. METHOD Beginning in the senior year of high school, 197 late adolescents with T1D (Mage = 17.77) reported on their student status and living situation, and completed self-report measures of depressive symptoms and adherence to the diabetes regimen, annually at 3 time points. Glycemic control was gathered from hemoglobin A1c (HbA1c) assay kits at the same time points. RESULTS Results of multilevel models demonstrated high depressive symptoms at baseline, with significant increases in depressive symptoms across time when participants were not living in their parental home, but no change when living with parents. Participants with higher mean levels of depressive symptoms relative to peers (between-person association) had poorer adherence and glycemic control (i.e., higher HbA1c) on average. Within-person fluctuations in depressive symptoms were significantly associated with adherence: greater increases in depressive symptoms (relative to adolescents' own average) were associated with greater deteriorations in adherence. There was not a significant within-person effect of depressive symptoms on glycemic control. CONCLUSIONS The transition from late adolescence to emerging adulthood is particularly challenging for those with T1D. The findings that individuals with greater depressive symptoms have poorer adherence and glycemic control relative to those with lower depressive symptoms, and that increases in depressive symptoms are associated with declines in adherence, highlight the importance of screening and monitoring depressive symptoms during this life transition. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Deborah J Wiebe
- Psychological Sciences and the Health Sciences Research Institute, University of California, Merced
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Calkins-Smith AK, Marker AM, Clements MA, Patton SR. Hope and mealtime insulin boluses are associated with depressive symptoms and glycemic control in youth with type 1 diabetes mellitus. Pediatr Diabetes 2018; 19:1309-1314. [PMID: 29797445 PMCID: PMC6175638 DOI: 10.1111/pedi.12695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/20/2018] [Accepted: 05/16/2018] [Indexed: 11/26/2022] Open
Abstract
Adherence to treatment regimen is associated with improved glycemic control and is particularly problematic during adolescence for those with type 1 diabetes mellitus (T1DM). Both glycemic control and adherence may be negatively impacted by poor psychological outcomes in adolescence, such as depressive symptoms and low hopefulness. The purpose of this study was to examine associations between the mealtime insulin bolus score (BOLUS), a more robust proxy measure of adherence than frequency of blood glucose monitoring or self-report, with depressive symptoms, hope, and hemoglobin A1c (HbA1c). Ninety adolescents completed measures of hope (Children's Hope Scale) and depressive symptoms (Center for Epidemiologic Studies-Depression Scale), as well as lab-based measures of HbA1c and mealtime insulin bolus scores (BOLUS). Higher levels of hope were associated with lower levels of depressive symptoms, more frequent mealtime insulin boluses, and better glycemic control. Higher levels of BOLUS behavior were associated with lower depressive symptoms and better glycemic control. Both BOLUS behavior and hope independently and significantly impacted the relationship between depressive symptoms and HbA1c, suggesting a possible mediation. Since hope and BOLUS were each associated with the relationship between depressive symptoms and glycemic control, following confirmation of this relationship in a longitudinal study, clinics may consider measuring hope and BOLUS among youth with high depressive symptoms and further investigating BOLUS behavior and hope as potential intervention targets to improve glycemic control.
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Affiliation(s)
| | - Arwen M. Marker
- Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045
| | - Mark A. Clements
- Pediatric Clinical Research Unit, Children’s Mercy Hospital, 2401 Gillham Rd., Kansas City, MO 64108
| | - Susana R. Patton
- Division of Child Behavioral Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 4004, Kansas City, KS 66160
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Bratina N, Forsander G, Annan F, Wysocki T, Pierce J, Calliari LE, Pacaud D, Adolfsson P, Dovč K, Middlehurst A, Goss P, Goss J, Janson S, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school. Pediatr Diabetes 2018; 19 Suppl 27:287-301. [PMID: 30084519 DOI: 10.1111/pedi.12743] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/27/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Natasa Bratina
- Department of Endocrinology, Diabetes & Metabolism, University Children's Hospital, Ljubljana, Slovenia
| | - Gun Forsander
- The Queen Silvia Children's Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children Health System, Orlando, Florida
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children Health System, Orlando, Florida
| | - Luis E Calliari
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Brazil
| | - Danièle Pacaud
- Division of Diabetes and Endocrinology, Alberta Children's Hospital, Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Klemen Dovč
- Department of Endocrinology, Diabetes & Metabolism, University Children's Hospital, Ljubljana, Slovenia
| | - Angie Middlehurst
- International Diabetes Federation Life for a Child Program, Sydney, Australia
| | - Peter Goss
- Team Diabetes, Geelong, Victoria, Australia
| | | | - Staffan Janson
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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40
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Edraki M, Rambod M, Molazem Z. The Effect of Coping Skills Training on Depression, Anxiety, Stress, and Self-Efficacy in Adolescents with Diabetes: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2018; 6:324-333. [PMID: 30465005 PMCID: PMC6226609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diabetes patients are at risk of psychosocial problems. Some interventions might decrease these problems. This study aimed to evaluate the effect of coping skills training on depression, anxiety, stress, and self-efficacy of adolescents with type I diabetes. METHODS This randomized controlled trial with pre- and post-test design was performed in the diabetes clinic in Shiraz from June to November 2015. This study was conducted on 100 adolescents with type 1 diabetes who were randomly divided into an intervention (receiving coping skills training in groups for eight sessions) and a control group (usual care). Depression, Anxiety, and Stress Scales (42-items, scores=0-42) and General Self-Efficacy questionnaire (17-items, scores=17-85) were used. The variables were measured at baseline and two months after starting the intervention. Data were analyzed using SPSS, version 16 through Chi-square test, independent t-test, and paired t-test. P<0.05 was significant. RESULTS After the intervention, the mean scores of depression, anxiety and stress in the intervention group were 5.41±4.58, 6.44±7.01, and 7.46±7.01, and in the control groups they were 19.73±11.80, 18.28±10.51, 21.10±10.94, respectively. Moreover, after the intervention, the mean scores of self-efficacy were 70.82±10.84, and 50.13±15.42 in the intervention and control groups, respectively. The results showed differences between the two groups regarding depression, anxiety, stress, and self-efficacy after starting the intervention (P<0.001). CONCLUSION As coping skills training reduced depression, anxiety, and stress and improved the patients' self-efficacy, the use of this intervention could be a part of community-based nursing practice for adolescents with diabetes and more research for improving evidence-based practice in this regard are warranted. - Trial Registration Number: IRCT201505011369N4.
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Affiliation(s)
- Mitra Edraki
- Community Based Psychiatric Care Research Center, Department of Pediatrics, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Molazem
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Bjornstad P, Donaghue KC, Maahs DM. Macrovascular disease and risk factors in youth with type 1 diabetes: time to be more attentive to treatment? Lancet Diabetes Endocrinol 2018; 6:809-820. [PMID: 29475800 PMCID: PMC6102087 DOI: 10.1016/s2213-8587(18)30035-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 02/08/2023]
Abstract
Cardiovascular disease remains the leading cause of mortality in patients with type 1 diabetes. Although cardiovascular disease complications are rare until adulthood, pathology and early markers can manifest in adolescence. Whereas advances have been made in the management of microvascular complications of type 1 diabetes, similar progress in reducing macrovascular complications has not been made. The reasons for the absence of progress remain incompletely understood, but most likely relate to the long time needed for cardiovascular disease to manifest clinically and hence for risk factor management to show a clinical benefit, thus allowing inertia to prevail for diagnosis and particularly for targeting risk factors. In this Review, we summarise paediatric data on traditional and novel risk factors of cardiovascular disease, provide an overview of data from previous and current clinical trials, discuss future directions in cardiovascular disease research for paediatric patients with type 1 diabetes, and advocate for the early identification and treatment of cardiovascular disease risk factors as recommended in multiple guidelines.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO, USA.
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, NSW, Australia
| | - David M Maahs
- Department of Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA, USA
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Agarwal S, Khokhar A, Castells S, Marwa A, Hagerty D, Dunkley L, Cooper J, Chin V, Umpaichitra V, Perez-Colon S. Role of Social Factors in Glycemic Control Among African American Children and Adolescents with Type 1 Diabetes. J Natl Med Assoc 2018; 111:37-45. [PMID: 30129485 DOI: 10.1016/j.jnma.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/02/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE With the rising incidence of Type 1 diabetes (T1DM), it is important to recognize deficiencies in care and areas of improvement to provide better access to resources and education for T1DM patients. The objective of this study was to recognize social factors and compliance barriers affecting glycated hemoglobin (A1c) level in T1D patients among the minority population. METHODS A total of 84 T1DM patients, ages 3 to 21 years, 49% males, 87% African American participated in the study. Study questionnaires assessing patient knowledge and other variables were distributed and patient charts were reviewed retrospectively to obtain relevant clinical data. T-tests, one-way ANOVA and spearman correlation were used for analysis. RESULTS Mean A1c in our study was 10.5% and mean knowledge score was 10.1 out of 14. There was no significant correlation (r = 0.12, p = 0.26) between A1c and patients' knowledge scores. Patients with more frequent blood sugar (BS) monitoring (3-4 times/day) had 2 points lower A1c (9.6 vs 11.6 %, 95% CI 0.2-3.7, p = 0.03) than those with 2 or less times/day. No significant difference in A1c between 3-4 checks/day vs >4 checks/day BS checks. Most patients reported 'forgetfulness' (19%) followed by 'too time consuming' (17.9%) as barriers to daily BS monitoring. There was no significant difference in A1c between pen or pump users (10.5 vs 10.2 %, p = 0.55). Surprisingly, those with home supervision had higher A1c than those without (10.7 vs 9.6 %, p = 0.04) while there was no significant difference between those with or without nurse supervision at school (10.6 vs 9.8 %, p = 0.33). Those reporting happy mood interestingly had higher A1c than those with sad/depressed mood (10.7 vs 9.4 %, p = 0.04). On multiple linear regression analysis, frequency of BS checks, home supervision and mood were the most significant predictors of A1c and altogether explained 20% of the variability in A1c. CONCLUSION Frequent BS monitoring is associated with lower A1c. Supervision at home and school did not improve A1c, but it was self-reported information. Mood did not affect A1c contrary to that reported in other studies.
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Affiliation(s)
- Swashti Agarwal
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | | | | | - Albara Marwa
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Dawn Hagerty
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | | | - Vivian Chin
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital Center, Brooklyn, NY, USA
| | - Vatcharapan Umpaichitra
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital Center, Brooklyn, NY, USA
| | - Sheila Perez-Colon
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital Center, Brooklyn, NY, USA
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Almeida MC, Claudino DA, Grigolon RB, Fleitlich-Bilyk B, Claudino AM. Psychiatric disorders in adolescents with type 1 diabetes: a case-control study. ACTA ACUST UNITED AC 2018; 40:284-289. [PMID: 29412336 PMCID: PMC6899402 DOI: 10.1590/1516-4446-2017-2259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/03/2017] [Indexed: 01/09/2023]
Abstract
Objectives: To study the prevalence of psychiatric disorders in adolescents with and without type 1 diabetes, the factors associated with its presence, and to test the reliability of a screening tool for use in clinical settings. Methods: Eighty-one adolescents were enrolled in this case-control study, including 36 diabetic participants and 45 controls. Clinical and sociodemographic data were collected and psychiatric symptoms and diagnoses were obtained from adolescents and their parents using a screening tool (Strengths & Difficulties Questionnaire) and a semi-structured interview (Development and Well-Being Assessment). Results: Psychiatric disorders were identified in 22.2% of the sample (30.56% among diabetic adolescents vs. 15.56% of controls: OR = 2.39, 95%CI 0.82-6.99; p = 0.11). Overweight (body mass index percentile ≥ 85) was the only factor associated with psychiatric disorder (OR = 3.07; 95%CI 1.03-9.14; p = 0.04). Compared to the semi-structured interview, the screening instrument showed 80% sensitivity, 96% specificity, 88.9% positive predictive value and 92.3% negative predictive value for the presence of psychiatric diagnoses in adolescents. Conclusion: Psychiatric morbidity was high in this sample of adolescents, especially among those with diabetes. Routine use of the Strengths and Difficulties Questionnaire can help with early detection of psychiatric disorders in this at-risk group.
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Affiliation(s)
- Mireille C Almeida
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Denise A Claudino
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ruth B Grigolon
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Bacy Fleitlich-Bilyk
- Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (IPQ-FMUSP), São Paulo, SP, Brazil
| | - Angélica M Claudino
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Glick BA, Hong KMC, Obrynba K, Kamboj MK, Hoffman RP. Identifying depressive symptoms among diabetes type and the impact on hemoglobin A1c. J Pediatr Endocrinol Metab 2018; 31:39-44. [PMID: 29303779 DOI: 10.1515/jpem-2017-0241] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/10/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study was designed to determine the effects of diabetes type and gender on depression risk determined by a highly sensitive screening questionnaire in adolescents. Glycemic control and counseling affect were also studied. METHODS A retrospective chart review of patients seen between 2013 and 2015 was performed. Five hundred and thirty adolescents with type 1 (T1DM) or 2 (T2DM) diabetes mellitus completed the Patient Health Questionnaire-9 (PHQ-9) to identify depressive symptoms. Hemoglobin A1c (HbA1c) was measured when the PHQ-9 was given, and at 1 year. Patients with increased depression risk were referred for counseling and comparisons were made between those who did and did not attend. RESULTS Females with T2DM, but not males, had increased depression compared to T1DM. Females had increased depression compared to males in T1DM (p = 0.046) and a near significant increase in T2DM (p = 0.069). In T1DM, but not T2DM, HbA1c levels were increased in high and moderate, compared to low, risk depression risk groups (p = 0.007). Follow-up HbA1c was unchanged 1 year later and there were no differences between those involved in counseling and those who refused to attend. Sex and type of diabetes had no effect on response to counseling. CONCLUSIONS These results demonstrate increased depression in adolescents with T2DM compared to T1DM and in females compared to controls. Glycemic control did not change in adolescents who reported moderate to severe symptoms of depression and received counseling intervention compared to adolescents who declined counseling.
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Affiliation(s)
- Bethany A Glick
- Nationwide Children's Hospital, Pediatric Endocrinology, 700 Children's Drive, Columbus, OH, USA
| | - K Ming Chan Hong
- Nationwide Children's Hospital, Pediatric Endocrinology, 700 Children's Drive, Columbus, OH, USA
| | - Kathryn Obrynba
- Nationwide Children's Hospital, Pediatric Endocrinology, 700 Children's Drive, Columbus, OH, USA
| | - Manmohan K Kamboj
- Nationwide Children's Hospital, Pediatric Endocrinology, 700 Children's Drive, Columbus, OH, USA
| | - Robert P Hoffman
- Nationwide Children's Hospital, Pediatric Endocrinology, 700 Children's Drive, Columbus, OH, USA
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Jaser SS, Patel N, Xu M, Tamborlane WV, Grey M. Stress and Coping Predicts Adjustment and Glycemic Control in Adolescents with Type 1 Diabetes. Ann Behav Med 2018; 51:30-38. [PMID: 27496164 DOI: 10.1007/s12160-016-9825-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescents with type 1 diabetes are at increased risk for deteriorating glycemic control, poor quality of life, and depressive symptoms. Stress and coping are related to these outcomes in adolescents with diabetes, yet few studies have examined these constructs longitudinally. PURPOSE This study aimed to describe stress and coping in adolescents with type 1 diabetes and to examine coping strategies as predictors of adolescent adjustment (i.e., depressive symptoms, quality of life) and glycemic control. METHODS Adolescents with type 1 diabetes completed measures of diabetes-related stress, coping, symptoms of depression, and quality of life at baseline, 6 months, and 12 months. Data on glycemic control were collected from the adolescents' medical charts. RESULTS The adolescents' use of primary control coping (e.g., problem solving) and secondary control engagement coping (e.g., positive thinking) strategies predicted significantly fewer problems with quality of life and fewer depressive symptoms over time. In contrast, the use of disengagement coping strategies (e.g., avoidance) predicted more problems with quality of life and depressive symptoms. Coping was not a significant predictor of glycemic control. Coping mediated the effects of diabetes-related stress on depressive symptoms and quality of life. CONCLUSIONS The ways in which adolescents with type 1 diabetes cope with diabetes-related stress predict quality of life and symptoms of depression but not glycemic control. Through the use of screening to identify adolescent's diabetes-related stress and targeted interventions to improve coping strategies, there is potential to improve outcomes.
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Affiliation(s)
- Sarah S Jaser
- Vanderbilt University, DOT 11136, 2200 Children's Way, Nashville, TN, 37232, USA.
| | - Niral Patel
- Vanderbilt University, DOT 11136, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Meng Xu
- Vanderbilt University, DOT 11136, 2200 Children's Way, Nashville, TN, 37232, USA
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Relationship of depression to diabetes, prediabetes and nondiabetics according to HbA1c classification: Retrospective study on 72,175 patients. JOURNAL OF SURGERY AND MEDICINE 2017. [DOI: 10.28982/josam.370527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gourgari E, Dabelea D, Rother K. Modifiable Risk Factors for Cardiovascular Disease in Children with Type 1 Diabetes: Can Early Intervention Prevent Future Cardiovascular Events? Curr Diab Rep 2017; 17:134. [PMID: 29101482 PMCID: PMC5670186 DOI: 10.1007/s11892-017-0968-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Patients with type 1 diabetes have increased risk for cardiovascular disease. The purpose of this review is to examine the following: i) current evidence for subclinical cardiovascular disease (CVD) in children with type 1 diabetes (T1DM) ii) known modifiable risk factors for CVD and their relationship to subclinical CVD in this population iii) studies that have addressed these risk factors in order to improve CVD outcomes in children with T1DM RECENT FINDINGS: Subclinical CVD presents in children as increased carotid intima-media thickness, increased arterial stiffness, and endothelial and myocardial dysfunction. Modifiable risk factors for CVD include hyperglycemia, hyperlipidemia, obesity, hypertension, depression, and autonomic dysfunction. Very few randomized controlled studies have been done in children with T1DM to examine how modification of these risk factors can affect their CVD. Children with T1DM have subclinical CVD and multiple modifiable risk factors for CVD. More research is needed to define how modification of these factors affects the progression of CVD.
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Affiliation(s)
- Evgenia Gourgari
- Department of Pediatrics, Georgetown University, Washington DC, USA
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology & Genetics (PDEGEN) and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO USA
| | - Kristina Rother
- Section on Pediatric Diabetes and Metabolism, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD USA
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Oh H, Ell K, Palinkas LA. Self-care behavior change and depression among low-income predominantly Hispanic patients in safety-net clinics. SOCIAL WORK IN HEALTH CARE 2017. [PMID: 28622094 PMCID: PMC6100781 DOI: 10.1080/00981389.2017.1333972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study examined whether changes in self-care behaviors during a 12-month period predicted the likelihood of screening positive for depression concurrently and prospectively among low-income Hispanic patients with diabetes. Secondary analyses were conducted with longitudinal data collected from a randomized controlled trial that had tested effectiveness of collaborative depression care. We examined whether changes in self-care behaviors observed during the 12 months after baseline predicted the likelihood of screening positive for depression at 12-, 18-, and 24-month follow-up. Self-care behaviors included healthy diet, exercise, self-blood glucose monitoring, and foot care, which were measured by a validated self-reported instrument. Logistic regression analyses indicated that patients with more frequent healthy diet during the 12 months after baseline had significantly lower likelihood of depression. Patients with more frequent exercise had a lower likelihood of screening for depression at 18- and 24-month follow-up. No significant association was found with self-blood glucose monitoring and foot care. These findings suggest the importance of integrated care that emphasizes healthy diet and exercise, together with traditional depression treatment, when helping low-income Hispanic patients with diabetes and comorbid depression.
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Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University
| | - Kathleen Ell
- School of Social Work, University of Southern California
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Khater D, Omar M. Frequency and risk factors of depression in type 1 diabetes in a developing country. J Pediatr Endocrinol Metab 2017; 30:917-922. [PMID: 28771435 DOI: 10.1515/jpem-2016-0414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 07/11/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Living with type 1 diabetes, especially in developing countries, can feel overwhelming for parents and children because constant vigilance is required for proper care with an inadequacy of resources. Our aim was to investigate the frequency and risk factors of depressive symptoms in children and adolescents with type 1 diabetes. METHODS The study was conducted using epidemiologic studies Depression Scale Questionnaire for Children (CES-DC) on 86 patients with type 1 diabetes from the Diabetes Clinic in Alexandria University Children's Hospital, Egypt. Logistic regression models were used to detect the predictors of depression. RESULTS In the current study 45 children (52.3%) had scores ≥15 indicating a depressive state. Children who had depression were found to have a significantly longer duration of diabetes (5.84±2.53 year), a higher mean total daily insulin dose (1.36±0.45 unit/kg), HbA1c level (9.84±1.75) and were less frequently treated with a basal bolus insulin regimen (35.56%); p≤0.001. A multivariate logistic regression model showed that HbA1c is the only significant predictor for depression (p<0.001). HbA1c at a cutoff point of 8.6 could predict depression in type 1 diabetic children with specificity of 71.8%, sensitivity of 78.6%, (area under the curve [AUC]=0.8) and p-value ≤0.001. CONCLUSIONS Children and adolescents with type 1 diabetes have high frequency of depressive symptoms in a developing country. Poor glycemic control is the most significant predictor for depression in these patients.
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50
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Ehrmann D, Schmitt A, Reimer A, Haak T, Kulzer B, Hermanns N. The affective and somatic side of depression: subtypes of depressive symptoms show diametrically opposed associations with glycemic control in people with type 1 diabetes. Acta Diabetol 2017; 54:749-756. [PMID: 28555338 DOI: 10.1007/s00592-017-1006-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/19/2017] [Indexed: 01/26/2023]
Abstract
AIMS While depression has been linked to serious adverse outcomes in diabetes, associations with glycemic control are not conclusive. Inconsistencies could be due to the complex symptomatology of depression. Aim of this study was to analyze the associations of depressive subtypes with glycemic control in people with type 1 and type 2 diabetes. METHODS Patients completed the Center for Epidemiological Studies-Depression scale which comprises affective, somatic, and anhedonic symptoms. These subtypes were analyzed in a joint linear regression analysis with glycemic control as a dependent variable. Subtype scores were calculated as mean item scores. Separate analyses for people with type 1 and type 2 diabetes were conducted. All analyses were controlled for demographic and medical confounders. RESULTS The sample comprised 604 patients with type 1 and 382 patients with type 2 diabetes. In people with type 1 diabetes, the somatic and affective subtype showed diametrically opposed associations with glycemic control (somatic: β =+0.23, p < .05; affective: β = -0.23, p < .05). Anhedonia was not significantly associated with glycemic control. In people with type 2 diabetes, none of the depressive subtypes was significantly associated with glycemic control. CONCLUSIONS For people with type 1 diabetes, the distinction of subtypes offered a detailed picture of the associations of depressive symptoms with glycemic control. However, due to the cross-sectional design, inferences about the direction of these associations cannot be made. In clinical practice, instead of focusing on overall depression, healthcare providers should examine the nature of depressive symptoms and how they might be related to having diabetes.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany.
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
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