Depressive Symptoms at Critical Times in Youth With Type 1 Diabetes: Following Type 1 Diabetes Diagnosis and Insulin Pump Initiation

• Authors: Dayna E. McGill, Harvard Medical School; Lisa K. Volkening, Harvard Medical School; David M. Pober, Harvard Medical School; Andrew Muir, Emory University; Deborah L. Young-Hyman, Georgia Health Sciences University; Lori M. Laffel, Harvard Medical School
• Journal Title: Journal of Adolescent Health
• Volume: Volume 62, Number 2
• Publisher: Elsevier: 12 months | 2018-02-01, Pages 219-225
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jadohealth.2017.09.017
• Subjects: Psychology, Behavioral; Health Sciences, Medicine and Surgery
• Keywords: Social Sciences; Science & Technology; Life Sciences & Biomedicine; Psychology, Developmental; Public, Environmental & Occupational Health; Pediatrics; Psychology; Type 1 diabetes; Adolescent; Depression; New-onset; Insulin pump; Honeymoon; HbA1c; GLYCEMIC CONTROL; ADOLESCENTS; CHILDREN; PREVALENCE; MANAGEMENT; DISTRESS; SEARCH; CARE

Abstract

Purpose: Depressive symptoms occur at various times during the life cycle in persons with type 1 diabetes. We investigated depressive symptoms prospectively in youth with new-onset type 1 diabetes and in those beginning pump therapy. Methods: Youth with type 1 diabetes (N = 96), ages 10–17 years, completed the Children's Depression Inventory (CDI) at baseline and at 1, 6, and 12 months after diabetes onset or pump start; scores ≥13 indicated clinical elevation. The change in depressive symptoms and the association between CDI score and hemoglobin A1c (HbA1c) level were assessed over 1 year. Results: The new-onset group (n = 54) had an HbA1c level of 11.4% ± 2.5%. The pump group (n = 42) had a diabetes duration of 4.1 ± 3.4 years and an HbA1c level of 8.3% ± 1.3%. The baseline median CDI was 5.0 in both groups and remained low over time (ranging from 2.0 to 3.5). Most youth (new onset 72%, pump 81%) scored <13 at all times. Those with a CDI score of ≥13 in month 1 had 9-fold (95% confidence interval: 3–28) and 11-fold (95% confidence interval: 3–38) higher risks of CDI score of ≥13 at 6 and 12 months, respectively, than those with a CDI score of <13. New-onset youth with a CDI score of ≥13 in month 1 had a higher HbA1c level at 6 months (8.3% ± 1.7%) than new-onset youth with a CDI score of <13 (7.2% ± 1.6%, p =.04). Conclusions: CDI scores over 1 year were similar in the new-onset and pump groups. Youth with elevated CDI in the first month after diagnosis or pump start were significantly more likely to have a CDI score of ≥13 at 6 or 12 months, supporting recommendations to screen for depressive symptoms because of persistence over time. Those with new-onset diabetes and depressive symptoms in the first month had higher HbA1c at 6 months; confirmatory research is needed.