Anxiety and Depressive Symptoms in Adolescents with Type 1 Diabetes

Abstract

This research abstract was the winner of the 2022 NAPNAP Research Poster Award. Category/Date Clinical Research Podium Presentations: Research on Adolescents: Depression, Diabetes, Drugs. Presented at NAPNAP's 43rd National Conference on Pediatric Health Care, April 29th, 2022 Purpose The purpose of this secondary data analysis was to examine anxiety and depressive symptoms in adolescents with Type 1 diabetes (T1D) to determine differences based on school grade level and disease duration. Background T1D is one of the most prevalent chronic conditions in children and adolescents worldwide; its incidence is rising 3% per year. Over 200,000 youth under the age of 18 in the United States are currently living with T1D. The chronic nature of T1D, combined with the demands of the daily treatment regimen, increase the risk of mental health comorbidity, particularly anxiety and depressive symptoms. Anxiety and depressive symptoms are 2 to 3 times more prevalent in adolescents with T1D than in the general adolescent population and are associated with out-of-range glycemic control, severe hypoglycemia, and ketoacidosis. Reducing the burden of anxiety and depressive symptoms may be a key part of improving glycemic control and reducing long-term complications in this high-risk population. Methods After obtaining IRB approval, we conducted a secondary data analysis of baseline data collected from a previous research study validating a measure of diabetes-specific anxiety. The data set included the following self-report measures: demographic characteristics (age, race/ethnicity, disease duration, insulin pump use), general anxiety symptoms (Generalized Anxiety Disorders 7), and general depressive symptoms (Patient Health Questionnaire 2). Data was electronically collected through REDCap. We conducted descriptive statistics, bivariate, and multivariate analyses. Results A total of 147 adolescents aged 13-17 years old (M=14.5+1.26 years) were included in the analysis. Of these adolescents, 32% (n=47) were in middle school (grades 6 to 8) and 68% (n=100) were in high school (grades 9 to 12). Most participants (67.3%, n=99) had been diagnosed with diabetes for less than 3 years, with 41.4% (n=41) of these in middle school and 58.6% (n=58) of these in high school. Mean general anxiety scores were 9.78+5.13, indicating mild to moderate anxiety symptoms, and mean depressive symptom scores were 2.75+1.76, where scores above 3 indicate major depressive disorder likely. When controlling for demographic covariates and length of time since diagnosis, middle schoolers were more likely to report clinically significant depressive symptoms compared to their high school peers. However, this relationship was not seen with general anxiety symptoms. Without controlling for grade level, participants with less time since diagnosis were more likely to report clinically significant anxiety symptoms. Discussion The results of this secondary data analysis highlight the importance of screening and treatment for anxiety and depression in adolescents with T1D. Younger adolescents may be at a higher risk of a clinically significant symptom burden from depression and therefore should be closely screened at regular clinic visits. Adolescents newly diagnosed with T1D may be at a higher risk of suffering from anxiety symptoms than those who have been living with T1D for several years. Future research should be aimed at tailoring psychosocial interventions with particular attention to an adolescent's age and disease duration. This research abstract was the winner of the 2022 NAPNAP Research Poster Award. Clinical Research Podium Presentations: Research on Adolescents: Depression, Diabetes, Drugs. Presented at NAPNAP's 43rd National Conference on Pediatric Health Care, April 29th, 2022 The purpose of this secondary data analysis was to examine anxiety and depressive symptoms in adolescents with Type 1 diabetes (T1D) to determine differences based on school grade level and disease duration. T1D is one of the most prevalent chronic conditions in children and adolescents worldwide; its incidence is rising 3% per year. Over 200,000 youth under the age of 18 in the United States are currently living with T1D. The chronic nature of T1D, combined with the demands of the daily treatment regimen, increase the risk of mental health comorbidity, particularly anxiety and depressive symptoms. Anxiety and depressive symptoms are 2 to 3 times more prevalent in adolescents with T1D than in the general adolescent population and are associated with out-of-range glycemic control, severe hypoglycemia, and ketoacidosis. Reducing the burden of anxiety and depressive symptoms may be a key part of improving glycemic control and reducing long-term complications in this high-risk population. After obtaining IRB approval, we conducted a secondary data analysis of baseline data collected from a previous research study validating a measure of diabetes-specific anxiety. The data set included the following self-report measures: demographic characteristics (age, race/ethnicity, disease duration, insulin pump use), general anxiety symptoms (Generalized Anxiety Disorders 7), and general depressive symptoms (Patient Health Questionnaire 2). Data was electronically collected through REDCap. We conducted descriptive statistics, bivariate, and multivariate analyses. A total of 147 adolescents aged 13-17 years old (M=14.5+1.26 years) were included in the analysis. Of these adolescents, 32% (n=47) were in middle school (grades 6 to 8) and 68% (n=100) were in high school (grades 9 to 12). Most participants (67.3%, n=99) had been diagnosed with diabetes for less than 3 years, with 41.4% (n=41) of these in middle school and 58.6% (n=58) of these in high school. Mean general anxiety scores were 9.78+5.13, indicating mild to moderate anxiety symptoms, and mean depressive symptom scores were 2.75+1.76, where scores above 3 indicate major depressive disorder likely. When controlling for demographic covariates and length of time since diagnosis, middle schoolers were more likely to report clinically significant depressive symptoms compared to their high school peers. However, this relationship was not seen with general anxiety symptoms. Without controlling for grade level, participants with less time since diagnosis were more likely to report clinically significant anxiety symptoms. The results of this secondary data analysis highlight the importance of screening and treatment for anxiety and depression in adolescents with T1D. Younger adolescents may be at a higher risk of a clinically significant symptom burden from depression and therefore should be closely screened at regular clinic visits. Adolescents newly diagnosed with T1D may be at a higher risk of suffering from anxiety symptoms than those who have been living with T1D for several years. Future research should be aimed at tailoring psychosocial interventions with particular attention to an adolescent's age and disease duration.