Outpatient screening for anxiety and depression symptoms in adolescents with type 1 diabetes - a cross-sectional survey

Christina Reinauer; Sascha R Tittel; Annabel Müller-Stierlin; Harald Baumeister; Petra Warschburger; Katharina Klauser; Kirsten Minden; Doris Staab; Bettina Gohlke; Bettina Horlebein; Karl Otfried Schwab; Thomas Meißner; Reinhard W Holl

doi:10.1186/s13034-023-00691-y

Outpatient screening for anxiety and depression symptoms in adolescents with type 1 diabetes - a cross-sectional survey

Child Adolesc Psychiatry Ment Health. 2023 Dec 21;17(1):142. doi: 10.1186/s13034-023-00691-y.

Authors

Affiliations

¹ Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany. christina.reinauer@med.uni-duesseldorf.de.
² Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, 89081, Ulm, Germany.
³ German Center for Diabetes Research (DZD), 85764, Munich-Neuherberg, Germany.
⁴ Department of Psychiatry and Psychotherapy II, Regional Hospital Günzburg, Ulm University, 89312, Günzburg, Germany.
⁵ Clinical Psychology and Psychotherapy, Ulm University, 89081, Ulm, Germany.
⁶ Department of Psychology, University of Potsdam, 14476, Potsdam, Germany.
⁷ Social Pediatric Center (SPZ), German Center for Pediatric and Adolescent Rheumatology, 82467, Garmisch-Partenkirchen, Germany.
⁸ Epidemiology Unit, German Rheumatism Research Center Berlin, a Leibniz Institute and Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin and Berlin Institute of Health, 10117, Berlin, Germany.
⁹ Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, CF Center Charité - Universitätsmedizin Berlin, 13353, Berlin, Germany.
¹⁰ Pediatric Endocrinology Division, Children's Hospital, University of Bonn, 53127, Bonn, Germany.
¹¹ Buerger Hospital and Clementine Children Hospital, 60316, Frankfurt, Germany.
¹² Faculty of Medicine, Center for Pediatrics and Adolescent Medicine, Division of Pediatric Diabetes, Medical Center, University of Freiburg, 79110, Freiburg, Germany.
¹³ Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.

Abstract

Background: The daily demands of type 1 diabetes management may jeopardize adolescents' mental health. We aimed to assess anxiety and depression symptoms by broad-scale, tablet-based outpatient screening in adolescents with type 1 diabetes in Germany.

Methods: Adolescent patients with type 1 diabetes mellitus (n = 2,394; mean age 15.4 y [SD 2.0]; 50.7% male) were screened for anxiety (GAD-7) and depression symptoms (PHQ-9) by self-report questionnaires and linked to clinical data from the DPV patient registry. Logistic regression was used to estimate the contribution of clinical parameters to positive screening results.

Results: Altogether, 30.2% showed a positive screening (score ≥ 7 in either test), and 11.3% reported suicidal ideations or self-harm. Patients with anxiety and depression symptoms were older (15.7 y [CI 15.5-15.8] vs. 15.3 y [CI 15.2-15.4]; p < 0.0001), had higher HbA1c levels (7.9% [CI 7.8-8.0] (63 mmol/mol) vs. 7.5% [CI 7.4-7.5] (58 mmol/mol); p < 0.0001), and had higher hospitalization rates. Females (adjusted odds ratio (aOR) 2.66 [CI 2.21-3.19]; p < 0.0001), patients > 15 years (aOR 1.40 [1.16-1.68]; p < 0.001), who were overweight (aOR 1.40 [CI 1.14-1.71]; p = 0.001), with HbA1c > 9% (> 75 mmol/mol; aOR 2.58 [1.83-3.64]; each p < 0.0001), with a migration background (aOR 1.46 [CI 1.17-1.81]; p < 0.001), or smoking (aOR 2.72 [CI 1.41-5.23]; p = 0.003) had a higher risk. Regular exercise was a significant protective factor (aOR 0.65 [CI 0.51-0.82]; p < 0.001). Advanced diabetes technologies did not influence screening outcomes.

Conclusions: Electronic mental health screening was implemented in 42 centers in parallel, and outcomes showed an association with clinical parameters from sociodemographic, lifestyle, and diabetes-related data. It should be integrated into holistic patient counseling, enabling early recognition of mild mental health symptoms for preventive measures. Females were disproportionally adversely affected. The use of advanced diabetes technologies did not yet reduce the odds of anxiety and depression symptoms in this cross-sectional assessment.

Keywords: Adolescents; Anxiety; Depression; Mental health; Type 1 diabetes.