Mental health comorbidities can negatively affect disease management in adolescents with chronic illnesses. This study sought to determine the prevalence and impact of mental health issues in a population of adolescents and young adults with type 1 diabetes. A cross-sectional study of 150 patients aged 11 to 25 years with type 1 diabetes from an urban, academic diabetes center was conducted. Participants completed 3 validated mental health disorder screening instruments: Beck's Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders-41 anxiety screen, and the Eating Disorder Screen for Primary Care. More than a third screened positive: 11.3% for depression, 21.3% for anxiety, and 20.7% for disordered eating (14.7% had ≥2 positive screens). Patients with a positive screen had twice the odds of having poor glycemic control as those without, as measured by HgbA1c. This study supports screening for mental health issues in adolescents and young adults with type 1 diabetes.
"Screening for mental disorders has been frequently recommended to identify comorbid mental disorders in chronic medical conditions, such as coronary heart disease3-3 or diabetes mellitus.6-9 In fact, in primary care practice only about half of the patients having a depressive disorder are identified.10-12 "
[Show abstract][Hide abstract] ABSTRACT: Patient self-reported symptoms are of crucial importance to identify anxiety disorders, as well as to monitor their treatment in clinical practice and research. Thus, for evidence-based medicine, a precise, reliable, and valid (ie, "objective") assessment of the patient's reported "subjective" symptoms is warranted. There is a plethora of instruments available, which can provide psychometrically sound assessments of anxiety, but there are several limitations of current tools that need to be carefully considered for their successful use. Nevertheless, the empirical assessment of mental health status is not as accepted in medicine as is the assessment of biomarkers. One reason for this may be that different instruments assessing the same psychological construct use different scales. In this paper we present some new developments that promise to provide one common metric for the assessment of anxiety, to facilitate the general acceptance of mental health assessments in the future.
Dialogues in clinical neuroscience 06/2014; 16(2):197-211.
"Treatment of T1D is intensive and ongoing, requiring a strict daily regimen of insulin injections and monitoring of blood glucose levels and dietary intake to avoid episodes of extremely high or extremely low blood glucose, both of which can be life threatening . T1D is associated with serious long-term health complications such as kidney and heart disease, circulatory problems, retinopathy, and neuropathy  and a range of co-morbid mental health disorders including depression, anxiety, conduct and eating disorders [3-6]. A number of large scale trials have shown that optimal metabolic control, achieved through intensive disease management, reduces the risk of long term health complications (e.g., the Diabetes Control and Complications Trial ). "
[Show abstract][Hide abstract] ABSTRACT: Management of Type 1 diabetes is associated with substantial personal and psychological demands which are often exacerbated during adolescence thus placing young people at significant risk for mental health problems. Supportive parenting can mitigate these risks, however the challenges and stresses associated with parenting a child with a chronic illness can interfere with a parent's capacity to parent effectively. Therefore, interventions that provide support for both the adolescent and their parents are needed to prevent mental health problems in adolescents; to build and maintain positive parent-adolescent relationships; and to empower young people to better self-manage their Type 1 diabetes. This paper presents the research protocol for a study evaluating the efficacy of the Nothing Ventured Nothing Gained online adolescent and parenting intervention. The intervention aims to improve the mental health outcomes of adolescents with Type 1 diabetes.Method/design: A randomized controlled trial using repeated measures with two arms (intervention and wait-list control) will be used to evaluate the efficacy and acceptability of the online intervention. Approximately 120 adolescents with Type 1 diabetes, aged 13-18 years and one of their parents/guardians will be recruited from pediatric diabetes clinics across Victoria, Australia. Participants will be randomized to receive the intervention immediately or to wait 6 months before accessing the intervention. Adolescent, parent and family outcomes will be assessed via self-report questionnaires at three time points (baseline, 6 weeks and 6 months). The primary outcome is improved adolescent mental health (depression and anxiety). Secondary outcomes include adolescent behavioral (diabetes self-management and risk taking behavior), psychosocial (diabetes relevant quality of life, parent reported child well-being, self-efficacy, resilience, and perceived illness benefits and burdens); metabolic (HbA1c) outcomes; parent psychosocial outcomes (negative affect and fatigue, self-efficacy, and parent experience of child illness); and family outcomes (parent and adolescent reported parent-adolescent communication, responsibility for diabetes care, diabetes related conflict). Process variables including recruitment, retention, intervention completion and intervention satisfaction will also be assessed.
The results of this study will provide valuable information about the efficacy, acceptability and therefore the viability of delivering online interventions to families affected by chronic illnesses such as Type 1 diabetes.Trial registration: Australian New Zealand clinical trials registry (ANZCTR); ACTRN12610000170022.
BMC Public Health 12/2013; 13(1):1185. DOI:10.1186/1471-2458-13-1185 · 2.26 Impact Factor
"The differences in psychopathology can have a relevant prognostic impact. There is wide evidence that mental disorders (e.g., depressive disorders and eating disorders) are associated with impaired glycemic control in patients with type 1 diabetes ; furthermore, the presence of psychopathological symptoms, even without a full-blown psychiatric disorder diagnosis, can be sufficient to affect glucose control . If patients on CSII have a higher psychopathology, they should also be expected to encounter greater difficulties in attaining (and maintaining) therapeutic targets. "
[Show abstract][Hide abstract] ABSTRACT: Aim. Continuous subcutaneous insulin infusion (CSII) is used as an option in patients with diabetes failing to multiple daily injections (MDI). Psychological factors may play a relevant role in the failure to attain therapeutic goals in patients on MDI. This could lead to an overrepresentation of psychopathology in patients treated with CSII.
Methods. A consecutive series of 100 patients with type 1 diabetes was studied, collecting main clinical parameters and assessing psychopathology with the self-reported questionnaire Symptom Checklist 90-revised. Patients on CSII were then compared with those on MDI. Results. Of the 100 enrolled patients, 44 and 56 were on CSII and MDI, respectively. Among men, those on CSII were younger than those on MDI; conversely, no difference in age was observed in women. Women on CSII showed higher scores on most Symptom Checklist 90 subscales than those on MDI, whereas no differences were observed in men.
Conclusion. Women with type 1 diabetes treated with CSII display higher levels of psychopathology than those on MDI. This is probably the consequence of the fact that patients selected for CSII are those failing to MDI. Higher levels of psychopathology could represent a limit for the attainment and maintenance of therapeutic goals with CSII.
The Scientific World Journal 09/2013; 2013(5):672729. DOI:10.1155/2013/672729 · 1.73 Impact Factor
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