Establishing a Clinical Cut-Point for the PAID-Peds (Problem Areas in Diabetes-Pediatric) Survey

Abstract

Limited access to pediatric diabetes mental health care suggests a need to readily identify youth requiring referral. The current study aimed to establish a clinically meaningful cut-point on the PAID-Peds, a previously validated measure of diabetes distress in youth with type 1 diabetes (T1D). The 20-item PAID-Peds has shown construct validity with measures of depressive symptoms, diabetes-specific family conflict (DSFC), and general quality of life (QoL). Higher scores (range 0-100) indicate more distress. ROC analyses in youth 8-17 years old compared PAID-Peds scores against established clinical cutoffs for depressive symptoms on the Center for Epidemiological Studies - Depression Scale (CES-D) and Depression Scale for Children (CES-DC) to identify a meaningful clinical cutoff for the PAID-Peds. Confirmation of the cutoff score included assessment of convergent validity with glycemic control and teen-reported measures of treatment adherence, diabetes specific family conflict, and QoL. The sample included 427 youth ((M±SD) age 14.3±2.1 years, T1D duration 6.4±3.7 years, and A1c 8.4±1.1%); 49% were male, 83% white, 83% from 2-parent families, and 69% pump-treated. ROC analyses identified a cut-point of 41, with sensitivity of 79%, specificity of 69%, and negative predictive value (NPV) of 94%. Youth with PAID-Peds scores ≥41 (n=168) vs. <41 were more likely to be female (59 vs. 45%), perform less frequent BG monitoring (4.8 vs. 5.5x/day), and have higher A1c (8.6 vs. 8.2%) (p <.01 for all). Youth endorsing more distress (≥41 vs. <41) also reported lower adherence and QoL, and more DSFC (p <.001 for all). The cutoff score of 41 on the PAID-Peds has acceptable sensitivity, specificity, and NPV, and warrants future assessment in clinical research and practice. Establishing a cut-point for clinically meaningful diabetes distress may help clinicians to identify youth at risk for poorer biomedical and psychosocial outcomes, thereby prompting timelier referral for mental health support. Disclosure P.V. Commissariat: None. L.J. Tinsley: None. L. Volkening: None. D.A. Butler: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..