682-P: Intersectionality among Health-Related Social Needs Predicts Poor Mental Health among Youth and Young Adults with Diabetes

Abstract

Little is known about how multiple health-related social needs may overlap to contribute to increased risk for poor mental health outcomes among youth and young adults (YYA) with diabetes. This study aims to understand how household food insecurity (HFI) intersects with other health-related social needs to influence poor mental health among YYA with type 1 diabetes (T1D). Analyses included a total of 829 YYA with T1D from the SEARCH Food Security Cohort study. Classification tree analysis was used to identify patterns among 11 health-related social needs, demographic, and socioeconomic characteristics that distinguish between moderate-to-severe and minimal-to-mild depressive symptoms. Health-related social needs included HFI, housing insecurity, need for reliable transportation, and experiences of discrimination. HFI was measured using the USDA Household Food Security Survey Module and experiences of discrimination were measured using the Everyday Discrimination Scale. The outcome of depressive symptoms was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale. Overall, 35.6% reported moderate-to-severe depressive symptoms and 27.6% of YYA with T1D had anxiety symptoms; however, in the food insecure group, 73% and 56% were affected, respectively. Discrimination intersected with HFI among YYA with T1D such that 86% of YYA experiencing greater discrimination and HFI reported moderate-to-severe depressive symptoms (compared to 47% among the food secure group). In those reporting less discrimination, this corresponded to 56% and 17%, respectively. Adding discrimination to the model that included HFI, demographic, and socioeconomic measures improved the prediction accuracy (AUC= 0.71 versus AUC= 0.64). Study findings have implications for interventions to address multiple health-related social needs to decrease mental health problems among YYA with T1D. Disclosure A.D.Brown: None. A.Bellatorre: None. F.Malik: None. A.D.Liese: None. E.A.Frongillo: None. K.Flory: None. M.Lohman: None. J.Wei: None. J.A.Mendoza: None. B.A.Reboussin: None. E.T.Jensen: Consultant; Regeneron. L.M.Dolan: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK117461-01, 1UC4DK108173); National Institute of General Medical Sciences (T32GM081740)