Suicidal Screening in Youth with T1D—Risk or Benefit?

Abstract

Objectives: Insulin access with intent to overdose coupled with limited forethought and higher impulsivity during childhood and adolescence, makes identification of suicidal ideation (SI) among youth with type 1 diabetes (T1D) of high importance. Correlations between SI and poor diabetes self-management have been identified, with 13% of adolescents with T1D endorsing SI in the last 12 months. The present study aimed to determine feasibility and effectiveness of screening for SI in youth with T1D. Methods: Data were obtained during routine behavioral health screening of youth (ages 11-18) with T1D at a regional diabetes center. SI data were derived from question 9 of the Patient Health Questionnaire-9 (PHQ-9), “Thoughts that you would be better off dead or of hurting yourself in some way.” Results: PHQ-9 was completed by a total of 587 pediatric patients (Males =289; Females =298) with a mean HbA1c of 9.1% (SD= 2.2). Findings suggest a significant relationship between gender and endorsement of SI with more females endorsing SI (n=52) than males (n = 26). SI was significantly and positively associated with HbA1c. Of the 13% of youth who screened positive for SI, 3/4 indicated SI for several days in the last 7 days and received an on-site behavioral health consultation. Approximately, 1/5 indicated SI for more than 1/2 of the days in the last week and received an onsite referral and a telephone follow-up, and 5% indicated SI nearly every day in the last week and received an on-site clinical assessment with one youth requiring emergency services. Conclusions: SI screening in youth with T1D is necessary to address this concern. Results suggest our protocol was effective in identifying SI, allowed for rapid clinical assessment, and referral for additional care. In addition, SI rates in youth with T1D were consistent with the general population, suggesting that diabetes does not put youth at higher risk for SI, but imposes greater concern for suicide given the immediate availability of insulin. Disclosure H. Nagra: None. D.C. Duke: None. M. Jones: None. K. Kraus: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.