1798-PUB: Clinical Factors Associated with Positive Depression Screen in Youth with Type 1 Diabetes Before and During the COVID 19 Pandemic

Abstract

We have previously shown that 1 out of 5 adolescents with type 1 diabetes (T1D) scored positive for depression with no differences between 2019 (pre pandemic) vs 2020 (pandemic). We aimed to identify clinical factors associated with a positive screen and if these differ pre (2019) and during (2020) the pandemic in a large academic children’s hospital. We included 239 adolescents with T1D who completed a PHQ-9 screen in both years (52% female, 97 % non-Hispanic white, mean (SD) age 15.1 ± 1.7 years, T1D duration 7.0 ± 4.0 years, 54% and 63% were on insulin pumps, 68% and 62% were on continuous glucose monitors in 2019 and 2020 respectively. In 2019 12%, 4% and 3% had mild (PHQ-9 score 5-9), moderate (score 10-14), and severe (score >15) depression respectively with similar rates in 2020 at 9%, 3% and 3%. In univariable logistic regression, elevated HbA1c (OR 1.59, p<0.001) and prior mental health history (OR 15.5, p<0.001) increased the odds of a positive screen in 2019, but not age (p=0.94), diabetes duration (p=0.64) or pump/CGM use (p=0.33/p=0.16). Similar findings were seen in 2020. Proportion of adolescents with a positive 2019 screen who were not in counseling (n=6, 14%) doubled in 2020 (n=10, 29%), possibly reflecting inadequate access to services during the pandemic, albeit small numbers. There was no association between a positive depression screen and screening for comorbidities (thyroid, celiac disease, and dyslipidemia) or complications (nephropathy and retinopathy) in 2019 or 2020. Though the prevalence of depression did not change during the pandemic, the most vulnerable groups were those with pre-existing mental health diagnoses and uncontrolled diabetes. This highlights the need for continued mental health therapy services in this group. Screening for comorbidities or complications was not associated with a positive depression screen which is reassuring and may relate to these screens being done in clinic, including screening for retinopathy. Disclosure S.Sriram: None. C.March: None. L.M.Leikam: None. J.Schreiber: None. R.Muzumdar: None. I.Libman: Advisory Panel; Novo Nordisk.