Mental Health Comorbidities Research Articles

BH02 Online psychological support for patients with alopecia areata: an evaluation of available online psychological support material based on the National Centre for Complementary and Integrated Health guidelines

Abstract Alopecia areata is an autoimmune disorder causing nonscarring hair loss that is associated with significant psychological comorbidity (Macbeth AE, Holmes S, Harries M et al. The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care. Br J Dermatol 2022; 187:73–81). In addition to seeking psychological support from medical professionals, patients will often turn to online resources. In this study, we evaluated the range and quality of the online psychological support material available for patients with alopecia areata. A Google search was undertaken using private browsing on 5 June 2022, with several search terms: ‘alopecia areata online support group UK’, ‘alopecia support’ and ‘alopecia areata psychology’. The National Centre for Complementary and Integrated Health (NCCIH) guidelines for the evaluation of online resources were used. These guidelines assess information source and accuracy, funding, peer review status, linking policies and contemporaneity. Our search generated a total of 154 000 results. Advertisements, scientific articles, educational resources and duplicates were excluded, with nine resources included in the final analysis. Of the nine resources reviewed, three were specific for patients with alopecia areata, with the remaining resources focused on other types of hair loss. Six were authored or reviewed by dermatologists and seven had a documented peer review process of their content. One resource had no clear authorship and three had no clear peer review process. Nine of the resources were charity funded and one was a National Health Service resource. Four had been updated in the last 3 years and a further two within 5 years. All resources had clearly documented security and linking policies. All resources acknowledged the psychological impact of hair loss and eight had links to support groups or discussion forums. Only five had psychological support and advice on their website, with others only referring to the psychological burden and then signposting patients on to other sources for support. Only three of the resources referred to therapies such as cognitive behavioural therapy. The prevalence of mental health comorbidity in alopecia areata is high compared to the general population (Macbeth et al.). Our preliminary study has shown that the online psychological support available is lacking. With patients increasingly turning to the Internet for support and health information, there is an opportunity and need for development in this area.

Substance Use and Mental Health Comorbidities and Receipt of Specialty Care Among Patients Enrolled in a Low-Barrier HIV Clinic.

Low-barrier care is one model of a differentiated service delivery approach for people with HIV (PWH) who are not engaged in conventionally-organized HIV care. Although psychiatric and substance use disorders are common among patients in low-barrier clinics, approaches to behavioral health service delivery within this context have not been well-described. We conducted a descriptive analysis using retrospective review of medical records to evaluate substance use and psychiatric comorbidities and receipt of behavioral health services among patients in the Max Clinic in Seattle, Washington. Among 227 patients enrolled from 2015 to mid-2020, most had a history of hazardous substance use (85%), a psychiatric diagnosis (69%) or unstable housing (69%) documented in the medical record. Less than half of patients referred for depression treatment (33%) or for opioid use disorder treatment (40%) completed even one specialty care visit. More effective approaches are needed to engage patients in behavioral health services within the context of low-barrier HIV care.

Goals and Reasons for Entering Inpatient Withdrawal Treatment, and Perceptions of Help Received

Objective Abstinence has been the primary treatment goal for alcohol and other drug (AOD) users attending withdrawal treatment. However, other outcomes including harm reduction have also been identified. This observational study aimed to describe participants’ goals and reasons for seeking inpatient withdrawal treatment and compare the needs of clients with comorbid mental health problems and those without. Methods Participants completed questionnaires at intake and discharge. Questionnaires assessed reasons for entering withdrawal treatment, goals, comorbidity, and perceived help received. Results The sample comprised 1746 participants (69.4% male). Participants endorsed diverse reasons for entering withdrawal treatment. The most and least endorsed reasons were “stop using” (97.9%) and “legal reasons” (43.1%). Comorbidity groups varied significantly in their endorsement of reasons for mental health, physical health, harm reduction, financial, and legal. Conclusion AOD users enter withdrawal treatment with a variety of reasons and goals including harm reduction. Variations in rates of endorsement highlight the importance of identifying individual needs dependent on mental health comorbidity.

The association between lifetime trauma exposure typologies and mental health outcomes among veterans

We know little about veterans’ lifetime trauma exposure patterns and how such patterns are associated with mental health outcomes. This study sought to identify lifetime trauma exposure typologies among veterans and examine associations between these typologies and mental health outcomes. It used baseline data from a national longitudinal mail-based survey of 3,544 veterans and oversampled for women (51.6%) and veterans living in high crime areas (67.6%). Most veterans (94.2%) reported trauma exposure, and 80.1% reported exposure to two or more traumas. Prevalence of mental health outcomes was: 27.7% anxiety, 31.3% depression, 37.9% posttraumatic stress disorder, 44.4% alcohol use disorder, 10.4% suicide attempt, and 33.5% mental health comorbidity. Latent class analysis was used to identify patterns of lifetime trauma exposure and logistic regression was used to examine the odds of mental health outcomes as a function of class membership. Five lifetime trauma exposure typologies emerged: (1) low trauma; (2) high combat and community violence; (3) intimate partner violence trauma; (4) high global physical assault; and (5) high trauma. Classes showed differential associations with mental health outcomes. Findings have implications for clinical practice including informing providers’ mental health treatment plans to correspond to each veteran's trauma exposure typology.

A Call for Discovery and Therapeutic Development for Cutaneous Neurofibromas

A Call for Discovery and Therapeutic Development for Cutaneous Neurofibromas

Post-Traumatic Stress Disorder in Patients with Alopecia Areata: A Survey Study in the USA

Introduction: Alopecia areata (AA) is an autoimmune condition that results in nonscarring hair loss. AA is comorbid with mental health disorders including anxiety and depression. This study aimed to evaluate the presence of post-traumatic stress disorder (PTSD) in relation to hair loss in patients with AA. Methods: A cross-sectional national survey was distributed using the National Alopecia Areata Foundation’s (NAAF) email list. This study was approved by the Mass General Brigham Institutional Review Board. Participants were asked to complete the PTSD Checklist for the DSM-5 (PCL-5), a validated screening tool for PTSD in the context of their AA. Results: Of the 1,449 completed surveys (completion rate 79.6%), most respondents were female (83.8%) and white (76.6%) with an average age of 50.6 ± 15.6 years. Respondents had AA for an average of 17.7 ± 15.8 years, with 91.4% experiencing current active hair loss. A total of 33.9% of respondents screened positively for PTSD, with an average score of 48.8 ± 12.3 on the PCL-5 in participants who screened positively. Participants with alopecia totalis have the highest average PCL-5 score of 30.1 ± 19.2, followed by participants with alopecia universalis with an average score of 26.0 ± 19.9, and lastly patchy AA with an average score of 24.5 ± 18.3 (p = 0.003). Feelings of intrusion and avoidance were the predominant reported symptoms. Total PTSD scores were significantly higher in respondents who were younger and identified as Black or African American and Hispanic when compared to white and non-Hispanic respondents, respectively. Conclusion: These findings identify that one in 3 patients with AA in this cohort meet the screening criteria for PTSD specifically relating to their hair loss experience. These results further highlight the mental health comorbidities associated with AA and emphasize that these symptoms may persist even after hair regrowth. Limitations include the nonrandomized NAAF population with most participants being white females. Future studies should confirm these findings in other patient populations. Finally, respondent’s baseline mental health was not assessed; therefore, a causal relationship between AA and PTSD cannot be deduced.

Anxiety and Depression Diagnoses and the Cough Severity Index: A Retrospective Study.

Background: As mental health comorbidities can impact patient perception of symptoms, understanding a potential association of anxiety and depression with patients' perception of their cough may provide insight into preferred treatment plans. Methods: A retrospective cohort study of patients presenting with chronic cough was completed. Demographics, anxiety and depression diagnoses, and patient-reported outcome measures were collected. Patient-reported outcomes between the four groups of patients-anxiety only, depression only, anxiety and depression, and none of these conditions-were compared using Kruskal-Wallis and Mann-Whitney U tests that were used for post-hoc analysis. Results: Cough Severity Index scores were higher in those with both anxiety and depression as compared to neither, with a median score of 26 (range: 5-39) versus 19 (range: 1-38), respectively (P = .041). These results were persistent also after controlling for sex and smoking status in the robust regression analysis. Conclusions: Patients with prior diagnoses of anxiety and depression self-reported more severe symptoms for chronic cough. Adequately understanding the association of mental health with perceived cough severity may help for more individualized, successful treatment plans.

Irritable bowel syndrome and mental health comorbidity - approach to multidisciplinary management.

Irritable bowel syndrome (IBS) affects 5-10% of the global population. Up to one-third of people with IBS also experience anxiety or depression. Gastrointestinal and psychological symptoms both drive health-care use in people with IBS, but psychological comorbidity seems to be more important for long-term quality of life. An integrated care approach that addresses gastrointestinal symptoms with nutrition and brain-gut behaviour therapies is considered the gold standard. However, best practice for the treatment of individuals with IBS who have a comorbid psychological condition is unclear. Given the rising prevalence of mental health disorders, discussion of the challenges of implementing therapy for people with IBS and anxiety and depression is critical. In this Review, we draw upon our expertise in gastroenterology, nutrition science and psychology to highlight common challenges that arise when managing patients with IBS and co-occurring anxiety and depression, and provide recommendations for tailoring clinical assessment and treatment. We provide best practice recommendations, including dietary and behavioural interventions that could be applied by non-specialists andclinicians working outside an integrated care model.

SA32 Bridging the Gap for Type 2 Diabetes Management and Peer-Support Interventions for Mental Health Comorbidities in Adult Patients: A Systematic Review

Both depression and diabetes distress can negatively impact self-management behaviors among adult patients living with type 2 diabetes (T2D). The primary objective of this systematic review was to report evidence and gaps in the literature for the impact of peer support interventions on two mental health comorbidities—depression and diabetes distress in adults living with T2D.

Beyond the Surface: The Psychosocial Effects of Atopic Dermatitis

Purpose The purpose of this article is to review the psychosocial effects of atopic dermatitis. It is important for providers to identify the psychosocial comorbidities associated with atopic dermatitis to provide well rounded patient care. Method A PubMed literature search was conducted with search terms “atopic dermatitis,” “psychosocial,” and “comorbidities.” Filters were set to articles published after 2015 and limited to clinical and systematic reviews, meta-analysis, and clinical trials. This yielded nine articles. A second search was performed using the terms “atopic dermatitis,” “anxiety,” and “depression” with similar parameters and 41 studies were revealed. Additional searches were performed in Medline and the Cochrane library with the same key terms. Results Several quality studies showed that atopic dermatitis is associated with increased risk of anxiety, depression, attention deficit hyperactivity disorder, suicidality, and decreased quality of life. Additional research is needed to determine the relationship between atopic dermatitis and obsessive-compulsive disorder, and schizophrenia. Many studies proposed pruritus and sleep deprivation as primary factors in increasing mental health comorbidities of atopic dermatitis. Conclusion Dermatology providers should screen for associated comorbidities of atopic dermatitis and refer for appropriate treatment as necessary. Aggressive treatment of atopic dermatitis can improve overall quality of life and subsequently lessen the rate of associated comorbidities.

0336 Tele-Self CBTi: Results of a Randomized Controlled Trial of a Nurse-Supported Self-Management Intervention for Insomnia Disorder

Abstract Introduction Approximately half of all Veterans meet diagnostic criteria for Insomnia Disorder. Cognitive Behavioral Therapy for Insomnia (CBTi) is recommended as first-line treatment but access is limited. Self-help CBTi could increase patient access and is more effective with provider support. Self-help CBTi has not been evaluated in those with significant mental health morbidity or Veterans; a population having greater medical and mental health morbidity and more severe sleep difficulties than non-Veterans. Methods Treatment-seeking Veterans were randomly assigned to 6 sessions of Tele-Self CBTi or Health Education Control (HEC). Nurses without sleep medicine experience were trained to deliver Tele-Self CBTi; the combination of provider support plus professionally designed patient and provider CBTi treatment manuals developed through an iterative process integrating expert and patient feedback. Both arms received nurse phone contacts (≤20 minutes). Outcomes including insomnia severity, subjective and objective sleep parameters, fatigue and mood were assessed at baseline, post-treatment (8 weeks), and 6 months. Results Study participants (N=178) were 55 years of age (SD=13), mostly male (72%), with a mental health condition (83%), and about half African American (43%) and half Caucasian (49%). At post-treatment, Veterans randomized to Tele-Self CBTi realized greater reductions in insomnia severity (ISI estimated mean improvement 5.7 vs 2.0, p<.001) and greater improvements in fatigue and depression symptoms (ps<.04). At 6 months, ISI findings were sustained (5.3 vs. 2.4, p<.001) and more Tele-Self CBTi than HEC participants (32% vs 10%) scored below the cutoff suggestive of insomnia disorder (ISI< 11) (p=.001). Preliminary findings also suggest better post-treatment outcomes for Tele-Self CBTi on sleep diary SOL (25 vs 45 minutes) and WASO (34 vs 55 minutes). Conclusion A self-management CBTi requiring minimal provider resources was effective in reducing insomnia severity in veterans with considerable mental health co-morbidity. Tele-Self CBTi can help bridge the gap between unavailable resources and high demand for services and can serve as the entry level in stepped-care treatment for insomnia disorder. Future research is needed to identify characteristics of patients most likely to benefit from Tele-Self CBTi. Support (if any) Funding was provided by Veterans Affairs Office of Research and Development (CIN 13-410 and IIR 16-281).

Depression, poor sleep quality, and diabetic control in type 2 diabetes patients at Sunyani Regional Hospital, Ghana: a case–control study

BackgroundDiabetes patients are at risk of developing mental health comorbidities such as depression and poor quality of sleep. These conditions can affect diabetic management, including glycemic and plasma lipid control to optimal levels. We investigated the association between diabetic control and the presence of depression and poor sleep quality in type 2 diabetes (T2DM) patients at Sunyani Government hospital in Ghana. Using a case–control design, we recruited 200 T2DM patients and compared them to 160 non-diabetic controls. The presence of depression was assessed using the Patient Health Questionnaire (PHQ)-9 and sleep quality using the Pittsburgh Sleep Quality Instrument (PSQI). Blood samples were collected to measure glycated hemoglobin (HbA1c) levels and plasma lipid profiles. Poor glycemic control was defined as HbA1c > 7%, depression as PHQ-9 score > 9 and poor sleep quality as PSQI score ≥ 5.ResultsT2DM patients had a higher prevalence of depression (31.5% vs 10.6%, p < 0.001) and poor sleep quality (64% vs 40%, p < 0.001) compared to non-diabetic controls. Glycemic control was not associated with depression and poor sleep quality in T2DM patients. Depression was associated with increased odds of hypercholesteremia [OR (95% CI) = 10.71 (2.64–43.41), p < 0.001] in non-diabetic controls and poor sleep quality was associated with increased odds of low HDL cholesterol in T2DM patients [3.2 (1.38–7.48), p = 0.007] and hypertriglyceridemia in non-diabetic controls [2.54 (1.15–8.51), p < 0.001].ConclusionIn our study population, depression and poor sleep quality were common in T2DM patients compared to non-diabetic controls. Depression and poor sleep quality were associated with abnormalities in serum lipid levels, but not glycemic control.

0682 Adapting a Transdiagnostic Sleep Intervention for Young Adults with Autism Spectrum Disorder: Preliminary Data

Abstract Introduction Young adults with Autism Spectrum Disorder (ASD) frequently report a multitude of pervasive sleep and circadian problems, including difficulties initiating and maintain sleep, excessive sleepiness, delayed phase, and irregular sleep–wake schedules. These sleep and circadian problems often occur in unison rather than as isolated problems and further impair social functioning, cognition, mood, and overall quality of life, during a particularly challenging developmental stage. Although sleep and circadian problems have been identified as a critical and unmet public health concern for young adults with ASD, and there is a robust evidence for transdiagnostic sleep interventions, there is a paucity of research on the efficacy of these interventions in young adults with ASD. Methods Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), a patient-centered sleep intervention which has demonstrated improvements in sleep and circadian problems and reduce symptomology in both mental and physical health domains across a variety of mental health disorders, will be adapted and iteratively pilot-tested, so that its contents and service delivery methods are appropriate for young adults with ASD. Qualitative methods (semi-structured interviews) will be used to conduct and analyze feedback from key stakeholders (n=20; 10 dyads of young adults with ASD and their caregivers), and used to directly guide adaptations of TranS-C. Results Preliminary data of 5 young adults (18-24y) with ASD show that these individuals are likely to receive multiple sleep disorder diagnoses at equally similar rates (60% circadian rhythm sleep disorder, 60% insomnia disorder), and concurrently present with comorbid mental health problems (60% anxiety disorder, 60% depression). Conclusion Our preliminary data along with existing studies suggest that (1) sleep and circadian problems experienced by individuals with ASD are multidimensional in nature, (2) negatively impact daytime functioning, both within several cognitive and mental health domains, and (3) require transdiagnostic approaches in individuals with ASD to address the broader range of sleep and circadian dysfunction experienced. Potential adaptations to TranS-C format and delivery may serve as a novel module for promoting intervention adherence and responding to unique features of ASD. Support (if any) Brad Hollinger Autism Research Endowment Award

Integrated psychological care services within seizure settings: Key components and implementation factors among example services in four ILAE regions: A report by the ILAE Psychiatry Commission.

Mental health comorbidities are prevalent and problematic in patients with seizures but often suboptimally managed. To address common gaps in care, the Integrated Mental Health Care Pathways Task Force of the International League Against Epilepsy (ILAE) Psychiatry Commission was tasked with providing education and guidance on the integration of mental health management (e.g., screening, referral, treatment) into routine seizure care. This report aims to describe a variety of established services in this area, with a specific focus on psychological care models. Services were identified by members of the ILAE Psychiatry Commission and authors of psychological intervention trials in epilepsy. A total of eight services met inclusion criteria and agreed to be showcased. They include three pediatric and five adult services located across four distinct ILAE regions (Europe, North America, Africa, Asia Oceania). The report describes the core operations, known outcomes, and implementation factors (i.e., barriers and facilitators) of these services. The report concludes with a set of practical tips for building successful psychological care services within seizure settings, including the importance of having local champions, clearly defining the scope of the service, and establishing sustainable funding models. The breadth of exemplars demonstrates how models tailored to the local environment and resources can be implemented. This report is an initial step to disseminate information regarding integrated mental health care within seizure care settings. Future work is needed to systematically examine both psychological and pharmacological care models and to further establish the evidence base in this area, especially around clinical impact, and cost-effectiveness.

Mental Health and Health-Related Quality of Life After Firearm Injury: A Preliminary Descriptive Study.

Mental Health and Health-Related Quality of Life After Firearm Injury: A Preliminary Descriptive Study.

Mental Health Comorbidities, Household Firearm Ownership, and Firearm Access Among Children.

To examine how youth and their caregivers' mental health risk factors for suicide are associated with youth firearm access inside and outside the home. This study examines a cross-section of the Adolescent Brain and Cognitive Development Social Development study data collected from 2016 to 2021. The sample included 2277 children aged 10 to 15 years from 5 study sites across the United States. We estimated multilevel generalized linear models of household firearm ownership and the child's reported firearm access (hard access or easy access). The primary exposures were the child's and their caregivers' mental health risk factors for suicide. In the Adolescent Brain and Cognitive Development Social Development study sample, approximately 20% of children lived in a firearm-owning household and 5% of all children reported easy firearm access. In non-firearm-owning households, children with diagnosed lifetime suicidality were 2.48 times more likely (95% confidence interval [CI], 1.50-4.10) than their counterparts to report easy firearm access. In firearm-owning households, children of caregivers who self-reported any mental health history or externalizing problems were 1.67 times (95% CI, 1.10-2.54) and 2.28 times (95% CI, 1.55-3.37) more likely than their counterparts to report easy firearm access. Youths with mental health risk factors for suicide may be just as likely or more likely to report firearm access as those without such risk factors. Youth suicide prevention efforts should address youths' firearm access outside the home and caregiver mental health.

Hypnosis with depressed children and teens: Building skills, creating connection

ABSTRACT Depression in children and teens has been on the rise for several years. Recent increases in anxiety and loneliness, both contributors to the development of depression, are putting more young people at risk for chronic and comorbid mental health struggles. The use of hypnosis with depressed children offers the opportunity to target the identified skills depressed and anxious children need and is a modality clinicians should embrace. This article describes how to create hypnotic interventions focusing on improved emotional and cognitive management, better sleep, and the ability to make positive social connections. Such interventions serve to not only build the resources depressed children need for recovery, but also support a paradigm shift toward prevention in children and families.

Hazard of substance abuse onset among adults diagnosed with epilepsy or migraine

ObjectiveWe investigated adult-onset epilepsy as a risk factor for the development of substance use disorder (SUD) by comparing the rate of SUD diagnosis among adults diagnosed with epilepsy with presumably healthy controls with lower extremity fractures (LEF). For additional comparison, we investigated the risk for adults with migraine only. Epilepsy and migraine are both episodic neurological disorders and migraine is frequently comorbid with epilepsy. MethodsWe conducted a time-to-event analysis using a subset of surveillance data of hospital admissions, emergency department visits, and outpatient visits in South Carolina, USA from January 1, 2000, through December 31, 2011. Individuals aged 18 years or older were identified using the International Classification of Disease, 9thRevision Clinical Modification (ICD-9) with a diagnosis of epilepsy (n = 78,547; 52.7% female, mean age 51.3 years), migraine (n = 121,155; 81.5% female, mean age 40.0 years), or LEF (n = 73,911; 55.4% female, mean age 48.7 years). Individuals with SUD diagnosis following epilepsy, migraine, or LEF were identified with ICD-9 codes. We used Cox proportional hazards regression to model the time to SUD diagnosis comparing adults diagnosed with epilepsy, migraine, and LEF, adjusting for insurance payer, age, sex, race/ethnicity, and prior mental health comorbidities. ResultsCompared to LEF controls, adults with epilepsy were diagnosed with SUD at 2.5 times the rate [HR 2.48 (2.37, 2.60)] and adults with migraine only were diagnosed with SUD at 1.12 times the rate [HR 1.12 (1.06, 1.18)]. We found an interaction between disease diagnosis and insurance payer, with hazard ratios comparing epilepsy to LEF of 4.59, 3.48, 1.97, and 1.44 within the commercial payer, uninsured, Medicaid, and Medicare strata, respectively. SignificanceCompared to presumably healthy controls, adults with epilepsy had a substantially higher hazard of SUD, while adults with migraine only showed a small, but significant, increased hazard of SUD.

Counseling interventions for victims of intimate partner violence: A systematic review

AbstractIntimate partner violence is a serious public health problem with significant implications for the mental health and well‐being of victims. Therefore, we sought to critically review research on counseling interventions for victims to inform counselors’ work and identify areas of need for future research. We used the preferred reporting items for systematic reviews and meta‐analyses protocols to identify articles from 2000 to 2022 that investigated the impact of counseling interventions on the mental health and safety of victims. Four themes emerged: (1) participant demographics, (2) treatment modality, (3) interventions and study outcomes, and (4) study limitations. Study findings are synthesized to help counselors identify effective interventions for victims based on mental health concerns and violence type. Many of the studies were limited by high attrition rates and few researchers implemented randomized controlled trials. Further research is needed on interventions for LGBTQ victims and victims who present with comorbid mental health concerns.

Associations of Diabetes-related and Health-related Quality of Life With Glycemic Levels in Adolescents With Type 1 Diabetes Preparing to Transition to Adult Care

ObjectivesAs adolescents with type 1 diabetes (T1D) progress to adulthood, they assume responsibility for diabetes self-management while dealing with competing life demands, decreasing parental support, and the transfer to adult care. Lower perceived quality of life (QOL) may hamper diabetes management, which is associated with suboptimal glycemic levels. Our objective was to determine associations of diabetes- and health-related QOL with glycemic management (glycated hemoglobin [A1C]) in adolescents with T1D before their transfer to adult care. MethodsWe conducted a cross-sectional analysis of baseline data from the Group Education Trial to Improve Transition (GET-IT- T1D) in adolescents with T1D (16 to 17 years of age). Participants completed validated questionnaires measuring diabetes-related QOL (PedsQL 3.2 Diabetes Module) and health-related QOL (PedsQL 4.0 Generic Core Scales). Associations of QOL Total and subscale scores with A1C were assessed using linear regression models adjusted for sex, diabetes duration, socioeconomic status, insulin pump use, and mental health comorbidity. ResultsOne hundred fifty-three adolescents with T1D were included (mean age, 16.5 [standard deviation, 0.3] years). Diabetes-related QOL Total scores (adjusted β=−0.04; 95% confidence interval [CI], −0.05 to −0.02) as well as subscale scores for Diabetes Symptoms (adjusted β=−0.02; 95% CI, −0.04 to −0.00) and Diabetes Management (adjusted β=−0.04; 95% CI, −0.05 to −0.02) were inversely associated with A1C. Health-related QOL Total scores were not associated with A1C, but Psychosocial Health subscale scores were (adjusted β=−0.01; 95% CI, −0.03 to −0.00). ConclusionOur results suggest that strategies focussing on diabetes-related QOL and psychosocial health may help prepare adolescents for the increasing responsibility of diabetes self-care.