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Jalilova A, Pilan BŞ, Demir G, Özbaran B, Balkı HG, Arslan E, Köse SG, Özen S, Darcan Ş, Gökşen D. The psychosocial outcomes of advanced hybrid closed-loop system in children and adolescents with type 1 diabetes. Eur J Pediatr 2024; 183:3095-3103. [PMID: 38661816 PMCID: PMC11192657 DOI: 10.1007/s00431-024-05551-1] [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: 02/06/2024] [Revised: 03/14/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
The study was carried out to determine the psychosocial outcomes of advanced hybrid closed-loop (AHCL) systems in children and adolescents with type 1 diabetes (T1D). Single-center and cohort study with a duration 6 months consisted of 60 children and adolescents with T1D. Standard clinical procedures, including both glycemic indicators, e.g., sensor-measured time within the 70-180 mg/dL range and glycated hemoglobin (HbA1c) levels, and psychosocial metrics were used for data collection. The psychosocial metrics included the Pediatric Quality of Life Inventory (PedsQL) 3.0 Diabetes Module for both children (8-12 years) and parents; the Quality of Life for Youth scale for adolescents (13-18 years); the Strengths and Difficulties Questionnaire (SDQ); the Hypoglycemia Fear Survey for Children (HFS-C); the Revised Child Anxiety and Depression Scale (R-CADS); and AHCLS-specific DTSEQ satisfaction and expectation survey. These metrics were evaluated at the baseline and after 6 months of AHCL use. Of the 60 children and adolescents with T1D for whom the AHCL system was utilized, 41 of them, 23 female and 18 male, completed the surveys. The mean age of the 41 children and adolescents was 12.5 ± 3.2 (min. 6.7, max. 18) years. The time spent within the target glycemic range, i.e., time-in-range (TIR), improved from 76.9 ± 9% at the baseline to 80.4 ± 5% after 6 months of AHCL system use (p = 0.03). Additionally, HbA1c levels reduced from 7.1% ± 0.7% at the baseline to 6.8% ± 0.8% after 6 months of AHCL system use (p = 0.03). The most notable decline in HbA1c was observed in participants with higher baseline HbA1c levels. All patients' HFS-C and AHCL system-specific DTSEQ satisfaction and expectation survey scores were within the normal range at the baseline and remained unchanged during the follow-up period. No significant difference was found in the R-CADS scores of children and adolescents between baseline and after 6 months of AHCL system use. However, there was a significant decrease in the R-CADS scores of the parents. Patients' PedsQL scores were high both at the baseline and after 6 months. The SDQ scores were high at baseline, and there was no significant improvement at the end of 6 months. Conclusion: This is the first study to investigate in detail the psychosocial outcomes of AHCL system use in T1D patients and their parents. Although state-of-the-art technologies such as AHCL provide patients with more flexibility in their daily lives and information about glucose fluctuations, the AHCL resulted in a TIR above the recommended target range without a change in QOL, HFS-C, SDQ, and R-CADS scores. The scores obtained from the R-CADS conducted by the parents of the children indicated that the use of pumps caused a psychological improvement in the long term, with a significant decrease in the R-CADS scores of the children and adolescents with T1D. What is Known: • Previous studies focused on clinical outcomes of AHCL systems in pediatric T1D patients, showing glycemic control improvements. • Limited attention given to psychosocial outcomes of AHCL systems in children and adolescents with T1D. • Crucial psychosocial factors like quality of life, emotional well-being, and fear of hypoglycemia underexplored in AHCL system context. What is New: • First study to comprehensively examine psychosocial outcomes of AHCL systems in pediatric T1D patients. • Study's robust methodology sets new standard for diabetes technology research and its impact on qualiy of life.
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Affiliation(s)
- Arzu Jalilova
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Birsen Şentürk Pilan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Günay Demir
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burcu Özbaran
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hanife Gul Balkı
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Emrullah Arslan
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sezen Gökcen Köse
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Samim Özen
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Şükran Darcan
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Damla Gökşen
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
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Yuksel E, Bulbul L, Yilmaz S, Hatipoglu S, Cakir EDP. Evaluation of Quality of Life and Psychosocial Problems in Children with Type 1 Diabetes Mellitus. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:146-154. [PMID: 39021699 PMCID: PMC11249999 DOI: 10.14744/semb.2024.21456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/11/2024] [Indexed: 07/20/2024]
Abstract
Objectives To evaluate the frequency of psychosocial problems and the factors affecting the quality of life in children and adolescents aged between 8 and 18 years with type 1 diabetes mellitus (T1DM). Methods In the study, children and adolescents aged between 8 and 18 years who had been followed for at least 6 months for T1DM were evaluated (T1DM group), and compared with healthy children and adolescents who applied to the general pediatric outpatient clinic and did not have any chronic disease (control group). Data on disease follow-up of children and adolescents with T1DM were obtained from medical records. Sociodemographic characteristics of both groups were recorded in the study form. In addition, the Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED) and Children Quality of Life Questionnaire (KINDL: KINDerLebensqualitätsfragebogen) were applied to both groups. The scale scores of the T1DM group and the control group were compared. Factors affecting the scale scores of the T1DM group were evaluated. Results A total of 181 children or adolescents, 81 of whom were in the T1DM group and 100 in the control group, were evaluated for this study. The mean age was 13.1±2.4 years in the T1DM group and 12.4±2.1 years in the control group. The mean CDI, SCARED, and KINDL scores, respectively; it was 15.3±7.2, 23.6±11.9, and 53.5±13.7 in the T1DM group and 7.9±6.8, 14.7±13, 60±11.6 in the control group. There was a statistically significant difference between the two groups in terms of mean CDI, SCARED, and KINDL scores (all p values <0.001). As compliance with the diabetic diet decreased at home, there was a significant increase in the mean CDI score (p=0.005) and a significant decrease in the KINDL score (p=0.002). It was observed that KINDL score decreased significantly as compliance with the diabetic diet decreased outside the home (p=0.001). Conclusion Quality of life is lower, and levels of depression and anxiety are higher in children with T1DM compared to healthy children. Psychosocial support should be provided from the moment of diagnosis in order to improve the psychosocial problems and quality of life of children with T1DM.
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Affiliation(s)
- Elida Yuksel
- Department of Pediatrics, Acibadem Atakent Hospital, Istanbul, Türkiye
| | - Lida Bulbul
- Department of Pediatric Allergy and Immunology, University of Health Science Türkiye, Bagcilar Training and Research Hospital, Istanbul, Türkiye
| | - Semra Yilmaz
- Department of Pediatric Psychiatry, Memorial Bahcelievler Hospital, Istanbul, Türkiye
| | - Sami Hatipoglu
- Department of Pediatrics, University of Health Science Türkiye, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Esra Deniz Papatya Cakir
- Department of Pediatric Endocrinology, University of Health Science Türkiye, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
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Schmid C, Reinisch E, Klier C, Eisenwort B. Assessment of first language adds important information to the diagnosis of language disorders in multilingual children. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:82-91. [PMID: 37285014 PMCID: PMC11142998 DOI: 10.1007/s40211-023-00469-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE 59% of Viennese day care children have a first language other than German. Lower proficiency in the second language German might be typical in multilingual settings, but might also be due to language disorder (ICD-10:F80 or comorbid). Diagnostic practise in Austria focuses on second language evaluation. This study describes a group of multilingual children with suspected language impairment at a specialized counselling hour and reflects the role of the first language in language evaluation. METHOD Linguistic evaluation (typically developed, ICD-10:F80, comorbid language disorder) and sociodemographic parameters of 270 children (time period: 2013-2020) are investigated. Linguistic results are reported according to primary diseases. For children without primary disease the relation between the linguistic evaluation and sociodemographic parameters is assessed. RESULTS Overall, the children had 37 different first languages (74% were bilingual, 26% multilingual). The percentage of children with typical development and comorbid language development varied according to primary disease. Children without primary disease had higher chances of typical development the older they were at the examination, the earlier they produced first words, and if there was no heredity for ICD-10:F80. CONCLUSIONS Results suggest that evaluating the children's first language is useful since it contributes to understanding the individual language development at different linguistic levels, despite the heterogeneity of the children, and, thus, allows practitioners to recommend the best possible support.
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Affiliation(s)
- Carolin Schmid
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Eva Reinisch
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
- Acoustics Research Institute, Austrian Academy of Sciences, Wohllebengasse 12-14, 1040, Vienna, Austria
| | - Claudia Klier
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Brigitte Eisenwort
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria.
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Seiffge-Krenke I, Volz M. Effectiveness of psychodynamic treatment: Comparing trajectories of internalizing and externalizing psychopathology of adolescents in treatment, healthy and physically ill adolescents. Dev Psychopathol 2024; 36:478-493. [PMID: 36744527 DOI: 10.1017/s0954579422001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effectiveness of psychodynamic therapy for adolescents in reducing internalizing and externalizing psychopathology was determined by comparing treated adolescents (86 sessions) with the normative developmental progression in two groups without treatment: healthy and diabetic adolescents. In a three-wave longitudinal study, n = 531 adolescents (n = 303 patients, n = 119 healthy, n = 109 diabetics) and their mothers filled out psychopathology questionnaires (Youth Self-Report and Child Behavior Checklist). Latent growth curve modeling and multilevel modeling were used to analyze and compare within-person symptoms changes across groups. Analyses showed a significant reduction over the course of treatment for internalizing (Cohen's d = .90-.92) and externalizing (d = .58-.72) symptoms, also when the developmental progression of both control groups was accounted for (d = .48-.76). Mothers reported lower levels than their children in internalizing symptoms (p ≤ .01) while this discrepancy increased over time for treated adolescents (p = .02). Results established the effectiveness of psychodynamic treatment for adolescents both with externalizing and internalizing symptoms in comparison with growth and change in nonclinical samples. Cross-informant differences and age-specific trajectories require attention in psychotherapy treatment and research.
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Affiliation(s)
| | - Matthias Volz
- Department of Psychology, University of Kassel, Kassel, Germany
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Park JW, Wilson-Barthes MG, Dulin AJ, Hogan JW, Mugavero MJ, Napravnik S, Carey MP, Fava JL, Dale SK, Earnshaw VA, Johnson B, Dougherty-Sheff S, Agil D, Howe CJ. Multilevel Resilience and HIV Virologic Suppression Among African American/Black Adults in the Southeastern United States. J Racial Ethn Health Disparities 2024; 11:313-325. [PMID: 37043167 PMCID: PMC10092932 DOI: 10.1007/s40615-023-01520-w] [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: 08/24/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To assess overall and by neighborhood risk environments whether multilevel resilience resources were associated with HIV virologic suppression among African American/Black adults in the Southeastern United States. SETTING AND METHODS This clinical cohort sub-study included 436 African American/Black participants enrolled in two parent HIV clinical cohorts. Resilience was assessed using the Multilevel Resilience Resource Measure (MRM) for African American/Black adults living with HIV, where endorsement of a MRM statement indicated agreement that a resilience resource helped a participant continue HIV care despite challenges or was present in a participant's neighborhood. Modified Poisson regression models estimated adjusted prevalence ratios (aPRs) for virologic suppression as a function of categorical MRM scores, controlling for demographic, clinical, and behavioral characteristics at or prior to sub-study enrollment. We assessed for effect measure modification (EMM) by neighborhood risk environments. RESULTS Compared to participants with lesser endorsement of multilevel resilience resources, aPRs for virologic suppression among those with greater or moderate endorsement were 1.03 (95% confidence interval: 0.96-1.11) and 1.03 (0.96-1.11), respectively. Regarding multilevel resilience resource endorsement, there was no strong evidence for EMM by levels of neighborhood risk environments. CONCLUSIONS Modest positive associations between higher multilevel resilience resource endorsement and virologic suppression were at times most compatible with the data. However, null findings were also compatible. There was no strong evidence for EMM concerning multilevel resilience resource endorsement, which could have been due to random error. Prospective studies assessing EMM by levels of the neighborhood risk environment with larger sample sizes are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
- Program in Epidemiology, University of Delaware, Newark, DE, USA
| | - Marta G Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
| | - Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joseph W Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA.
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Yu L, Guo S, Ji W, Sun H, Lee S, Zhang D. Intervention Effects of Physical Activity on Type 2 Diabetic Patients Potentially Infected with COVID-19. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1772. [PMID: 37893490 PMCID: PMC10608032 DOI: 10.3390/medicina59101772] [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: 09/10/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has clearly had a great influence on the lifestyles of the population, especially on patients with type 2 diabetes mellitus. During the COVID-19 outbreak, many countries/regions implemented social-isolation measures, leading to an increase in negative behaviors and impairing the capability of diabetic patients to resist COVID-19, ultimately causing severe prognoses. Moreover, as the epidemic progressed, multiple studies emphasized the significance of physical exercise in the management of type 2 diabetic patients infected with COVID-19. In this study, we selected research from 1 December 2019 to 9 August 2023 that focused on COVID-19-infected diabetic patients to investigate the impact of type 2 diabetes on the immune functions, inflammation factor levels, lung injuries, and mental disorders of such patients, as well as to assess the risk of novel coronavirus pneumonia in these patients. Additionally, the effects of high-intensity, moderate-intensity, and low-intensity exercises on novel coronavirus pneumonia infection in type 2 diabetic patients and the mechanisms of the effects of such exercise were considered. We concluded that elderly diabetic patients with COVID-19 should perform low-intensity exercises to facilitate their recoveries. This study offers guidance for a proper understanding of the dangers of diabetes and the use of appropriate measures to reduce the risk of novel coronavirus pneumonia infections in type 2 diabetic patients.
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Affiliation(s)
- Lihua Yu
- College of Arts and Sports, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; (L.Y.)
- Institute of Public Foundations, University of Health and Rehabilitation Sciences, Qingdao 266000, China
| | - Sainyu Guo
- College of Arts and Sports, Myongji University, Seoul 04763, Republic of Korea
| | - Wen Ji
- College of Arts and Sports, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; (L.Y.)
| | - Hailian Sun
- College of Arts and Sports, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; (L.Y.)
| | - Seongno Lee
- College of Arts and Sports, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; (L.Y.)
| | - Deju Zhang
- Food and Nutritional Sciences, School of Biological Sciences, The University of Hong Kong, Pokfulam Road, 0000, Hong Kong
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Aljohani AA, Almoghamsi EY, Alzaman N, Alharbi MB, Bin Faidh AJ. Diabetes Distress Among Adults With Type 1 Diabetes Mellitus in Saudi Arabia. Cureus 2023; 15:e37525. [PMID: 37193469 PMCID: PMC10182781 DOI: 10.7759/cureus.37525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
Background Psychological morbidity is clinically important for diabetes patients because it is often associated with worse glycemic outcomes. This study aimed to assess the prevalence of diabetes distress among adult type 1 diabetes mellitus (DM) patients in the Kingdom of Saudi Arabia (KSA). Methodology A descriptive, cross-sectional study was conducted among type 1 DM patients in KSA from 2021 to 2022. An online validated questionnaire was adopted to collect data, including demographic information, medical and social information, and Saudi Arabian Diabetes Distress Scale-17 (SADDS-17) score to assess diabetes distress. Results This study included 356 type 1 DM patients. Most patients were females (74%), with ages ranging between 14 and 62 years. More than half (53%) had a high level of diabetes distress with a mean score of 3.1 ± 1.23. Among those patients, the highest score (up to 60%) was related to regimen-related distress, the lowest score (around 42%) was related to diabetes-related interpersonal distress, and physician-related distress and emotional burden were reported among 55% and 51%, respectively. More than half (56%) of the patients treated with an insulin pen compared to 43% treated with an insulin pump had high diabetes distress (p = 0.049). The level of HbA1c was significantly higher among patients with high diabetic distress (7.93 ± 1.72 vs. 7.55 ± 1.65; p = 0.038). Conclusions Diabetes distress is prevalent among adult type 1 DM patients in KSA. Therefore, we recommend organizing a screening program for early discovery and prompt psychiatric management, incorporating diabetes education and nutrition consultation to improve their quality of life, and engaging patients in their own management to improve their glycemic control.
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Affiliation(s)
- Alaa A Aljohani
- Department of Family Medicine, Ministry of Health Holdings, Madinah, SAU
| | | | - Naweed Alzaman
- Department of Internal Medicine, College of Medicine Taibah University, Madinah, SAU
| | - Mansour B Alharbi
- Department of Family Medicine, Ministry of Health Holdings, Madinah, SAU
| | - Amjad J Bin Faidh
- Department of Psychiatry, Prince Mohammad Bin Abdulaziz Hospital, Madinah, SAU
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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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Skowroński B, Talik E. Psychophysical quality of life and its determinants in prisoners: the role of selected psychosocial factors. Int J Prison Health 2022; 19:376-391. [PMID: 36156461 DOI: 10.1108/ijph-10-2021-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Penal institutions affect their inmates' mental as well as physical health. Prisoners have higher rates of physical health conditions than the public. While it is known that psychosocial factors determine patients' quality of life, little research has focused on factors related to prisoners' psychophysical quality of life (PQoL). The purpose of this study is to analyze the determinants of prisoners' PQoL. DESIGN/METHODOLOGY/APPROACH The sample consisted of 390 prisoners recruited from correctional facilities administered by the Warsaw District Inspectorate of Prisons. This study hypothesized that social support, coherence and self-efficacy would be positive determinants of PQoL and that depression, anxiety and anger would be its negative determinants. The collected data were analyzed by means of structural equation modeling. FINDINGS The positive determinants of PQoL in prisoners are coherence, self-efficacy and social support. The negative determinant of PQoL is trait depression. ORIGINALITY/VALUE This study has revealed a list of factors significant for improving prisoners' PQoL. Factors have also indicated which of the predictors measured are the most significant. The identified set of significant factors should be taken into account in social rehabilitation programs for prisoners as contributing to the preservation of life and health.
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Affiliation(s)
- Bartłomiej Skowroński
- Department of Applied Social Sciences and Resocialization, University of Warsaw, Warsaw, Poland
| | - Elżbieta Talik
- Faculty of Social Sciences, John Paul II Catholic University of Lublin, Lublin, Poland
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Full-Time or Working Caregiver? A Health Economics Perspective on the Supply of Care for Type 1 Diabetes Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031629. [PMID: 35162654 PMCID: PMC8835134 DOI: 10.3390/ijerph19031629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is a chronic disease requiring lifelong insulin treatment. T1DM patients require care given not only by themselves but also by their family members, particularly in childhood-onset cases. This study aims to identify the relationship between health expenditure, HbA1c and other health outcomes and the socio-economic status of patients and their families, with a focus on family employment status, i.e., whether the caregiver is employed or is a homemaker. To clarify the relationship between the level of health, such as expenditure on health care and HbA1c, and the socioeconomic status of patients and their families, we focus on whether they are “potential full-time caregivers”. Using this analysis, we estimated the hypothetical health care expenditure and HbA1c and showed that male patients have higher expenditure and lower HbA1c when their caregiver is a potential full-time caregiver, whereas younger female patients have higher health care expenditure and lower HbA1c when their caregiver is employed. This finding is not meant to serve as criticism of health care policy in this area; rather, the aim is to contribute to economic policy in Japan for T1DM patients 20 years and older.
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Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312529. [PMID: 34886259 PMCID: PMC8657055 DOI: 10.3390/ijerph182312529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
People with type 1 diabetes (T1D) are more likely to have depression than the general population and their prognosis is worse. Unfortunately, the characteristics of persons with T1D lead to inadequate screening for depression in this population. To aid in the detection of depression in this population, this study was undertaken to develop a depressive symptoms assessment instrument specific to patients with T1D and to examine its psychometric properties. A total of 207 people with T1D participated in this study. The reliability of the new scale was assessed using Cronbach’s alpha and the Spearman-Brown split-half coefficient. The Depression Inventory for type 1 Diabetes (DID-1), composed of 45 items on a Likert scale (1–7), shows high internal and temporal consistency, as well as adequate concurrent, convergent and discriminant validity. Factor analysis identified 7 factors (Symptoms of depression, Diminished interest, Hopelessness and dissatisfaction, Guilt, Fear, frustration and irritability, Defenselessness, and Interference in daily life) that explained 61.612% of the total variability. The cut-off score for diagnosis was set at 155 points. It was concluded that the DID-1 scale is a reliable, valid and useful tool for the assessment of depressive symptoms, eliminating the bias of other nonspecific diabetes scales.
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Missambou Mandilou SV, Atipo-Ibara Ollandzobo LC, Kitemo Mpolo FLG, Ngoulou BPS, Elenga Bongo CL, Bouénizabila E, Mabiala Babela JR. Psychosocial functioning and health related quality of life in children, adolescents and young adults with type 1 diabetes mellitus in Congo. Pediatr Diabetes 2021; 22:675-682. [PMID: 33528086 DOI: 10.1111/pedi.13187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To describe the psychosocial functioning and assess the quality of life of children, adolescents and young adults with T1DM; and to identify the risk factors associated with the psychosocial experience and quality of life of these patients. MATERIAL AND METHODS A cross-sectional, descriptive study of children, adolescents and young adults with type 1 diabetes. Symptoms of anxiety and depression, and the quality of life were assessed using the Beck's Anxiety and Depression Scales and the pedsQL diabetes module score respectively. RESULTS A total of 74 patients were recruited. The mean age was 18 ± 4.1 years. Minimal symptoms of anxiety were noted in 51 (69%) patients, 23 (31%) had non-minimal symptoms of anxiety (mild:14, moderate: 5, severe: 4). Symptoms of depression were absent in 43 (58.1%) patients and present in 31 (41.9%) patients (mild: 19, moderate: 12). The patients total score of quality of life was 65.4. Higher socioeconomic status (p = 0.03) was a protective factor against Symptoms of anxiety, while the age above 14 years (p = 0.01) was a risk factor for symptoms of depression. The quality of life was lower in patients from low socio-economic status (p = 0.01), those with poor glycemic control (p = 0.03), and when symptoms of depression were present (p = 0.02). CONCLUSIONS Patients with type 1 diabetes in Congo experienced a significant elevated symptoms of anxiety and depression, and a fairly good quality of life. These findings support recommendations for integrating psychosocial aspects in the management of these patients.
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Affiliation(s)
- Steve Vassili Missambou Mandilou
- Department of Pediatrics, Teaching Hospital of Brazzaville, Brazzaville, Congo.,Institut du Diabète Maison Bleue of Brazzaville, Brazzaville, Congo
| | - Lucie Charlotte Atipo-Ibara Ollandzobo
- Department of Pediatrics, Teaching Hospital of Brazzaville, Brazzaville, Congo.,Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo
| | | | | | - Charley Loumade Elenga Bongo
- Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo.,Department of Metabolic and Endocrine Diseases, General Hospital Adolph Sicé, Pointe-Noire, Congo
| | - Evariste Bouénizabila
- Institut du Diabète Maison Bleue of Brazzaville, Brazzaville, Congo.,Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo.,Department of Metabolic and Endocrine Diseases, Teaching Hospital of Brazzaville, Brazzaville, Congo
| | - Jean Robert Mabiala Babela
- Department of Pediatrics, Teaching Hospital of Brazzaville, Brazzaville, Congo.,Department of Medicine, Health Sciences Faculty, Marien Ngouabi University, Brazzaville, Congo
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13
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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: 0] [Impact Index Per Article: 0] [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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Abstract
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for childhood cancer and cystic fibrosis.
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Affiliation(s)
- Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.
| | - Gordon Liu
- Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
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15
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Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems. J Clin Psychol Med Settings 2021; 27:727-745. [PMID: 31587133 DOI: 10.1007/s10880-019-09665-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ2 = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.
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16
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Hydrogen sulfide alleviates the anxiety-like and depressive-like behaviors of type 1 diabetic mice via inhibiting inflammation and ferroptosis. Life Sci 2021; 278:119551. [PMID: 33945828 DOI: 10.1016/j.lfs.2021.119551] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/20/2021] [Accepted: 04/17/2021] [Indexed: 12/19/2022]
Abstract
Studies reported that sodium hydrosulfide (NaHS) can remit the depressive-like and anxiety-like behaviors induced by type 1 diabetes mellitus (T1DM). However, the mechanism is still unclear. In this study, we aimed to investigate the mechanism of NaHS on T1DM. Mice were randomly divided into four groups, including the control group (CON group), DM group, DM + 5.6 mg/kg NaHS group, and CON + 5.6 mg/kg NaHS group. Data showed that NaHS did attenuate the depressive-like and anxiety-like behaviors by OFT, EPM test, FST, and TST. Results suggest that NaHS markedly alleviated the ferroptosis in the prefrontal cortex (PFC) of diabetic mice by reducing iron deposition and oxidative stress, increasing the expression of GPX4 and SLC7A11. Moreover, NaHS could dampen the activation of microglias and the release of pro-inflammatory cytokines, enhance the protein expression of sirtuin 6 (Sirt6) and the interaction between Sirt6 and the acetylation of histoneH3 lysine9 (H3K9ac), and decrease the protein expressions of the Notch1 receptor and H3K9ac. In vitro experiment, NaHS ameliorated the ferroptosis via increasing the protein expressions of SLC7A11, glutathione peroxidase 4 (GPX4), and cystathionine β-synthase (CBS), reducing the pro-inflammatory cytokines, decreasing the levels of Fe2+, MDA, ROS, and lipid ROS. In conclusion, our results suggested that NaHS did alleviate anxiety-like and depressive-like behaviors. It can inhibit inflammation via modulating Sirt6 and was able to decrease the ferroptosis in the PFC of type 1 diabetic mice and the BV2 cells.
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17
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Goethals ER, Lemiere J, Snoek FJ, Casteels K, Luyckx K, de Wit M. Executive function mediates the link between externalizing behavior and HbA1c in children and adolescents with type 1 diabetes: A cross-national investigation. Pediatr Diabetes 2021; 22:503-510. [PMID: 33314616 DOI: 10.1111/pedi.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/14/2020] [Accepted: 11/11/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes-related and psychosocial outcomes but have not been examined in relationship to each other. We aimed to examine whether externalizing behavior is associated with HbA1c and whether this relationship is mediated by EF problems, specifically metacognition (i.e., ability to initiate, plan, organize and monitor behavior) and behavioral regulation (i.e., impulse control, regulation of emotion and behavior). RESEARCH DESIGN AND METHODS Cohorts of Belgian and Dutch parents of children and adolescents (6-18 years) with T1D filled out questionnaires on externalizing behavior (Strengths and Difficulties Questionnaire; SDQ) and EF (Behavior Rating Inventory of Executive Function; BRIEF) composite scales. Treating physicians collected HbA1c values. Mediation analyses were performed separately for the BRIEF composite Metacognition and Behavior Regulation scales, correcting for age, sex and diabetes duration. RESULTS The 335 parents of children and adolescents with T1D (mean age 12.3 ± 2.8 SD; mean HbA1c 7.6% ± 1.1 SD [60 mmol/mol ± 12.0 SD]; mean diabetes duration 5.3 ± 3.6 SD; 49.6% female) participated. Analyses showed that the association between externalizing behavior and HbA1c is mediated by metacognition (ab path Point estimate = 0.05 BCa CI 95% 0.02-0.08), and not behavioral regulation. CONCLUSIONS Results uncovered the influence externalizing behavior may have on EF problems in the metacognition domain, which in turn seem to influence HbA1c. Clinicians should be mindful of these EF problems when working with children and adolescents displaying externalizing behavior, and not only target behavioral but also cognitive processes.
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Affiliation(s)
- Eveline R Goethals
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Jurgen Lemiere
- Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Frank J Snoek
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Koen Luyckx
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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18
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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: 3] [Impact Index Per Article: 1.0] [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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19
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Zimmerman K, May B, Barnes K, Arynchyna A, Alford EN, Arata C, Dreer L, Aban I, Johnston J, Rozzelle C, Blount JP, Rocque BG. Anxiety, depression, fatigue, and headache burden in the pediatric hydrocephalus population. J Neurosurg Pediatr 2020; 26:483-489. [PMID: 32707553 PMCID: PMC8934588 DOI: 10.3171/2020.4.peds19697] [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: 11/23/2019] [Accepted: 04/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Childhood hydrocephalus is a common chronic medical condition. However, little is known about the burden of headache and psychological comorbidities in children living with hydrocephalus. The purpose of this study was to determine the prevalence and severity of these conditions among the pediatric hydrocephalus population. METHODS During routine neurosurgery clinic visits from July 2017 to February 2018, the authors administered four surveys to children ages 7 years and older: Pediatric Migraine Disability Assessment (PedMIDAS), Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, PROMIS Depression, and PROMIS Fatigue. The PedMIDAS is an assessment of headache disability in pediatric and adolescent patients. The PROMIS measures are pediatric self-reported instruments to assess social and emotional health. PROMIS measures utilize T-scores (mean 50, SD 10) to compare anxiety, depression, and fatigue in specific populations to those in the US general population. Clinical and demographic data were collected from the medical record (hydrocephalus etiology, shunt infection, race, etc.) and tested for associations with survey measure scores. RESULTS Forty children completed the PedMIDAS. Ten percent of them were in the severe headache range, 5% were in the moderate range, and 5% were in the mild range. There was a statistically significant association between undergoing a cluster of shunt operations and headache burden (p = 0.003).Forty children completed all three PROMIS measures. The mean anxiety score was 45.8 (SD 11.7), and 2.5% of children scored in the severe anxiety range, 17.5% in the moderate range, and 20% in the mild range. The mean depression score was 42.7 (SD 10.0), with 2.5% of children scoring in the severe depression range, 5% in the moderate range, and 12.5% in the mild range. The mean fatigue score was 45.1 (SD 16.4), with 15% percent of children scoring in the severe fatigue range, 10% in the moderate range, and 7.5% in the mild range. There were no statistically significant associations between child anxiety, depression, or fatigue and clinical or demographic variables. CONCLUSIONS Children with hydrocephalus have an average burden of headache, anxiety, depression, and fatigue as compared to the general population overall. Having a cluster of shunt operations correlates with a higher headache burden, but no clinical or demographic variable is associated with anxiety, depression, or fatigue.
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Affiliation(s)
- Kathrin Zimmerman
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Bobby May
- School of Medicine, University of Mississippi Medical Center
| | - Katherine Barnes
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Anastasia Arynchyna
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Elizabeth N. Alford
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Caroline Arata
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Laura Dreer
- Department of Psychology, University of Alabama at Birmingham
| | - Inmaculada Aban
- Department of Statistics, University of Alabama at Birmingham
| | - James Johnston
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Curtis Rozzelle
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Jeffrey P. Blount
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
| | - Brandon G. Rocque
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham
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20
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Samuels S, Menand EV, Mauer EA, Hernandez S, Terekhova D, Mathews TL, Albright AA, Antal Z, Kanellopoulos D. Anxiety and Type 1 Diabetes Management: Guardian and Child Report in a Pediatric Endocrinology Clinic. PSYCHOSOMATICS 2020; 61:231-237. [PMID: 31982171 DOI: 10.1016/j.psym.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Childhood anxiety prevents optimal diabetes management yet may be underrecognized by guardians. OBJECTIVE We aimed to investigate associations among anxiety, diabetes treatment adherence, and diabetes symptom control through child and guardian report. METHODS Cross-sectional pilot study surveying a convenience sample of children (ages 2-21) in a pediatric endocrinology clinic. Behavior Assessment System for Children, Second Edition 2, Self-Care Inventory Report, and Pediatric Quality of Life measured anxiety, diabetes treatment adherence, and diabetes symptom control. Analyses were performed with Spearman correlations. RESULTS Prevalence of anxiety and related behaviors was higher when reported by children (13% and 24%) vs. guardians (5% and 13%). Child-reported anxiety was associated with worse symptom control in all ages (Pediatric Quality of Life [rs = -0.55, P < 0.01]) and worse treatment adherence in children aged ≤12 (Self-Care Inventory Report [rho = -0.601, P = 0.023]). Guardian-reported anxiety was associated with worse symptom control (Peds QL [rs = -0.38, P = 0.02]). Child- and guardian-reported anxiety were positively correlated (rho = 0.426, P = 0.017)-particularly for children aged >12 (rho = 0.686, P = 0.003)-although not significantly for children ≤ 12 (rho = 0.201, P = 0.473). CONCLUSION Anxiety in children with type 1 diabetes varies with the domain of diabetes management (treatment adherence vs. symptom control) and reporting source (child vs. guardian). Children aged ≤12 exhibited a stronger relationship between higher anxiety and worse diabetes management with worse treatment adherence and symptom control in the presence of higher anxiety. Guardians of younger children were less effective at recognizing symptoms. Challenges identifying anxiety and its detrimental effects on diabetes management suggest routine screening of anxiety in pediatric endocrinology clinics is especially salient.
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Affiliation(s)
- Susan Samuels
- Department of Psychiatry, Weill Cornell Medicine, New York, NY.
| | - Emily V Menand
- Department of Psychiatry, Weill Cornell Medicine, New York, NY
| | - Elizabeth A Mauer
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY
| | - Sasha Hernandez
- Department of Obstetrics-Gynecology, New York University Langone, New York, NY
| | - Darya Terekhova
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
| | - Tara L Mathews
- Department of Psychiatry, Weill Cornell Medicine, New York, NY
| | - Ashly A Albright
- Medical Student, University of Queensland School of Medicine Ochsner Clinical School, Queensland, Australia
| | - Zoltan Antal
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
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21
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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: 1.0] [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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22
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Responsivity of lateral septum-mPFC connections in alloxan-induced hyperglycemia. Behav Brain Res 2019; 368:111919. [PMID: 31005560 DOI: 10.1016/j.bbr.2019.111919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/18/2019] [Accepted: 04/17/2019] [Indexed: 02/02/2023]
Abstract
The lateral septal nucleus (LSN) is related to the actions of antidepressants, and the prelimbic cortex (PL) and infralimbic cortex (IL) modulate responses to fear. However, unknown is whether experimental diabetes that is induced by alloxan alters the responsivity of these regions. We used a method in which one forebrain region (LSN) was electrically stimulated while single-unit extracellular recordings were performed in another mPFC region (PL and IL). Several experimental groups were tested: (a) animals that were subjected to long-term (42-day) alloxan-hyperglycemia and protected with insulin, (b) healthy animals that received a low dose of insulin that does not produce changes in glycemia, and (c) animals that received long-term treatment with fluoxetine. Additional healthy groups of animals received insulin or fluoxetine and underwent the forced swim test. Biological measurements indicated the induction of diabetes in alloxan-treated rats. In this group, a shift toward an inhibitory response to LSN stimulation was observed in the PL and IL compared with the control group. A low dose of insulin or fluoxetine produced similar changes in LSN-PL and LSN-IL responsivity. Long-term hyperglycemia increased inhibitory responsivity in the LSN-PL and LSN-IL, but this action was less pronounced than the action that was exerted by insulin and fluoxetine, which produced similar actions. Such similar actions were confirmed in the forced swim test, in which the antidepressant-like effects of insulin partially resembled the effects of fluoxetine. The changes that were observed in the alloxan group appeared to be related to neuronal damage, and a low dose of insulin exerted some antidepressant-like actions.
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Assessment and Management of Depression and Anxiety in Children and Adolescents with Epilepsy. Behav Neurol 2019; 2019:2571368. [PMID: 31191736 PMCID: PMC6525933 DOI: 10.1155/2019/2571368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/07/2019] [Indexed: 11/29/2022] Open
Abstract
Anxiety and depression in children and adolescents with epilepsy are common comorbidities which place a significant burden on patients and families and complicate the clinical management of epilepsy. This paper presents a narrative review on the aetiology, phenomenology, assessment, and management of depression and anxiety among paediatric patients with epilepsy. The recognition of affective comorbidity in paediatric epilepsy is limited at present, and the contributory role of antiepileptic medication towards such comorbidity must be considered by clinicians.
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Berger G, Waldhoer T, Barrientos I, Kunkel D, Rami‐Merhar BM, Schober E, Karwautz A, Wagner G. Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria. Pediatr Diabetes 2019; 20:127-136. [PMID: 30267464 PMCID: PMC7379731 DOI: 10.1111/pedi.12784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to systematically assess the association of insulin-manipulation (intentional under- and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. METHODS Two diagnostic interviews (Diabetes-Self-Management-Patient-Interview and Children's-Diagnostic-Interview for Psychiatric Disorders) were conducted with 241 patients (age 10-22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records. RESULTS Psychiatric comorbidity was found in nearly half of the patients with insulin-manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin-manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non-adherence to insulin therapy. Insulin-manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin-manipulation. CONCLUSIONS This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under- and/or overdosing. Internalizing psychiatric disorders were associated with insulin-manipulation, especially in female patients and insulin-manipulation was associated with deteriorated metabolic control and diabetes complications.
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Affiliation(s)
- Gabriele Berger
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Thomas Waldhoer
- Department of Public Health, EpidemiologyMedical University ViennaViennaAustria
| | - Irene Barrientos
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Daniela Kunkel
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Birgit M. Rami‐Merhar
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Edith Schober
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Andreas Karwautz
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Gudrun Wagner
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
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Prevalence of Depression and Associated Factors among Diabetic Patients in an Outpatient Diabetes Clinic. PSYCHIATRY JOURNAL 2019; 2019:2083196. [PMID: 30775378 PMCID: PMC6350613 DOI: 10.1155/2019/2083196] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022]
Abstract
Despite adequate treatment for diabetes, it is estimated that 15%- 20% of people with diabetes are struggling with a moderate to severe form of depression daily. Little is known about depression in diabetes in East Africa, particularly in Tanzania. The study is aimed at determining the prevalence of depression and associated factors among patients with diabetes. A descriptive cross-sectional study was carried out at the diabetes clinic of Muhimbili National Hospital. The 9-item Patient Health Questionnaire (PHQ 9) scale was used to assess presence of depressive symptoms among diabetes patients at the clinic. In addition, patient's sociodemographic and clinical characteristics were obtained and analysed for their association with depression. A total of 353 participants were recruited, of whom 229 (64.9%) patients were female and 156 (44.2%) were aged between 41 and 60 years. The overall prevalence of depression among diabetes patients at the diabetes clinic was 87%. Most (56.7%) had minimal depression, 22.1% had mild depression, and 8.2% had moderate depression. None had severe depression. Factors independently associated with a diagnosis of mild to moderate depression were being on insulin therapy and being a current smoker. There was a high prevalence of depression in this diabetic population. Majority of patients had minimal depression but about 30% had either mild or moderate depression. A holistic approach that focuses on the identification and management of depression among patients with diabetes is recommended.
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Thabrew H, Stasiak K, Hetrick SE, Donkin L, Huss JH, Highlander A, Wong S, Merry SN. Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions. Cochrane Database Syst Rev 2018; 12:CD012488. [PMID: 30578633 PMCID: PMC6353208 DOI: 10.1002/14651858.cd012488.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Long-term physical conditions affect 10% to 12% of children and adolescents worldwide. These individuals are at greater risk of developing psychological problems, particularly anxiety and depression, sometimes directly related to their illness or medical care (e.g. health-related anxiety). There is limited evidence regarding the effectiveness of psychological therapies for treating anxiety and depression in this population. Therapies designed for children and adolescents without medical issues may or may not be appropriate for use with those who have long-term physical conditions. OBJECTIVES This review was undertaken to assess the effectiveness and acceptability of psychological therapies in comparison with controls (treatment-as-usual, waiting list, attention placebo, psychological placebo, or non-psychological treatment) for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 27 September 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). In addition we searched the Web of Science (Core Collection) (12 October 2018) and conducted a cited reference search for reports of all included trials. We handsearched relevant conference proceedings, reference lists of included articles, and grey literature. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-randomised trials and cross-over trials of psychological therapies for treating anxiety or depression in children with long-term physical conditions were included. DATA COLLECTION AND ANALYSIS Abstracts and complete articles were independently reviewed by two authors. Discrepancies were addressed by a third author. Odds ratio (OR) was used for comparing dichotomous data and standardised mean differences (SMD) for comparing continuous data. Meta-analysis was undertaken when treatments, participants, and the underlying clinical question were similar. Otherwise, narrative analysis of data was undertaken. MAIN RESULTS Twenty-eight RCTs and one cross-over trial with 1349 participants were included in the review. Most participants were recruited from community settings and hospital clinics in high-income countries. For the primary outcome of treatment efficacy, short-term depression (versus any control), there was low-quality evidence from 16 trials involving 1121 participants suggesting that psychological therapies may be more effective than control therapies (SMD -0.31, 95% CI -0.59 to -0.03; I2 = 79%). For the primary outcome of treatment efficacy, short-term anxiety (versus any control), there was inadequate evidence of moderate-quality from 13 studies involving 578 participants to determine whether psychological therapies were more effective than control conditions (SMD -0.26, CI -0.59 to 0.07, I2 = 72%). Planned sensitivity analyses could not be undertaken for risk of bias due to the small number of trials that rated high for each domain. Additional sensitivity analysis demonstrated that psychological interventions specifically designed to reduce anxiety or depression were more effective than psychological therapies designed to improve other symptoms or general coping. There was some suggestion from subgroup analyses that they type of intervention (Chi² = 14.75, df = 5 (P = 0.01), I² = 66.1%), the severity of depression (Chi² = 23.29, df = 4 (P = 0.0001), I² = 82.8%) and the type of long-term physical condition (Chi² = 10.55, df = 4 (P = 0.03), I² = 62.1%) may have an impact on the overall treatment effect.There was qualitative (reported), but not quantitative evidence confirming the acceptability of selected psychological therapies for anxiety and depression. There was low-quality evidence that psychological therapies were more effective than control conditions in improving quality of life (SMD 1.13, CI 0.44 to 1.82, I2 = 89%) and symptoms of long-term physical conditions (SMD -0.34, CI -0.6 to -0.06, I2 = 70%), but only in the short term. There was inadequate low-quality evidence to determine whether psychological therapies were more effective than control conditions at improving functioning in either the short term or long term. No trials of therapies for addressing health-related anxiety were identified and only two trials reported adverse effects; these were unrelated to psychological therapies. Overall, the evidence was of low to moderate quality, results were heterogeneous, and only one trial had an available protocol. AUTHORS' CONCLUSIONS A limited number of trials of variable quality have been undertaken to assess whether psychological therapies are effective for treating anxiety and depression in children and adolescents with long-term physical conditions. According to the available evidence, therapies specifically designed to treat anxiety or depression (especially those based on principles of cognitive behaviour therapy (CBT)) may be more likely to work in children and adolescents who have mild to moderate levels of symptoms of these disorders, at least in the short term. There is a dearth of therapies specifically designed to treat health-related anxiety in this age group.
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Affiliation(s)
- Hiran Thabrew
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Karolina Stasiak
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
| | - Liesje Donkin
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Jessica H Huss
- University of KasselDepartment of PsychologyKasselGermany
| | | | - Stephen Wong
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
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Kristensen LJ, Birkebaek NH, Mose AH, Berg Jensen M, Thastum M. Multi-informant path models of the influence of psychosocial and treatment-related variables on adherence and metabolic control in adolescents with type 1 diabetes mellitus. PLoS One 2018; 13:e0204176. [PMID: 30235290 PMCID: PMC6147740 DOI: 10.1371/journal.pone.0204176] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background We assessed the associations between metabolic control and adherence and a broad range of adolescent and family characteristics (e.g., gender, family structure), treatment-related variables (e.g., disease duration, treatment modality), and psychosocial factors (e.g., symptoms of depression and anxiety, parental support, self-efficacy) in a nationwide study of Danish adolescents (age 12–17 years) with type 1 diabetes mellitus (T1DM). Methods Sixty-four percent of invited families participated by completing a survey and providing a blood sample. Two path models of associations between generic and diabetes-related family factors, adolescent self-efficacy, emotional difficulties, and metabolic control and adherence were tested, one for adolescents and one for caregivers. Demographic variables were included as covariates. Results Both path models demonstrated a satisfying model fit. In both models, metabolic control was associated with adherence, age, and T1DM duration. In the adolescent model, metabolic control was also related to treatment modality, single-parent household, caregiver non-support, and anxiety, whereas in the caregiver model metabolic control was associated with family conflict and caregiver support. In both models, adherence was related to age, duration, treatment modality, family conflict, caregiver support, family functioning, and emotional difficulties of the adolescent. In the adolescent model, adherence was also related to adolescent self-efficacy, whereas in the caregiver model adherence was associated with adolescent gender and caregiver non-support and support. Adolescent self-efficacy, emotional well-being, and difficulties related to adolescent/caregiver interaction appeared to be particularly important, as indicated by their stronger association with adherence and/or metabolic control. Conclusion The results highlight the value of applying a multi-informant approach to address the psychosocial well-being of adolescents with diabetes in a large national sample. Self-efficacy, emotional, and family-related difficulties are important aspects to address in both clinical care and future research regarding adolescents with T1DM.
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Affiliation(s)
- Lene Juel Kristensen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | | | - Morten Berg Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions. Cochrane Database Syst Rev 2018; 8:CD012489. [PMID: 30110718 PMCID: PMC6513202 DOI: 10.1002/14651858.cd012489.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term physical conditions affect 10% to 12% of children and adolescents worldwide; these individuals are at greater risk of developing psychological problems, particularly anxiety and depression. Access to face-to-face treatment for such problems is often limited, and available interventions usually have not been tested with this population. As technology improves, e-health interventions (delivered via digital means, such as computers and smart phones and ranging from simple text-based programmes through to multimedia and interactive programmes, serious games, virtual reality and biofeedback programmes) offer a potential solution to address the psychological needs of this group of young people. OBJECTIVES To assess the effectiveness of e-health interventions in comparison with attention placebos, psychological placebos, treatment as usual, waiting-list controls, or non-psychological treatments for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDTR to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2017), Web of Science (1900 - 18 August 2016, updated 31 August 2017) and Ovid MEDLINE, Embase, PsycINFO (cross-search 2016 to 18 Aug 2017). We hand-searched relevant conference proceedings, reference lists of included articles, and the grey literature to May 2016. We also searched international trial registries to identify unpublished or ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-randomised trials, and cross-over trials of e-health interventions for treating any type of long-term physical condition in children and adolescents (aged 0 to 18 years), and that measured changes in symptoms or diagnoses of anxiety, depression, or subthreshold depression. We defined long-term physical conditions as those that were more than three-months' duration. We assessed symptoms of anxiety and depression using patient- or clinician-administered validated rating scales based on DSM III, IV or 5 (American Psychological Association 2013), or ICD 9 or 10 criteria (World Health Organization 1992). Formal depressive and anxiety disorders were diagnosed using structured clinical interviews. Attention placebo, treatment as usual, waiting list, psychological placebo, and other non-psychological therapies were eligible comparators. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed titles, abstracts, and full-text articles; discrepancies were resolved through discussion or addressed by a third author. When available, we used odds ratio (OR) to compare dichotomous data and standardised mean differences (SMD) to analyse continuous data, both with 95% confidence intervals (CI). We undertook meta-analysis when treatments, participants, and the underlying clinical question were adequately similar. Otherwise, we undertook a narrative analysis. MAIN RESULTS We included five trials of three interventions (Breathe Easier Online, Web-MAP, and multimodal cognitive behavioural therapy (CBT)), which included 463 participants aged 10 to 18 years. Each trial contributed to at least one meta-analysis. Trials involved children and adolescents with long-term physical conditions, such as chronic headache (migraine, tension headache, and others), chronic pain conditions (abdominal, musculoskeletal, and others), chronic respiratory illness (asthma, cystic fibrosis, and others), and symptoms of anxiety or depression. Participants were recruited from community settings and hospital clinics in high income countries.For the primary outcome of change in depression symptoms versus any control, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.06, 95% CI -0.35 to 0.23; five RCTs, 441 participants). For the primary outcome of change in anxiety symptoms versus any comparator, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.07, 95% CI -0.29 to 0.14; two RCTs, 324 participants). For the primary outcome of treatment acceptability, there was very low-quality evidence that e-health interventions were less acceptable than any comparator (SMD 0.46, 95% CI 0.23 to 0.69; two RCTs, 304 participants).For the secondary outcome of quality of life, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.83, 95% CI -1.53 to -0.12; one RCT, 34 participants). For the secondary outcome of functioning, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.08, 95% CI -0.33 to 0.18; three RCTs, 368 participants). For the secondary outcome of status of long-term physical condition, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD 0.06, 95% CI -0.12 to 0.24; five RCTs, 463 participants).The risk of selection bias was considered low in most trials. However, the risk of bias due to inadequate blinding of participants or outcome assessors was considered unclear or high in all trials. Only one study had a published protocol; two trials had incomplete outcome data. All trials were conducted by the intervention developers, introducing another possible bias. No adverse effects were reported by any authors. AUTHORS' CONCLUSIONS At present, the field of e-health interventions for the treatment of anxiety or depression in children and adolescents with long-term physical conditions is limited to five low quality trials. The very low-quality of the evidence means the effects of e-health interventions are uncertain at this time, especially in children aged under 10 years.Although it is too early to recommend e-health interventions for this clinical population, given their growing number, and the global improvement in access to technology, there appears to be room for the development and evaluation of acceptable and effective technologically-based treatments to suit children and adolescents with long-term physical conditions.
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Affiliation(s)
- Hiran Thabrew
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Karolina Stasiak
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
| | - Stephen Wong
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Jessica H Huss
- University of KasselDepartment of PsychologyKasselGermany
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
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Bathina S, Das UN. Dysregulation of PI3K-Akt-mTOR pathway in brain of streptozotocin-induced type 2 diabetes mellitus in Wistar rats. Lipids Health Dis 2018; 17:168. [PMID: 30041644 PMCID: PMC6058366 DOI: 10.1186/s12944-018-0809-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/02/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Proteins of the insulin signaling pathway are needed for cell proliferation and development and glucose homeostasis. It is not known whether insulin signalling markers (Foxo1, Gsk3β) can be correlated with the expression on PI3K-Akt-mTOR pathway, which are needed for cell survival and maintenance of glucose homeostasis. In the present study, we studied the expression of Foxo1, Gsk3β and PI3K-Akt-mTOR in the brain of streptozotocin-induced type 2 diabetes mellitus Wistar rats. METHODS The study was performed both in vitro (RIN5F cells) and in vivo (male Wistar rats). Gene expression of Nf-kB, IkB, Bax, Bcl-2 and Pdx1 gene was studied invitro by qRT-PCR in RIN5F cells. In STZ (65 mg/kg i.p.)-induced type 2 DM Wistar rats, blood glucose and insulin levels, iNOS, Foxo1, NF-κB, pGsk3β and PPAR-γ1 levels along with PI3k-Akt-mTOR were measured in brain tissue. RESULTS RIN5F cells treated with STZ showed increase in the expression of NF-kB and Bax and decrease in IkB, Bcl-2 and PDX1. Brain tissue of STZ-induced type 2 DM animals showed a significant reduction in secondary messengers of insulin signalling (Foxo1) (P < 0.001) and Gsk3β (P < 0.01) and a significant alteration in the expression of phosphorylated-Akt (P < 0.001) mTOR (P < 0.01) and PI3K. CONCLUSION These results suggest that STZ induces pancreatic β cell apoptosis by enhancing inflammation. Significant alterations in the expression brain insulin signaling and cell survival pathways seen in brain of STZ-treated animals implies that alterations neuronal apoptosis may have a role in altered glucose homeostasis seen in type 2 DM that may also explain the increased incidence of cognitive dysfunction seen in them.
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Affiliation(s)
- Siresha Bathina
- BioScience Research Centre, Department of Medicine, Gayatri Vidya Parishad Hospital, GVP College of Engineering Campus, Visakhapatnam, 530048 India
| | - Undurti N. Das
- BioScience Research Centre, Department of Medicine, Gayatri Vidya Parishad Hospital, GVP College of Engineering Campus, Visakhapatnam, 530048 India
- UND Life Sciences, 2221, NW 5th St, Battle Ground, WA 98604 USA
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Tokatly Latzer I, Rachmiel M, Zuckerman Levin N, Mazor-Aronovitch K, Landau Z, Ben-David RF, GrafBar-El C, Gruber N, Levek N, Weiss B, Stein D, Lerner-Geva L, Pinhas-Hamiel O. Increased prevalence of disordered eating in the dual diagnosis of type 1 diabetes mellitus and celiac disease. Pediatr Diabetes 2018; 19:749-755. [PMID: 29493097 DOI: 10.1111/pedi.12653] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/20/2017] [Accepted: 01/22/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Disordered eating behaviors (DEBs) may lead to full blown eating disorders. Both type 1 diabetes mellitus (T1DM) and celiac disease (CD) have been linked to DEBs. OBJECTIVE To compare the presence of DEBs between adolescents and young adults with a dual diagnosis of T1DM and CD, and individuals with only one of the diagnoses. METHODS Individuals with a dual diagnosis of T1DM and CD ("T1DM + CD group" n = 39), with a diagnosis of T1DM only ("T1DM group" n = 97) and with a diagnosis of CD only ("CD group" n = 267) filled the Eating Attitude Test-26 (EAT-26) questionnaire. Those with T1DM completed in addition to the Diabetes Eating Problem Survey-Revised (DEPS-R). RESULTS The study population comprised of 403 individuals, of whom 65% were females. There were no statistically significant differences among the groups in distribution of sex, age, hemoglobin A1c (HbA1c) levels, age of disease diagnosis and duration. The prevalence of DEBs in the T1DM + CD group was 3-fold higher (26.0%) than in the T1DM (8.2%) and CD (8.2%) groups (P = .003). This trend was observed for both females and males. Multivariate analysis demonstrated that the T1DM + CD group had an increased risk for DEBs (odds ratio, OR: 4.7, 95% confidence interval, CI: 1.9-11.2, P = .001) after adjustment for age, sex, and body mass index. Additionally, being female, older and overweight increased the risk for DEBs. HbA1c values were not associated with an increased DEBs rate. CONCLUSIONS Individuals with the dual diagnoses of T1DM and CD have an increased likelihood to develop DEBs compared to those with only one of these diagnoses.
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Affiliation(s)
- Itay Tokatly Latzer
- Department of Pediatrics A, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marianna Rachmiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology Unit, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Nehama Zuckerman Levin
- Pediatric Diabetes Clinic, Institute of Diabetes, Endocrinology and Metabolism, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kineret Mazor-Aronovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.,National Juvenile Diabetes Center, Maccabi Health Care Services Ra'anana, Israel
| | - Zohar Landau
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Juvenile Diabetes Center, Maccabi Health Care Services Ra'anana, Israel.,Pediatric Endocrinology and Diabetes Unit, Wolfson Medical Center, Holon, Israel
| | | | - Chana GrafBar-El
- National Juvenile Diabetes Center, Maccabi Health Care Services Ra'anana, Israel
| | - Noah Gruber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Noa Levek
- National Juvenile Diabetes Center, Maccabi Health Care Services Ra'anana, Israel
| | - Batia Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Daniel Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Psychosomatic Department, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Liat Lerner-Geva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.,National Juvenile Diabetes Center, Maccabi Health Care Services Ra'anana, Israel
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Dybdal D, Tolstrup JS, Sildorf SM, Boisen KA, Svensson J, Skovgaard AM, Teilmann GK. Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: a population-based cohort study. Diabetologia 2018; 61:831-838. [PMID: 29242985 DOI: 10.1007/s00125-017-4517-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate psychiatric morbidity following childhood onset of type 1 diabetes. METHODS In a matched, population-based cohort study based on Danish national registers, we identified children and adolescents who had been diagnosed as an in- or outpatient with type 1 diabetes before the age of 18, and afterwards diagnosed with a psychiatric disorder (n = 5084). Control individuals were matched according to sex and date of birth (n = 35,588). The Cox proportional hazards model was used to assess associations between type 1 diabetes and the incidence of psychiatric disorders as well as the effects of age at onset and duration of type 1 diabetes on the risk of subsequently developing psychiatric morbidities. RESULTS An increased risk of being diagnosed with mood disorders and anxiety, dissociative, eating, stress-related and somatoform disorders was observed in both sexes in the years following type 1 diabetes onset, with the highest risk observed five years or more after onset (HR 1.55 [95% CI 1.38, 1.74]). The risk of psychoactive substance-misuse disorders increased significantly only in boys, and the risk of personality disorders increased only in girls. CONCLUSIONS/INTERPRETATION In the years following type 1 diabetes onset, an increased risk of eating disorders, anxiety and mood disorders, substance misuse, and personality disorders was found. These findings highlight a clinical need to monitor the mental health of children and adolescents in the years following type 1 diabetes onset to identify and treat psychiatric problems associated with type 1 diabetes.
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Affiliation(s)
- Daniel Dybdal
- Department of Paediatrics and Adolescent Medicine, Nordsjællands Hospital, Dyrehavevej 29, DK 3400, Hillerød, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Stine M Sildorf
- Department of Paediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark
| | - Kirsten A Boisen
- Centre of Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Jannet Svensson
- Department of Paediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grete K Teilmann
- Department of Paediatrics and Adolescent Medicine, Nordsjællands Hospital, Dyrehavevej 29, DK 3400, Hillerød, Denmark.
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Cooper MN, Lin A, Alvares GA, de Klerk NH, Jones TW, Davis EA. Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up. Pediatr Diabetes 2017; 18:599-606. [PMID: 27878933 DOI: 10.1111/pedi.12469] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/22/2022] Open
Abstract
AIM To determine the incidence of and risk factors for psychiatric disorders in early adulthood in patients with childhood onset type 1 diabetes (T1D). METHODS In this retrospective-cohort study, we identified a population-based childhood onset T1D cohort and an age and sex matched (5:1) non-diabetic comparison cohort. Data linkage was used to access inpatient hospitalization data, mental health support service data, and mortality data to follow-up both cohorts into early adulthood. RESULTS The mean age of T1D diagnosis was 9.5 years (SD 4.1), with a mean age at end of follow-up of 26.4 years (SD 5.2, max 37.7). The diagnosis of any psychiatric disorder was observed for 187 of 1302 (14.3%) in the T1D cohort and 400 of 6422 (6.2%) in the comparison cohort [adjusted hazard ratio (HR) 2.3; 95% CI 1.9, 2.7]. Anxiety, eating, mood, and personality and behaviour disorders were observed at higher rates within the T1D cohort. Comorbid psychiatric disorders were more frequent, at the cohort level, within the T1D cohort (2-3 disorders 3.76% vs 1.56%) and service utilization was higher (15+ contacts 6.8% vs 2.8%); though these differences did not remain when restricted to only those individuals diagnosed during follow-up. A history of poor glycaemic control was associated with an increased risk of anxiety, mood, and 'any' disorder (HR ranging from 1.35 to 1.42 for each 1% increase in mean paediatric HbA1c). CONCLUSION Our findings highlight the need for access to mental health support services as part of routine patient care for young adults with T1D, and for better predictive tools to facilitate targeting at-risk patients with early intervention programs.
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Affiliation(s)
- M N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - A Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - G A Alvares
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - N H de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,The School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - T W Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,The School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - E A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,The School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
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Riaz M, Imran N, Fawwad A, Basit A. Frequency of depression among patients with Type-I diabetes in a developing country, Pakistan. Pak J Med Sci 2017; 33:1318-1323. [PMID: 29492051 PMCID: PMC5768817 DOI: 10.12669/pjms.336.13911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the frequency of depressive symptoms among young people with Type-I diabetes. METHODS This cross sectional study was conducted at Baqai Institute of Diabetology & Endocrinology, Karachi, Pakistan from February to December 2015. All People aged between 12-20 years with Type-I diabetes for at least 1 year attending the OPD were included in the study. Information about participants' demographic characteristics, co morbidities and Complications, current treatment and medications were obtained. Acylated hemoglobin (HbA1C) levels were checked in all People. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess the depressive symptoms in the study participants. A cut off value of ≥ 16 was used to screen for depression. SPSS 19 was used to analyze the results. RESULTS Out of 104 people with Type-I diabetes, depressive symptoms were observed in 44 (42.3%) participants. Depressive symptoms were more frequent in females (28/55, 50.9%). Depressed people had more episodes of DKA (11/44, 25%), hypoglycemia (12/44, 27.3%) or hospitalization (7/44, 15.9%) in the last six months which were not statistically significant. CONCLUSION Depressive symptoms are quite common in people with Type-I diabetes. Health care professionals should consider screening youth with diabetes for depression regularly. Further large scale studies are needed to validate our findings.
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Affiliation(s)
- Musarrat Riaz
- Musarrat Riaz, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Nazish Imran
- Nazish Imran, Department of Child and Family, King Edward Medical University, Lahore, Pakistan
| | - Asher Fawwad
- Asher Fawwad, Department of Research, Department of Biochemistry, Baqai Medical University, Karachi, Pakistan. Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Abdul Basit
- Abdul Basit, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Eray Ş, Uçar HN, Çetinkaya F, Eren E, Vural P. The Relationship Between Perceived Family Climate and Glycemic Control in Type 1 Diabetes Mellitus Adolescent Patients. J Clin Res Pediatr Endocrinol 2017; 9:253-259. [PMID: 28218068 PMCID: PMC5596807 DOI: 10.4274/jcrpe.3825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) is a chronic disease which ranks third in children under age 16 years. Expressed emotion (EE) is a term that indicates a specific family climate including lack of emotional support (LES), irritability, and emotional over-involvement. It is known that the family environment is highly important for glycemic control in diabetic adolescents. In this study, the relationship between perceived EE and glycemic control in adolescents diagnosed with T1DM not accompanied by psychopathology were investigated. METHODS The study included 49 adolescents with T1DM and 50 adolescents as a control group. Adolescents with psychopathology and intellectual disability were excluded from the study. Perceived EE was measured by the Shortened Level of Expressed Emotion Scale (SLEES) and blood sugar regulation was assessed by HbA1c levels. RESULTS The adolescents with T1DM showed a significant difference in perceived EE (p=0.020) and LES (p=0.014) when compared with the control group. When diabetic adolescents were compared among themselves, the diabetic adolescents with poor glycemic control perceived greater EE (p=0.033) and less emotional support (p=0.049). In regression analyses, the predictive power of mother's educational level, the employment status of mothers and the subscale "LES" of SLEES combined to explain HbA1c level was determined to be 37.8%. CONCLUSION The strong relationship between perceived EE and glycemic control showed us that perceived EE can hinder treatment compliance without causing psychopathology. For this reason, it is recommended that not only patients with psychopathology, but all diabetic adolescents receive psychosocial support and family interventions.
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Affiliation(s)
- Şafak Eray
- Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey
,* Address for Correspondence: Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey E-mail:
| | - Halit Necmi Uçar
- Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey
| | - Fatma Çetinkaya
- Taksim Training and Research Hospital, Clinic of Child Health and Diseases, İstanbul, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Pınar Vural
- Uludağ University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey
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Cognitive impairment in diabetes and poor glucose utilization in the intracellular neural milieu. Med Hypotheses 2017; 104:160-165. [DOI: 10.1016/j.mehy.2017.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 02/01/2023]
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Brady AM, Deighton J, Stansfeld S. Psychiatric outcomes associated with chronic illness in adolescence: A systematic review. J Adolesc 2017; 59:112-123. [PMID: 28605691 DOI: 10.1016/j.adolescence.2017.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/13/2017] [Accepted: 05/21/2017] [Indexed: 11/16/2022]
Abstract
Recent years have seen an increased focus on the high rates of psychiatric comorbidities in adults with chronic illness. This systematic review explored whether chronic illness in adolescents was similarly associated with poor psychiatric outcomes. The literature search identified 129 articles, only 5 of which were indicated to be at a low risk of methodological bias. Four of these articles found a strong relationship between asthma in adolescence and an increase in the prevalence of anxiety and depressive disorders, while the remaining article, which focused on diabetes mellitus, indicated similarly increased rates of psychiatric illness. Trends among the remaining studies suggested that many illnesses were not associated with poor adolescent mental health. Please note that chronic conditions with a neurological aetiology were excluded from the main review due to indications of qualitative differences in comorbidities. Findings highlight that the well-being of adolescents with chronic illness warrants a specific research focus.
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Affiliation(s)
- Ann Marie Brady
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Bart's and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, United Kingdom.
| | - Jessica Deighton
- Evidence Based Practice Unit, University College London and Anna Freud Centre, London N1 9JH, United Kingdom.
| | - Stephen Stansfeld
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Bart's and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, United Kingdom.
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions. Hippokratia 2017. [DOI: 10.1002/14651858.cd012488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hiran Thabrew
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Karolina Stasiak
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne; 35 Poplar Road Parkville Melbourne Victoria Australia 3054
| | - Stephen Wong
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Jessica H Huss
- University of Kassel; Department of Psychology; Kassel Germany
| | - Sally N Merry
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. eHealth interventions for anxiety and depression in children and adolescents with long-term physical conditions. Hippokratia 2017. [DOI: 10.1002/14651858.cd012489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiran Thabrew
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Karolina Stasiak
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne; 35 Poplar Road Parkville Melbourne Victoria Australia 3054
| | - Stephen Wong
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Jessica H Huss
- University of Kassel; Department of Psychology; Kassel Germany
| | - Sally N Merry
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
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Khandelwal S, Sengar GS, Sharma M, Choudhary S, Nagaraj N. Psychosocial Illness in Children with Type 1 Diabetes Mellitus: Prevalence, Pattern and Risk Factors. J Clin Diagn Res 2016; 10:SC05-SC08. [PMID: 27790539 DOI: 10.7860/jcdr/2016/21666.8549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Type 1 Diabetes Mellitus (T1DM) and psychosocial illness influence each other in multiple ways. The extent of psychosocial disorders in children with T1DM remains largely unstudied in India. AIM To assess the prevalence, severity, pattern and variables affecting psychosocial illness in children with type 1 diabetes mellitus. MATERIAL AND METHODS This observational study included 84 children (6-14 years of age) having T1DM at least for 1 year and 100 non diabetic children for comparison. "DSM-5 parent/guardian-Rated Level 1 & 2 Cross-Cutting Symptom Measure -Child age 6-17" was used to assess psychosocial illness, specific domains and severity. Socio-demographic variables were studied and HbA1c levels were measured. RESULTS Significantly higher prevalence of psychosocial illness was observed in children with T1DM as compared with non diabetic group (55.95% vs 20%; p<0.0001). The prevalence for mild, moderate and severe psychosocial illness was 8.33%, 27.38% and 20.24% respectively in diabetic children. Most common psychosocial abnormality was irritation (38.1%), followed by depression (36.9%) and anxiety (32.1%). The prevalence of psychosocial illness was significantly higher in T1DM patients with poorer metabolic control (HbA1c>7.5, p=0.014). Significant association of psychosocial illness was also noticed with poor dietary compliance (p=0.021) and higher mean HbA1c level (p<0.001). CONCLUSION This study established T1DM as a risk factor for development of psychosocial illness. Irritation, depression and anxiety were most common abnormalities. Significant association of psychosocial illness with poor dietary compliance and poor metabolic control was observed. Psychosocial assessment of every diabetic child is suggested for optimal management.
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Affiliation(s)
- Shikha Khandelwal
- 3rd Year Resident, Department of Paediatrics, S.P. Medical College , Bikaner, Rajasthan, India
| | | | - Monika Sharma
- 3rd Year Resident, Department of Paediatrics, S.P. Medical College , Bikaner, Rajasthan, India
| | - Shyama Choudhary
- Senior Resident, Department of Paediatrics, S.N. Medical College , Jodhpur, Rajasthan, India
| | - Niranjan Nagaraj
- 3rd Year Resident, Department of Paediatrics, S.P. Medical College , Bikaner, Rajasthan, India
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AlBuhairan F, Nasim M, Al Otaibi A, Shaheen NA, Al Jaser S, Al Alwan I. Health related quality of life and family impact of type 1 diabetes among adolescents in Saudi Arabia. Diabetes Res Clin Pract 2016; 114:173-9. [PMID: 26830857 DOI: 10.1016/j.diabres.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 11/12/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Abstract
AIM To measure the health related quality of life (HRQoL) among Saudi Arabian adolescents with type 1 diabetes mellitus (T1DM) and the impact the disease has on the family. METHODOLOGY A cross sectional study was conducted involving 315 adolescent patients (12-18 years) and their caregivers. Adolescent HRQoL was assessed by adolescents and their parents completing the Peds QL™ Diabetes Module 3.0. Family impact was assessed by the parent completing the Peds QL™ Family Impact module (FIM). RESULTS Adolescents reported a cumulative mean HRQoL score of 64.8, while parents reported significantly lower scores of 60.3 (p=0.003). The lowest scores reported by both adolescents and parents were for "Worry". Female gender and late adolescent age were predictors of lower HRQoL for adolescents with T1DM. The FIM showed low scores for "Emotional functioning" (59.8) and high scores for "Family relationships" (80.9). CONCLUSION These findings emphasize the importance of an interdisciplinary, biopsychosocial and family centered care approach to adolescents with a chronic disease. Future work could assess the effectiveness of direct care involvement of adolescent and mental health experts in improving the HRQoL for this population.
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Affiliation(s)
- Fadia AlBuhairan
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia.
| | - Maliha Nasim
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahlam Al Otaibi
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| | - Naila A Shaheen
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Al Jaser
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Internal Medicine, King AbdulAziz Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Al Alwan
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
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Eilander MMA, de Wit M, Rotteveel J, Snoek FJ. Low Self-Confidence and Diabetes Mismanagement in Youth with Type 1 Diabetes Mediate the Relationship between Behavioral Problems and Elevated HbA1c. J Diabetes Res 2016; 2016:3159103. [PMID: 26682230 PMCID: PMC4670876 DOI: 10.1155/2016/3159103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Previous studies indicated an association between behavior problems (internalizing, externalizing) and glycemic control (HbA1c) in youth with type 1 diabetes (T1D). The aim of this study is to examine if this association is mediated by self-confidence and mismanagement of diabetes. METHODS Problem behavior was assessed with the Strengths and Difficulties Questionnaire. Mediating variables were assessed using the Confidence in Diabetes Self-Care-Youth and Diabetes Mismanagement Questionnaire. HbA1c was derived from hospital charts. Bootstrap mediation analysis for multiple mediation was utilized. RESULTS 88 youths with T1D, age 11-15 y, participated. The relation between both overall problem behavior and externalizing behavior problems and HbA1c was mediated through confidence in diabetes self-care and mismanagement (a 1 b 1 + a 2 b 2 path; point estimate = 0.50 BCa CI 95% 0.25-0.85; a 1 b 1 + a 2 b 2 path; point estimate = 0.73 BCa CI 95% 0.36-1.25). CONCLUSIONS Increased problem behavior in youth with T1D is associated with elevated HbA1c and mediated by low self-confidence and diabetes mismanagement. Screening for problem behavior and mismanagement and assisting young patients in building confidence seem indicated to optimize glycemic control.
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Affiliation(s)
- Minke M. A. Eilander
- Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
- *Minke M. A. Eilander:
| | - Maartje de Wit
- Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Joost Rotteveel
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
- Department of Pediatrics, VU Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, Netherlands
| | - Frank J. Snoek
- Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
- Department of Medical Psychology, Academic Medical Center (AMC), Meibergdreef 9, 1100 DD Amsterdam, Netherlands
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Retentissement psychologique du diabète type 1 sur l’enfant. Expérience d’une unité de diabétologie pédiatrique. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.258] [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: 11/18/2022] Open
Abstract
ObjectifL’objectif de notre travail est d’étudier le retentissement psychologique de diabète type 1 chez un échantillon d’enfants suivis par l’unité de diabétologie pédiatrique du service PUC de l’hôpital Béchir Hamza de Tunis.Patients et méthodesNotre étude est une enquête épidémiologique transversale de type descriptif des enfants vus en consultation externe ou au cours de l’hospitalisation pendant une période de 6 mois (juillet 2014–décembre 2014). Les informations sont recueillies sur le dossier médical et auprès des parents et/ou des enfants (quand l’âge est supérieur ou égal à 6 ans).RésultatsTrente-quatre enfants présentant un diabète de type 1 ont été colligés. L’âge moyen est de 9 ans (2–18 ans), 73,5 % ont une histoire familiale de diabète avec un lien de parenté du 1er degré dans 32 % des cas. Soixante-quatre pour cent avaient un diabète de type 2, la notion de diabète compliqué était présente dans 28 % des cas. La durée d’évolution de la maladie dans notre série est de 33 mois. 16,7 % des malades ont un fléchissement scolaire après le début du diabète, cause directe de redoublement dans 14,7 % des cas. 40 % des enfants cachent leur maladie à l’école et en société. Au total, 22,6 % des enfants ont présenté une dépression masquée sous forme de plaintes somatiques, 54,8 % ont présenté des troubles de comportement après l’annonce de diagnostic dont 82,4 % sous forme d’agressivité. De plus, 6,9 % des malades ont présenté des équivalents suicidaires (auto-injection de doses élevées d’insuline, consommation excessive de sucreries, mise en danger…) 18,8 % ont verbalisé un besoin de consulter en pédopsychiatrie.ConclusionIl est fondamental de bien comprendre la réaction de l’enfant face à sa maladie chronique, qui peut parfois produire ou renforcer des modes relationnels pathogènes restructurant les défenses de l’enfant sur un mode pathologique. Un dépistage précoce avec une prise en charge multidisciplinaire est nécessaire.
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Abstract
Although anxiety is a normal and developmentally appropriate experience of childhood and anxiety disorders are among the most commonly diagnosed disorders, the prevalence of anxiety symptomatology and anxiety disorders in children with type 1 diabetes (T1D) is not well documented. Most studies have focused on anxiety-related syndromes associated with T1D including fear of hypoglycemia, specific phobia of needles (i.e., needle anxiety), and anxiety related to uptake of new and sophisticated diabetes technology (e.g., continuous glucose monitors, continuous subcutaneous infusion therapy), but the extant literature is sparse, and more research is greatly needed. Identification, prevention, and treatment of anxiety are critical to providing comprehensive diabetes care and management. This review provides a summary of the literature focused on anxiety in children and adolescents with T1D with suggestions for future research and clinical implications.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, A140, Aurora, CO, 80045, USA,
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Eilander MMA, de Wit M, Rotteveel J, Aanstoot HJ, Waarde WMBV, Houdijk ECAM, Luman M, Nuboer R, Oosterlaan J, Winterdijk P, Snoek FJ. Diabetes IN develOpment (DINO): the bio-psychosocial, family functioning and parental well-being of youth with type 1 diabetes: a longitudinal cohort study design. BMC Pediatr 2015; 15:82. [PMID: 26173476 PMCID: PMC4502615 DOI: 10.1186/s12887-015-0400-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 07/02/2015] [Indexed: 02/08/2023] Open
Abstract
Background Strict glycemic control during adolescence decreases the risk of developing complications later in life, even if this level of control is not maintained afterwards. However, the majority of adolescents with type 1 diabetes (T1D) are in poor control and so far medical or psychological interventions have shown limited success. Adolescence is characterized by major biological, psychosocial, cognitive and parent–child relationship changes and the complex interaction between these developmental trajectories, and its impact on health outcomes is still poorly understood. A specific topic of interest in this context is the timing of diagnosis. The longitudinal study DINO (Diabetes IN develOpment) aims to examine:If and how the onset of T1D before vs. during puberty results in different outcomes of glycemic control, self-management, psychological functioning and diabetes-related quality of life. The timing of onset of disturbed eating behavior, its risk factors and its prospective course in relation to glycemic and psychological consequences. If and how the onset of T1D before vs. during puberty results in different family functioning and parental well-being. If and how the cognitive development of youth with T1D relates to glycemic control and diabetes self-management.
Methods/design DINO, a longitudinal multi-center cohort study is conducted in youth with T1D in the age range 8–15 years at baseline. Participants will be divided into two subgroups: pre-pubertal and pubertal. Both groups will be followed for 3 years with assessments based on a bio-psychosocial model of diabetes, scheduled at baseline, 12 months, 24 months and 36 months examining the biological, psychosocial -including disturbed eating behaviors- and cognitive development, family functioning and parental well-being. Discussion A better understanding of how the different trajectories affect one another will help to gain insight in the protective and risk factors for glycemic outcomes and in who needs which support at what moment in time. First results are expected in 2016. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0400-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minke M A Eilander
- Department of Medical Psychology, VU University Medical Center, De Boelenlaan 1117, 1081, HV, Amsterdam, The Netherlands. .,EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Maartje de Wit
- Department of Medical Psychology, VU University Medical Center, De Boelenlaan 1117, 1081, HV, Amsterdam, The Netherlands. .,EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Joost Rotteveel
- EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands. .,Department of Pediatrics, VU Medical Center, De Boelelaan 1118, 1081, HV, Amsterdam, The Netherlands.
| | - Henk Jan Aanstoot
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, The Netherlands.
| | - Willie M Bakker-van Waarde
- Department Pediatrics, University Hospital of Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
| | - Euphemia C A M Houdijk
- Department of Pediatrics, Haga Hospital Juliana Children's Hospital, Sportlaan 600, 2566, MJ, the Hague, The Netherlands.
| | - Marjolein Luman
- Department Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
| | - Roos Nuboer
- Department of Pediatrics, Meander Medical Centre, Maatweg 3, 3813, TZ, Amersfoort, The Netherlands.
| | - Jaap Oosterlaan
- Department Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
| | - Per Winterdijk
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, The Netherlands.
| | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Center, De Boelenlaan 1117, 1081, HV, Amsterdam, The Netherlands. .,EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands. .,Department of Medical Psychology, Academic Medical Center (AMC), Meibergdreef 9, 1100, DD, Amsterdam, The Netherlands.
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Wyckoff L, Hanchon T, Gregg SR. PSYCHOLOGICAL, BEHAVIORAL, AND EDUCATIONAL CONSIDERATIONS FOR CHILDREN WITH CLASSIFIED DISABILITIES AND DIABETES WITHIN THE SCHOOL SETTING. PSYCHOLOGY IN THE SCHOOLS 2015. [DOI: 10.1002/pits.21848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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ŞAHİN N, ÖZTOP DB, YILMAZ S, ALTUN H. Assessment of Psychopathology, Quality of Life, and Parental Attitudes in Adolescents with Type 1 Diabetes Mellitus. Noro Psikiyatr Ars 2015; 52:133-138. [PMID: 28360693 PMCID: PMC5353187 DOI: 10.5152/npa.2015.7248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 01/02/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of the present study was to identify psychopathology, parental attitudes, perceptions of quality of life, and relationships between these factors in adolescents with type 1 diabetes mellitus (DM). METHODS Fifty adolescents (12-18 years old) with type 1 diabetes mellitus and 50 healthy adolescents and their parents were recruited for the study. Clinical interviews with the diabetic adolescents were performed using "Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL)." Both groups completed the "Depression Scale for Children," "State-Trait Anxiety Inventory," and "Health Related Quality of Life Scale for Children," while their parents completed the "Parental Attitude Research Instrument," "The Coping Strategy Indicator," and "Health Related Quality of Life Scale for Children-Parent Form." RESULTS The psychological disorder ratio in diabetic adolescents was 68%. No significant difference was found regarding perceptions of quality of life between the diabetic group and control group. However, diabetic adolescents with psychological disorder had reduced perception of quality of life than those without psychological disorder. Among parental attitudes, an authoritarian attitude was found to be more common in the diabetic group. It was found that among coping strategies, parents in the diabetic group use avoidance more commonly. CONCLUSION In the present study, a high rate of psychopathology was detected among adolescents with type 1 DM. In addition, no clear impairment in quality of life was reported in patients with type 1 DM; however, there was worsening in the perception of quality of life in the presence of psychiatric disorders accompanying diabetes. It was found that parents of diabetic children use inappropriate coping strategies and negative parental attitudes more often than those of healthy controls.
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Affiliation(s)
- Nilfer ŞAHİN
- Department of Child and Adolescent Psychiatry, Muğla Training and Research Hospital, Muğla, Turkey
| | - Didem Behice ÖZTOP
- Department of Child and Adolescent Psychiatry, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Savaş YILMAZ
- Department of Child and Adolescent Psychiatry, Konya Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Hatice ALTUN
- Department of Child and Adolescent Psychiatry, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
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Lord JH, Rumburg TM, Jaser SS. Staying Positive: Positive Affect as a Predictor of Resilience in Adolescents With Type 1 Diabetes. J Pediatr Psychol 2015; 40:968-77. [PMID: 25979081 DOI: 10.1093/jpepsy/jsv042] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/16/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents with Type 1 Diabetes (T1D) are at increased risk for diminished quality of life, deteriorating glycemic control, and psychological symptoms, yet some adolescents are able to adapt to the challenges associated with having diabetes exceptionally well. We sought to examine positive affect as a protective process predicting resilience over time in youth with T1D. METHOD Adolescents and their mothers completed questionnaire data, and HbA1c was obtained from adolescents' medical records at baseline and after 6 months. Adolescents were coded for observed positive mood during a videotaped interaction with their mothers. RESULTS Positive mood, including both self-report and observed mood, was associated with glycemic control, psychological symptoms, and quality of life. In addition, positive mood predicted improvements in glycemic control and externalizing problems over 6 months. CONCLUSIONS Positive affect emerged as a protective process for resilient outcomes in adolescents with T1D, suggesting novel targets for intervention in this high-risk population.
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Pinhas-Hamiel O, Hamiel U, Levy-Shraga Y. Eating disorders in adolescents with type 1 diabetes: Challenges in diagnosis and treatment. World J Diabetes 2015; 6:517-526. [PMID: 25897361 PMCID: PMC4398907 DOI: 10.4239/wjd.v6.i3.517] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/09/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Eating disorders (ED) are characterized by a persistent disturbance of eating that impairs health or psychosocial functioning. They are associated with increased rates of medical complications and mortality. Insulin omission is a unique purging behavior available to individuals with type 1 diabetes mellitus (T1DM). The standard treatment regimen for T1DM requires a major focus on food and eating patterns. Moreover, intensive insulin therapy is associated with increasing body weight. These factors, combined with the psychological burden of chronic disease management and depression, may contribute to ED. The comorbidity of ED in T1DM patients is associated with poorer glycemic control and consequently higher rates of diabetes complications. Early recognition and adequate treatment of ED in T1DM is essential.
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Kristensen LJ, Birkebaek NH, Mose AH, Hohwü L, Thastum M. Symptoms of emotional, behavioral, and social difficulties in the danish population of children and adolescents with type 1 diabetes--results of a national survey. PLoS One 2014; 9:e97543. [PMID: 24842772 PMCID: PMC4026318 DOI: 10.1371/journal.pone.0097543] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/22/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the prevalence of psychological difficulties in Danish children and adolescents with type 1 diabetes using both child/adolescent and caregiver reports, and to investigate associations between these symptoms and metabolic control, adherence, and quality of life. RESEARCH DESIGN AND METHOD A total of 786 children and adolescents (8-17 years) recruited through the Danish Registry of Childhood Diabetes completed subscales of the Beck's Youth Inventories (BYI-Y), while 910 caregivers completed the Strength and Difficulties Questionnaire (SDQ). The participants also completed questionnaires assessing adherence and quality of life. BYI-Y and SDQ responses were compared with results from normative samples. RESULTS Children with diabetes generally reported a lower level of symptoms of depression and anxiety, while older adolescents in most cases were comparable to the normative samples. However, the numbers of patients with elevated scores were similar to normative groups, especially regarding the proportion of participants with 'Extremely elevated' scores. Caregivers of children and adolescents with diabetes generally reported the prevalence of elevated scores on the SDQ to exceed the prevalence observed in the norm sample--particularly with regard to older boys. Both BYI-Y and SDQ responses were significantly correlated with HbA1c, adherence, and quality of life. CONCLUSIONS This study finds Danish children and adolescents with diabetes to report lower or comparable levels of emotional difficulties compared to norms, while caregiver reports are less positive. The results therefore support the value of a multi-informant approach to the assessment of symptoms of psychological difficulty in girls and boys with diabetes.
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Affiliation(s)
- Lene J. Kristensen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Niels H. Birkebaek
- Department of Pediatrics, Aarhus University Hospital, Aarhus N., Denmark
| | - Anne H. Mose
- Department of Pediatrics, Aarhus University Hospital, Aarhus N., Denmark
| | - Lena Hohwü
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Troncone A, Prisco F, Cascella C, Chianese A, Zanfardino A, Iafusco D. The evaluation of body image in children with type 1 diabetes: A case-control study. J Health Psychol 2014; 21:493-504. [DOI: 10.1177/1359105314529682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the body image perception in children with type 1 diabetes in order to identify symptoms of disordered eating behaviours early. Children with type 1 diabetes and controls showed underestimation and dissatisfaction with body size. The patients, especially girls, were more accurate in their perception of body size than the control group. The study sheds light on some of the underlying factors that may contribute to the development of disordered eating behaviours in adolescence. The causes of the differences of perception of body size are discussed.
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