Frequency and risk factors of depression in type 1 diabetes in a developing country
-
Doaa Khater
and
Magdy Omar
Abstract
Background:
Living with type 1 diabetes, especially in developing countries, can feel overwhelming for parents and children because constant vigilance is required for proper care with an inadequacy of resources. Our aim was to investigate the frequency and risk factors of depressive symptoms in children and adolescents with type 1 diabetes.
Methods:
The study was conducted using epidemiologic studies Depression Scale Questionnaire for Children (CES-DC) on 86 patients with type 1 diabetes from the Diabetes Clinic in Alexandria University Children’s Hospital, Egypt. Logistic regression models were used to detect the predictors of depression.
Results:
In the current study 45 children (52.3%) had scores ≥15 indicating a depressive state. Children who had depression were found to have a significantly longer duration of diabetes (5.84±2.53 year), a higher mean total daily insulin dose (1.36±0.45 unit/kg), HbA1c level (9.84±1.75) and were less frequently treated with a basal bolus insulin regimen (35.56%); p≤0.001. A multivariate logistic regression model showed that HbA1c is the only significant predictor for depression (p<0.001). HbA1c at a cutoff point of 8.6 could predict depression in type 1 diabetic children with specificity of 71.8%, sensitivity of 78.6%, (area under the curve [AUC]=0.8) and p-value ≤0.001.
Conclusions:
Children and adolescents with type 1 diabetes have high frequency of depressive symptoms in a developing country. Poor glycemic control is the most significant predictor for depression in these patients.
Acknowledgments
The authors acknowledge Dr. Heba Omar, Lecturer of Tropical Medicine and Hepatology, Cairo University, Egypt, for the statistical analysis.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Hood K, Naranjo D, Barnard K. Measuring depression in children and young people. In: Lloyd CE, Pouwer F, Hermanns N, editors. Screening for depression and other psychological problems in diabetes: a practical guide. New York: Springer Press, 2012:119–38.Search in Google Scholar
2. Agrawal J, Kumar R, Malhi P, Dayal D. Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India. J Pediatr Endocrinol Metab 2016;29:893–9.10.1515/jpem-2015-0335Search in Google Scholar
3. Grey M, Whittemore R, Tamborlane W. Depression in type 1 diabetes in children: natural history and correlates. J Psychosom Res 2002;53:907–11.10.1016/S0022-3999(02)00312-4Search in Google Scholar
4. La Greca AM, Swales T, Klemp S, Madigan S, Skyler J. Adolescents with diabetes: gender differences in psychosocial functioning and glycemic control. Child Health Care 1995;24:61–78.10.1207/s15326888chc2401_6Search in Google Scholar
5. Grey M, Boland EA, Yu C, Sullivan-Bolyai S, Tamborlane WV. Personal and family factors associated with quality of life in adolescents with diabetes. Diabetes Care 1998;21:909–14.10.2337/diacare.21.6.909Search in Google Scholar PubMed
6. Stewart SM, Rao J, Emslie GJ, Klein D, White PC. Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus. Pediatrics 2005;115:1315–9.10.1542/peds.2004-1717Search in Google Scholar PubMed
7. Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression and quality of life: a population study. Diabetes Care 2004;27:1066–70.10.2337/diacare.27.5.1066Search in Google Scholar PubMed
8. De Groot M, Pinkerman B, Wagner J, Hockman E. Depression treatment and satisfaction in a multicultural sample of type 1 and type 2 diabetic patients. Diabetes Care 2006;29:549–53.10.2337/diacare.29.03.06.dc05-1396Search in Google Scholar PubMed
9. Faulstich ME, Carey MP, Ruggiero L. Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Am J Psychiatry 1986;143:1024–7.10.1176/ajp.143.8.1024Search in Google Scholar PubMed
10. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385–401.10.1177/014662167700100306Search in Google Scholar
11. Chandola T, Jenkinson C. The new UK National Statistics Socio-Economic Classification (NS-SEC); investigating social class differences in self-reported health status. J Public Health Med 2000;22:182–90.10.1093/pubmed/22.2.182Search in Google Scholar PubMed
12. Kovacs M, Obrosky DS, Goldston D, Drash A. Major depressive disorder in youths with IDDM. A controlled prospective study of course and outcome. Diabetes Care 1997;20:45–5.10.2337/diacare.20.1.45Search in Google Scholar PubMed
13. McGrady M, Hood KK. Depressive symptoms in adolescents with type 1 diabetes: associations with longitudinal outcomes. Diabetes Res Clin Pract 2010;88:35–7.10.1016/j.diabres.2010.03.025Search in Google Scholar PubMed PubMed Central
14. Jaser SS, Whittemore R, Ambrosino JM, Lindemann E, Grey M. Mediators of depressive symptoms in children with type 1 diabetes and their mothers. J Pediatr Psychol 2008;33:509–19.10.1093/jpepsy/jsm104Search in Google Scholar PubMed PubMed Central
15. Kokkonen K, Kokkonen ER. Mental health and social adaptation in young adults with juvenile-onset diabetes. Nord J Psychiatry 1995;49:175–81.10.3109/08039489509011903Search in Google Scholar
16. Adal E, Önal Z, Ersen A. Recognizing the psychosocial aspects of type 1 diabetes in adolescents. J Clin Res Pediatr Endocrinol 2015;7:57–62.10.4274/jcrpe.1745Search in Google Scholar PubMed PubMed Central
17. Leone T, Coast E, Narayanan S, de Graft Aikins A. Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence. Global Health 2012;8:39.10.1186/1744-8603-8-39Search in Google Scholar PubMed PubMed Central
18. Khandelwal S, Sengar GS, Sharma M, Choudhary S, Nagaraj N. Psychosocial illness in children with type 1 diabetes mellitus: prevalence, pattern and risk factors. J Clin Diagn Res 2016;10:SC05–8.10.7860/JCDR/2016/21666.8549Search in Google Scholar PubMed PubMed Central
19. Maia AC, Braga Ade D, Paes F, Machado S, Nardi AE, et al. Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study. Rev Assoc Med Bras (1992) 2014;60:59–62.10.1590/1806-9282.60.01.013Search in Google Scholar PubMed
20. McGrady ME, Laffel L, Drotar D, Repaske D, Hood KK. Depressive symptoms and glycemic control in adolescents with type 1 diabetes. Diabetes Care 2009;32:804–6.10.2337/dc08-2111Search in Google Scholar PubMed PubMed Central
21. Whittemore R, Kanner S, Singleton S, Hamrin V, Chiu J, et al. Correlates of depressive symptoms in adolescents with type 1 diabetes. Pediatr Diabetes 2002;3:135–43.10.1034/j.1399-5448.2002.30303.xSearch in Google Scholar PubMed
22. Hilliard ME, Herzer M, Dolan LM, Hood KK. Psychological screening in adolescents with type 1 diabetes predicts outcomes one year later. Diabetes Res Clin Pract 2011;94:39–44.10.1016/j.diabres.2011.05.027Search in Google Scholar
23. Winkley K, Landau S, Eisler I, Ismail K. Psychological interventions to improve glycemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomized controlled trials. BMJ 2006;333:65–70.10.1136/bmj.38874.652569.55Search in Google Scholar
24. Goldston DB, Kelley AE, Reboussin DM, Daniel SS, Smith JA, et al. Suicidal ideation and behavior and noncompliance with the medical regimen among diabetic adolescents. J Am Acad Child Adolesc Psychiatry 1997;36:1528–36.Search in Google Scholar
25. Sawyer MG, Arney FM, Baghurst PA, Clark JJ, Graetz BW, et al. The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being. Aust N Z J Psychiatry 2001;35:806–14.10.1046/j.1440-1614.2001.00964.xSearch in Google Scholar
26. Bennett DS. Depression among children with chronic medical problems: a meta-analysis. J Pediatr Psychol 1994;19:149–69.10.1093/jpepsy/19.2.149Search in Google Scholar
27. Hood KK, Huestis S, Maher A, Butler D, Volkening L, et al. Depressive symptoms in children and adolescents with type 1 diabetes association with diabetes-specific characteristics. Diabetes Care 2006;29:1389–91.10.2337/dc06-0087Search in Google Scholar
28. Eaton W. Epidemiologic evidence on the comorbidity of depression and diabetes. J Psychosom Res 2002;53:903–6.10.1016/S0022-3999(02)00302-1Search in Google Scholar
29. Read UM, Adiibokah E, Nyame S. Local suffering and the global discourse of mental health and human rights: an ethnographic study of responses to mental illness in rural Ghana. Global Health 2009;5:13–28.10.1186/1744-8603-5-13Search in Google Scholar PubMed PubMed Central
30. Hamilton J, Daneman D. Deteriorating diabetes control during adolescence: physiological or psychosocial? J Pediatr Endocrinol Metab 2002;15:115–26.10.1515/JPEM.2002.15.2.115Search in Google Scholar
31. AlQarni ZA, Yunus F, Househ MS. Health information sharing on Facebook: An exploratory study on diabetes mellitus. J Infect Public Health 2016;9:708–12.10.1016/j.jiph.2016.08.015Search in Google Scholar PubMed
32. Vučić Lovrenčić M, Pibernik-Okanović M, Šekerija M, Prašek M, Ajduković D, et al. Improvement in depressive symptoms is associated with reduced oxidative damage and inflammatory response in type 2 diabetic patients with subsyndromal depression: the results of a randomized controlled trial comparing psychoeducation, physical exercise, and enhanced treatment as usual. Int J Endocrinol 2015;2015:210406.10.1155/2015/210406Search in Google Scholar PubMed PubMed Central
33. Mutlu EK, Mutlu C, Taskiran H, Ozgen IT. Association of physical activity level with depression, anxiety, and quality of life in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2015;28:1273–8.10.1515/jpem-2015-0082Search in Google Scholar PubMed
34. Topçu S, Orhon FŞ, Tayfun M, Uçaktürk SA, Demirel F. Anxiety, depression and self-esteem levels in obese children: a case-control study. J Pediatr Endocrinol Metab 2016;29: 357–61.10.1515/jpem-2015-0254Search in Google Scholar PubMed
©2017 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Original Articles
- Standard body mass index reference data of prepubescent diabetic Egyptian children
- Frequency and risk factors of depression in type 1 diabetes in a developing country
- Association of obesity and health related quality of life in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study
- Association between urinary phthalates and metabolic abnormalities in obese Thai children and adolescents
- A pilot study of the effect of human breast milk on urinary metabolome analysis in infants
- Assessment of the correlation between the atherogenic index of plasma and cardiometabolic risk factors in children and adolescents: might it be superior to the TG/HDL-C ratio?
- Cardiovascular and metabolic risk in pediatric patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency
- Application of povidone-iodine at delivery significantly increases maternal urinary iodine but not neonatal thyrotropin in an area with iodine sufficiency
- Influence of topical iodine-containing antiseptics used during delivery on recall rate of congenital hypothyroidism screening program
- Applying targeted next generation sequencing to dried blood spot specimens from suspicious cases identified by tandem mass spectrometry-based newborn screening
- Short Communication
- Initial patient choice of a growth hormone device improves child and adolescent adherence to and therapeutic effects of growth hormone replacement therapy
- Case Reports
- An occult ectopic parathyroid adenoma in a pediatric patient: a case report and management algorithm
- Fetal goitrous hypothyroidism treated by intra-amniotic levothyroxine administration: case report and review of the literature
- Carotid intima media thickness in a girl with sitosterolemia carrying a homozygous mutation in the ABCG5 gene
- Sirolimus in the treatment of three infants with diffuse congenital hyperinsulinism
Articles in the same Issue
- Frontmatter
- Original Articles
- Standard body mass index reference data of prepubescent diabetic Egyptian children
- Frequency and risk factors of depression in type 1 diabetes in a developing country
- Association of obesity and health related quality of life in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study
- Association between urinary phthalates and metabolic abnormalities in obese Thai children and adolescents
- A pilot study of the effect of human breast milk on urinary metabolome analysis in infants
- Assessment of the correlation between the atherogenic index of plasma and cardiometabolic risk factors in children and adolescents: might it be superior to the TG/HDL-C ratio?
- Cardiovascular and metabolic risk in pediatric patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency
- Application of povidone-iodine at delivery significantly increases maternal urinary iodine but not neonatal thyrotropin in an area with iodine sufficiency
- Influence of topical iodine-containing antiseptics used during delivery on recall rate of congenital hypothyroidism screening program
- Applying targeted next generation sequencing to dried blood spot specimens from suspicious cases identified by tandem mass spectrometry-based newborn screening
- Short Communication
- Initial patient choice of a growth hormone device improves child and adolescent adherence to and therapeutic effects of growth hormone replacement therapy
- Case Reports
- An occult ectopic parathyroid adenoma in a pediatric patient: a case report and management algorithm
- Fetal goitrous hypothyroidism treated by intra-amniotic levothyroxine administration: case report and review of the literature
- Carotid intima media thickness in a girl with sitosterolemia carrying a homozygous mutation in the ABCG5 gene
- Sirolimus in the treatment of three infants with diffuse congenital hyperinsulinism
