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Glick BA, Chan Hong KM, Hoffman RP. Identifying depression, diabetes distress, and suicidality among adolescents with diabetes. SOCIAL WORK IN HEALTH CARE 2024; 63:489-500. [PMID: 39292600 DOI: 10.1080/00981389.2024.2400883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/26/2024] [Indexed: 09/20/2024]
Abstract
This study explored the frequency of adolescents with diabetes who endorse suicidality on the Patient Health Questionnaire (PHQ-9) with varying degrees of depression scores. Additionally, compared whether diabetes distress levels from the Problem Areas in Diabetes-Teen (PAID-T) assessment tool is associated with and without suicidal ideation. Χ2 analysis was used to assess differences in subjects with or without suicidal ideation based on depression severity. Since all the data were nonparametrically distributed (Shapiro-Wilk test, p < .05), Kruskal-Wallis test assessed differences in continuous variables. Overall, 27 of 355 adolescents screened endorsed suicidal ideation. Both PHQ-9 [13 (9-17.8) vs 1 (0-4.5)] and PAID-T [88 (61.8-104.5) vs 40 (30-58.8)] scores were significantly higher in patients with suicidal ideation. The frequency of suicidal ideation increased with the severity of depression. The frequency of severe depression was higher in adolescents with type 2 diabetes (n = 48) than in type 1, but there was no difference in suicidality. Adolescents with no demonstrable or minimal depression can still have potential suicidal ideation. Suicidality is a separate construct that should be screened routinely and apart from any measures screening for distress or adjustment disorders associated with adolescents experiencing life-long chronic conditions in a healthcare follow-up setting.
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Affiliation(s)
- Bethany A Glick
- Clinical Medical Social Work, Nationwide Children's Hospital, Columbus, OH, USA
| | - K Ming Chan Hong
- Clinical Medical Social Work, Nationwide Children's Hospital, Columbus, OH, USA
| | - Robert P Hoffman
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
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Addala A, Wong JJ, Penaranda RM, Hanes SJ, Abujaradeh H, Adams RN, Barley RC, Iturralde E, Lanning MS, Tanenbaum ML, Naranjo D, Hood KK. Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations. J Diabetes Complications 2023; 37:108514. [PMID: 37263033 DOI: 10.1016/j.jdiacomp.2023.108514] [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: 10/07/2022] [Revised: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
AIM Youth from lower socioeconomic status (SES) have suboptimal type 1 diabetes (T1D) outcomes. Patient reported outcomes (PROs) measure psychosocial states and are associated with T1D outcomes, however are understudied in low SES youth. We aimed to evaluate associations between PROs and public insurance status, a proxy for low SES. METHODS We analyzed survey data from 129 youth with T1D (age 15.7 ± 2.3 years, 33 % publicly insured) screened with PROMIS Global Health (PGH, measuring global health) and Patient Health Questionnaire (PHQ-9, measuring depressive symptoms) during diabetes appointments. Correlation and regression analyses evaluated differences in PGH and PHQ-9 by insurance status. RESULTS For youth with public insurance, lower global health correlated with lower self-monitoring blood glucose (SMBG; r = 0.38,p = 0.033) and older age (r = -0.45,p = 0.005). In youth with private insurance, lower global health correlated with lower SMBG (r = 0.27,p = 0.018) and female sex (rho = 0.26,p = 0.015). For youth with private insurance, higher depressive symptoms correlated with higher body mass index (r = 0.22,p = 0.03) and fewer SMBG (r = -0.35,p = 0.04). In multivariate regression analyses, public insurance was inversely associated with global health (p = 0.027). CONCLUSION PGH is a particularly salient PRO in youth with public insurance. Global health may be an important psychosocial factor to assess in youth with T1D from low SES backgrounds.
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Affiliation(s)
- Ananta Addala
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States; Stanford Diabetes Research Center, United States.
| | - Jessie J Wong
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | | | - Sarah J Hanes
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | | | - Rebecca N Adams
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Regan C Barley
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, United States
| | - Monica S Lanning
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Molly L Tanenbaum
- Stanford Diabetes Research Center, United States; Stanford University School of Medicine, Department of Medicine, Division of Endocrinology, Gerontology, and Metabolism, United States
| | - Diana Naranjo
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
| | - Korey K Hood
- Stanford University, Division of Pediatric Endocrinology, Stanford, CA, United States
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An Integrated Care Model to Support Adolescents With Diabetes-related Quality-of-life Concerns: An Intervention Study. Can J Diabetes 2023; 47:3-10. [PMID: 35843836 DOI: 10.1016/j.jcjd.2022.05.004] [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: 08/04/2021] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aim in this study was to determine whether participating in an integrated stepped care model for adolescents with type 1 diabetes (T1D) would lead to improvements in overall quality of life (QoL), diabetes-related quality of life (DRQoL) and glycated hemoglobin (A1C) levels compared with usual care. METHODS A nonrandomized, 2-group, pre/post, delayed-intervention design was used for this study. The Mind Youth Questionnaire (MY-Q) was used to assess QoL and DRQoL. Adolescents attending the diabetes clinic using the stepped care model formed the intervention group (n=77). These adolescents completed the MY-Q, and the identified concerns were discussed and addressed with them by their care team as part of the care model. Adolescents attending a pediatric diabetes clinic on another site completed the MY-Q as a comparison group (n=39), results were not shared with their care team, and they received the standard care. RESULTS There were 116 adolescents between 13 to 17 years of age, who completed the MY-Q on 2 occasions. Baseline data were obtained on the first occasion, and, on the second occasion, an average of 12 months later, there was a follow-up assessment. At follow-up, adolescents in the intervention group had a significantly higher overall QoL and reported significantly fewer concerns on DRQoL domains than those in the comparison group. Participation in the intervention group, however, did not lead to improvements in A1C. CONCLUSION This study shows that implementing an integrated stepped care model within an interprofessional pediatric diabetes clinic can lead to the improvement of adolescents' overall QoL and DRQoL.
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McVoy M, Hardin H, Fulchiero E, Caforio K, Briggs F, Neudecker M, Sajatovic M. Mental health comorbidity and youth onset type 2 diabetes: A systematic review of the literature. Int J Psychiatry Med 2023; 58:37-55. [PMID: 35026126 DOI: 10.1177/00912174211067335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Type 2 diabetes (T2D) is a burgeoning epidemic in children and adolescents. Adult T2D doubles the risk of depression and mental health comorbidity, makes it more difficult to make the lifestyle, medication adherence and health behavior changes needed to optimize outcomes. There is limited research on the impact of depression and depressive symptoms on youth T2D. METHODS A search of the literature in the last 10 years regarding youth with depression and T2D was conducted. Abstracts were screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by a third author. Selected full-text articles were divided among all authors for review. RESULTS 13 publications from 8 studies (N=2244, age 6-17) were included. 6 of 13 publications utilized Treatment Options for Type 2 Diabetes in Youth (TODAY) study data. While studies included evaluation of depressive symptoms, most did not formally assess for major depressive disorder (MDD) and excluded participants with a previous diagnosis of MDD. Depressive symptoms were common in this population and were associated with negative T2D outcomes. CONCLUSIONS While there is a growing body of adult literature highlighting the extensive relationship between T2D and mental health, there is a dearth of data in youth. Future studies are needed that include, 1.) youth with diagnosed MDD, 2.) treatment studies of both T2D and MDD, 3.) larger, more racially diverse samples of youth with T2D, and 4.) studies that evaluate the impact of social determinants of health, including mental health comorbidity on outcomes of T2D.
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Affiliation(s)
- Molly McVoy
- Department of Psychiatry, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,12304Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Neurological and Behavioral Outcomes Center, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Division of Child and Adolescent Psychiatry, Cleveland, OH, USA
| | - Heather Hardin
- Frances Payne Bolton School of Nursing, 15735Case Western Reserve University, Cleveland, OH, USA
| | - Erin Fulchiero
- Department of Psychiatry, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kate Caforio
- 2546Case Western Reserve University, Cleveland, OH, USA
| | - Farren Briggs
- Neurological and Behavioral Outcomes Center, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Division of Child and Adolescent Psychiatry, Cleveland, OH, USA
| | - Mandy Neudecker
- University Hospitals Cleveland Medical Center, 159284Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Neurological and Behavioral Outcomes Center, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Division of Child and Adolescent Psychiatry, Cleveland, OH, USA.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Hoffman RP, Damilano CP, Hong KMC, Glick BA, Kamboj MK. Glycemic control, depression, diabetes distress among adolescents with type 2 diabetes: effects of sex, race, insurance, and obesity. Acta Diabetol 2022; 59:1083-1089. [PMID: 35648254 DOI: 10.1007/s00592-022-01902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
AIMS To determine (1) differences in depression and distress scores between adolescents with type 1 (T1D) and type 2 diabetes (T2D), (2) how socioeconomic factors, obesity, race, and treatment regimen affect depression and diabetes distress in adolescent T2D, (3) the relationships between depression and diabetes distress scores in adolescents with T2D, and (4) how depression and diabetes distress scores relate to current and future glycemic control in adolescents with T2D. BACKGROUND Diabetes distress is a negative emotional reaction to diabetes complications, self-management demands, unresponsive providers, poor interpersonal relationships, and to diabetes itself. It is frequently mistaken for depression and the two are interrelated. Increases in both predict poor glycemic control in adolescents with T1D. METHOD Depression (PHQ-9) and diabetes distress (PAID-T) scores from self-administered tests were studied in 364 patients with diabetes between the ages of 13-17. Kruskal-Wallis test was used to assess differences between types of diabetes, sexes, races, and insurance status. Spearman correlations, and robust rank order multivariable regression analysis were used to assess relationships. Medical records were reviewed for follow-up hemoglobin A1c (HbA1c) levels over 3 years. RESULTS HbA1c was significantly lower in females with T2D than with T1D (p = 0.019) but not in males. It, also, did not differ between females and males with T2D. Median PHQ-9 score in females with T2D was significantly greater than in females with T1D (p = 0.007) but did not differ between females and males with T2D. PHQ-9 scores did not differ between males with T2D and T1D. PAID-T scores, however, were higher in males with T2D than in males with T1D but did not differ between females. PHQ-9 scores and PAID-T scores were significantly related in T2D (rs = 0.65, p < 0.001). Neither was related to HbA1c in T2D. CONCLUSIONS As in adolescents with T1D, depression and diabetes distress screening scores are closely related in adolescent T2D. However, unlike T1D, they are not related to glycemic control in T2D. Depression and diabetes distress may be more closely related to weight and lifestyle concerns.
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Affiliation(s)
- Robert P Hoffman
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Cecilia P Damilano
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - K Ming Chan Hong
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Bethany A Glick
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Manmohan K Kamboj
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
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Baechle C, Stahl-Pehe A, Castillo K, Lange K, Holl RW, Rosenbauer J. Course of screening-based depression in young adults with a long type 1 diabetes duration: Prevalence and transition probabilities - A cohort study. Diabetes Res Clin Pract 2022; 185:109220. [PMID: 35104568 DOI: 10.1016/j.diabres.2022.109220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/14/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
AIMS To extend the current knowledge of the prevalence and course of screening-based depression (SBD) and its predictors in emerging adults with a long type 1 diabetes duration. METHODS A total of 487 young adults (64.7% women, mean age 24.0 years) who participated in a nationwide cohort study provided data on SBD (Patient Health Questionnaire (PHQ-9) score ≥ 10). We estimated the overall and age- and sex-specific prevalence of SBD, identified the associated covariates, and determined the transition probabilities between SBD states using adjusted first-order Markov transition models. RESULTS The prevalence of SBD was 17.7% in women and 7.0% in men. A total of 70.4% (95%-CI 57.4%; 80.8%) of the participants with SBD at the first screening still had SBD at the three-year follow-up. Of the subjects without SBD at baseline, 6.9% (4.9%; 9.8%) had SBD at follow-up. The main predictor of current SBD was previous SBD (OR 39.0 (15.4; 98.6)), followed by living in one's own or in a shared apartment vs. living with both parents (OR: 2.75 (1.03; 7.36)). CONCLUSIONS Using an innovative analytical approach, emerging adults with a long diabetes duration demonstrated a moderate rate of incident SBD but a high rate of persistent SBD.
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Affiliation(s)
- Christina Baechle
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Katty Castillo
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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Prevalence of depression and anxiety among children with type 1 and type 2 diabetes: a systematic review and meta-analysis. World J Pediatr 2022; 18:16-26. [PMID: 34807367 DOI: 10.1007/s12519-021-00485-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evaluation of psychiatric disorders in children is essential in timely treatment. Despite individual studies, there is no information on the exact status of psychiatric disorders in children. The present study was conducted to determine the prevalence of depression among children with type 1 and type 2 diabetes. METHODS This meta-analysis is registered with PROSPERO (CRD42021231491). Several databases (Web of Science, Scopus, and PubMed) were searched from January 1, 2000 to December 15, 2020. The key words included: depression, anxiety, children, and diabetes. The steps of search, comprising screening, risk of bias, and extraction of study data, were performed separately by two researchers. RESULTS It was found that a total of 109 studies had been conducted involving 52,493 children with type 1 and type 2 diabetes. These studies were included in the present review study. The prevalence of depression, anxiety among children with type 1 diabetes were 22.2% [95% confidence interval (CI) 19.2-25.2], and 17.7% (95% CI 15.2-20.1), respectively. The prevalence of depression was higher among girls (29.7%) than boys (19.7%). The prevalence of depression was higher in lower-middle-income countries at 29.3% (95% CI 18.6-40.0). The prevalence of depression among children with type 2 diabetes was 22.7% (95% CI 17.3-28.0). CONCLUSION The results of the present study indicate the importance of paying attention to extensive periodic screening and appropriate activities to reduce pediatric depression.
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Hong KMC, Glick BA, Kamboj MK, Hoffman RP. Glycemic control, depression, diabetes distress among adolescents with type 1 diabetes: effects of sex, race, insurance, and obesity. Acta Diabetol 2021; 58:1627-1635. [PMID: 34213654 DOI: 10.1007/s00592-021-01768-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 01/09/2023]
Abstract
AIMS To determine whether diabetes distress or depression screening better predict increased hemoglobin A1c (HbA1c) and to assess interactions with age, sex, race, obesity, and insurance status. BACKGROUND Diabetes distress is a negative emotional reaction to diabetes, diabetes complications, self-management demands, unresponsive providers, and/or poor interpersonal relationships. Guidelines recommend annual depression screening, however diabetes distress may be mistaken for depression. METHOD Depression (PHQ-9) and diabetes distress (PAID-T) scores from self-administered tests were studied in 313 patients with type 1 diabetes (T1D) between the ages of 13-17. Spearman correlations and robust rank order multivariable regression analysis were used to assess relationships to age, duration, HbA1c. Kruskal-Wallis test was used to assess differences between sexes, races, and insurance status. Receiver operator curves (ROC) were constructed to see whether PAID-T or PHQ-9 scores more closely predicted HbA1c greater than 9%. RESULTS HbA1c was more strongly correlated with PAID-T (rs = 0.37, p < 0.01), than PHQ-9 (rs = 0.27, p < 0.01) scores. Area under ROC curve for poor HbA1c was 0.75 for PAID and 0.64 for PHQ-9. PAID-T and PHQ-9 scores were increased in females and subjects with public insurance and both were significantly related to HbA1c even when accounting for age, sex, race obesity, and insurance status. PHQ-9 and PAID-T scores correlated with BMI-Z scores in Blacks, but not Whites. CONCLUSIONS Both depression and diabetes distress are associated with increased HbA1c in adolescents with T1D, though distress is more so. Diabetes distress and depression should be routinely assessed in T1D adolescents, particularly those with public insurance.
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Affiliation(s)
- K Ming Chan Hong
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43105, USA
| | - Bethany A Glick
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43105, USA
| | - Manmohan K Kamboj
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, 43105, USA
| | - Robert P Hoffman
- Pediatric Endocrinology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Wong JJ, Hanes S, Iturralde E, Lanning MS, Naranjo D, Tanenbaum M, Hood KK. Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability. J Pediatr Psychol 2021; 46:332-340. [PMID: 33316061 DOI: 10.1093/jpepsy/jsaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Psychosocial screenings are recommended and increasingly common in pediatric subspecialty clinics, though little is known about their acceptability. This study seeks to uncover profiles of acceptability and assess demographic and clinical correlates among adolescents with diabetes. METHODS A sample of 124 adolescents (57.7% female) ages 12-21 years (M = 16.2 ± 2.3) completed screenings during routine diabetes appointments. K-means clustering of responses to acceptability items derived profiles; Analysis of Variance (ANOVA) and Chi-square tests assessed correlates. RESULTS Adolescents with the most common profile (72.6%) placed high importance on medical providers' awareness of their emotions and reported no difficulties/discomfort with the screener. These youth had moderate depressive symptoms, low diabetes distress, and low A1c. Those who fit a less common profile (18.5%) were uncomfortable with the screener and had the highest depressive symptoms and lowest A1c. Youth who fit a smaller profile (6.5%) endorsed technical difficulties and had high depressive symptoms and lowest diabetes distress. The smallest profile (2.4%, N = 3) had difficulty understanding and experienced discomfort with the screening and had the lowest depressive symptoms and the highest diabetes distress and A1c. These differences in depressive symptoms (F = 3.54, p = .017), A1c values (F = 4.03, p = .009), and diabetes distress (F = 3.27, p = .036) were significant though differences in age, gender, and diabetes duration were not. CONCLUSIONS Most youth responded favorably to in-clinic psychosocial screenings. Youth who were less satisfied were at increased risk for psychosocial and medical complications. Findings highlight areas of need, such as enhanced support with and an emphasized rationale for screenings, which may improve patient experience in subspecialty care.
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Affiliation(s)
- Jessie J Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Sarah Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California
| | - Monica S Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Molly Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
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Monaghan M, Mara CA, Kichler JC, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Stone JY, Hood KK, Mulvaney SA. Multisite Examination of Depression Screening Scores and Correlates Among Adolescents and Young Adults With Type 2 Diabetes. Can J Diabetes 2021; 45:411-416. [PMID: 33722492 DOI: 10.1016/j.jcjd.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Our aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. METHODS The Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. RESULTS Adolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. CONCLUSIONS Screening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Research, Children's National Hospital, Washington, District of Columbia, United States.
| | - Constance A Mara
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Sarah C Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Alana Rawlinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Laura M Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, United States
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jenine Y Stone
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shelagh A Mulvaney
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Hamburger ER, Goethals ER, Choudhary A, Jaser SS. Sleep and depressive symptoms in adolescents with type 1 diabetes not meeting glycemic targets. Diabetes Res Clin Pract 2020; 169:108442. [PMID: 32941959 PMCID: PMC7736492 DOI: 10.1016/j.diabres.2020.108442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
AIMS Adolescents with type 1 diabetes (T1D) are at risk for problems with self-management and suboptimal glycemic control, and depressive symptoms and sleep disturbances predict poorer diabetes outcomes. Despite evidence for associations between adolescent depressive symptoms and sleep in the general population, few studies have investigated this link in the vulnerable group of adolescents with T1D not meeting glycemic targets. The current study sought to assess both depressive symptoms and sleep in relation to diabetes indicators in adolescents with T1D. METHODS 120 adolescents (ages 13-17 years) with above target glycemic control completed measures of depressive symptoms, sleep duration and quality, and self-management; parents also reported on adolescents' diabetes management. Clinical data (i.e., HbA1c) were extracted from medical records. RESULTS In our sample, 40% of adolescents reported at least mild depressive symptoms, and 26% reported clinically significant sleep disturbances. Adolescents with sleep disturbances were more likely to report at least mild symptoms of depression, and both depressive symptoms and sleep quality were associated with poorer diabetes management. No significant differences emerged regarding HbA1c or frequency of blood glucose monitoring. CONCLUSIONS The current findings highlight the importance of clinical assessment of both depressive symptoms and sleep in the vulnerable group of adolescents with T1D.
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Affiliation(s)
| | - Eveline R Goethals
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States; KU Leuven, Leuven, Belgium
| | - Arjun Choudhary
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, United States.
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12
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Taş D, Mengen E, Kocaay P, Uçaktürk SA. The Effects of Risk Behaviors and Orthorexic Behavior on Glycemic Control in Adolescents with Type 1 Diabetes. J Clin Res Pediatr Endocrinol 2020; 12:233-240. [PMID: 31722516 PMCID: PMC7499139 DOI: 10.4274/jcrpe.galenos.2019.2019.0128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022] Open
Abstract
Objective Adolescents with chronic disease are as likely to exhibit risk-taking behavior as their peers. The aim was to investigate the risk behaviors of adolescents with type 1 diabetes (T1D) and the effect of orthorexic eating behaviors (OEB) on glycemic control (GC). Methods This cross-sectional study was conducted with 107 adolescents with T1D, aged between 13-18 years and attending high school. The Risk Behavior Scale (RBS) and Orthorexic Behavior Scale (ORTO-11) were administered. A high RBS score indicates risky behavior; a low ORTO-11 score suggests a tendency to OEB. Participants hemoglobin A1c (HbA1c) status was used to assess GC: optimal GC (HbA1c ≤7%); or poor GC (HbA1c >7%). Results Among females, those with poor GC had significantly lower (p=0.031) ORTO-11 scores than those with optimal GC, which was not the case in males. A significant correlation (r=0.358, p<0.001) was found between HbA1c and total RBS, eating habits subscale, and suicidal tendency subscale scores. Participants with poor GC had significantly higher eating habits subscale, alcohol use, and tobacco use subscale scores (p<0.05). Among females, total RBS and suicidal tendency subscale score was found to be significantly higher in those with poor GC; among males, alcohol subscale score was found to be significantly higher in those with poor GC. Conclusion This study is the first to show the effect of the tendency for OEB on GC among female adolescents with T1D. The study showed that, along with inappropriate eating behaviors, adolescents with T1D should also be assessed for other risk behaviors to help achieve optimal GC.
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Affiliation(s)
- Demet Taş
- Ankara City Hospital, Children’s Hospital, Clinic of Pediatrics, Ankara, Turkey
| | - Eda Mengen
- Ankara City Hospital, Children’s Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Pınar Kocaay
- Ankara City Hospital, Children’s Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Seyit Ahmet Uçaktürk
- Ankara City Hospital, Children’s Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
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13
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Abstract
PURPOSE OF REVIEW To examine developments in the understanding of certain aspects of depression in diabetes mellitus patients with a special focus on diabetes distress, screening of depression and its management in persons with type 2 diabetes mellitus. RECENT FINDINGS Recent studies reviewed indicate an increasing trend of both major and minor depression in patients with diabetes. Depression is also reported to be persistent and chronic in diabetes patients. There is a bidirectional link between depression and diabetes. Diabetes-related distress independently increases the diabetes-related complications. Collaborative care is both applicable and helpful in managing depression in diabetes. SUMMARY Although a significant number of patients with diabetes suffer from depression or diabetes-related distress, majority of them remain undiagnosed and untreated. This treatment gap suggests the need for routine screening for depression and distress in patients with diabetes. Studies have confirmed that treatment focussing on diabetes may alleviate depressive symptoms. Diabetes-specific psychological interventions may prove useful in improving diabetes self-management in depressed diabetes patients. Effect of specific psychopharmacological and psychological interventions in treating depression in diabetes patients should be examined in future studies.
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14
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Wong JJ, Addala A, Abujaradeh H, Adams RN, Barley RC, Hanes SJ, Iturralde E, Lanning MS, Naranjo D, Tanenbaum ML, Hood KK. Depression in context: Important considerations for youth with type 1 vs type 2 diabetes. Pediatr Diabetes 2020; 21:135-142. [PMID: 31644828 DOI: 10.1111/pedi.12939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type. OBJECTIVE Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes. METHODS A sample of 149 youth ages 12 to 21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type. RESULTS Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = .025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -.98, P < .001) than type 1 (β = -.48, P < .001). Further probing revealed that among youth with better global health, adolescents with type 1 had more depressive symptoms than those with type 2 diabetes (β = .33, P = .035). Diabetes duration and depressive symptoms were positively associated among individuals with type 2 (β = .86, P = .043), but not type 1 diabetes. No gender differences were detected. CONCLUSION These findings suggest that correlates of depressive symptoms in youth with diabetes differ by diabetes type. Global health appears to be an important correlate among youth with both types, whereas diabetes duration was only a significant factor among those with type 2 diabetes. The current findings can inform future psychosocial intervention efforts within both these populations.
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Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Ananta Addala
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Hiba Abujaradeh
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Regan C Barley
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Esti Iturralde
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Monica S Lanning
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Diana Naranjo
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Korey K Hood
- Department of Pediatrics, Stanford University, Palo Alto, California
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15
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Duffus SH, Cooper KL, Agans RP, Jain N. Mental Health and Behavioral Screening in Pediatric Type 1 Diabetes. Diabetes Spectr 2019; 32:171-175. [PMID: 31168290 PMCID: PMC6528398 DOI: 10.2337/ds18-0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara H. Duffus
- Division of Endocrinology, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Katherine L. Cooper
- Division of Endocrinology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Robert P. Agans
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Nina Jain
- Division of Endocrinology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
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