Mental Health and Behavioral Screening in Pediatric Type 1 Diabetes.

Abstract

Mental health comorbidities are increasingly being recognized in children and adolescents with type 1 or type 2 diabetes (1–3). Several studies have found increased rates of depressive symptoms (1), clinical depression (2), and anxiety disorders (3) in pediatric patients with type 1 diabetes when compared to healthy peers. Some studies have also identified an association between poor glycemic control and more severe depression scores (4,5). Additional mental health and behavioral issues have been described in this population, including disordered eating behaviors and attention-deficit hyperactivity disorder (ADHD) (3,6). A wide variety of screening tools have been used in the diabetes population in attempts to identify patients with mental health comorbidities. These include the Patient Health Questionnaire-9 (4,7), the Children’s Depression Inventory (1), Beck’s Depression Inventory (5), and the Screen for Childhood Anxiety Related Emotional Disorders (5). However, a combination of several different screening tools is required to adequately identify the wide range of mental health and behavioral comorbidities that exist within the pediatric diabetes population. The Strengths and Difficulties Questionnaire (SDQ) has emerged as a more comprehensive tool for assessing mental health comorbidities in children with a variety of chronic diseases, including asthma, chronic kidney disease, primary antibody deficiency, and neurological disorders (8–10). The advantage of the SDQ is that it is a relatively short instrument that screens for a wider range of psychosocial and behavioral issues than other commonly used assessment tools, identifying symptoms of anxiety, depression, hyperactivity-inattention, conduct disorder, and peer relationship problems (11). The aim of this study was to examine the results of routine mental health and behavioral screening in children and adolescents with type 1 diabetes using the SDQ Self-Reported Version when compared to screening results from children without chronic disease. Clinically, the purpose …