Why are young people with diabetes distressed?

Abstract

1 ISSN 1758-1907 10.2217/DMT.11.61 © 2012 Future Medicine Ltd Diabetes Manage. (2012) 2(1), 1–4 Recent data from two large international studies (the Finnish Diabetic Nephropathy Study and the Pittsburgh Epidemiology of Diabetes Complications Study) have indicated that the lifespan of current young patients with Type 1 diabetes without kidney disease is close to normal. Other data from numerous sources including the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) studies indicate that diabetic kidney disease is becoming less frequent and will only affect a minority of patients with Type 1 diabetes who are now young. Thus, the prognosis for our current cohort of young people with Type 1 diabetes has improved significantly. Why then are they so depressed and anxious? Data from several Australian research studies and surveys consistently indicate that approximately one in three adolescents and young adults with Type 1 diabetes suffer from significant depression, anxiety or disordered eating behavior [1,2]. This is approximately double the background rate of mental-health disorders in age-matched control groups. Mental-health needs, ‘diabetes distress’ or ‘diabetes burn-out’ are also reflected in the ‘Statement of Issues’ by the Australian consumer group, The Type 1 Diabetes Network [101]. Disturbed mental health is arguably now the leading complication of Type 1 diabetes in this younger group. One of the main questions that has been driving our research activities is why? There are plenty of existential reasons as to why young people might feel challenged by life with diabetes. There is the omnipresent, Damoclean threat of hypoglycemia, ongoing painful treatment regimens, perceived dietary restrictions, difficulties in balancing a multidimensional condition that can become unstable without warning with a sprinkling of parental guilt as to the origins of an illness that can’t be adequately explained. These are all strong and unremitting reasons as to why our patients and their parents (mothers in particular) should feel psychologically challenged by Type 1 diabetes. Thankfully the majority appear to be able to cope with this psychic burden, but for some the challenges are too great. These people must be supported for many reasons not the least of which is that ongoing mental-health issues are a strong predictor of sudden death in diabetic patients in their 20s and 30s [3]. We and others have strongly advocated that mental-health screening should be part of routine care for young people with diabetes, particularly before their transition to adult services [4].