Depressive symptoms in adolescents with type 1 diabetes might be a marker for poor treatment compliance, a new report shows.
Adolescents with type 1 diabetes and clinically significant symptoms of depression were more likely than their nondepressed peers to have higher glycosylated hemoglobin A1c values, and to perform less frequent daily blood glucose monitoring (BGM), Meghan E. McGrady and Dr. Korey K. Hood wrote (Diabetes Res Clin Pract. 2010;88:e35–7 [doi:10.1016/jdiabres. 2010.03.025]).
The most commonly reported depressive symptoms among the 144 teens in the study included ineffectiveness and negative mood. These symptoms, linked to both A1c levels at baseline and to BGM at baseline and at 6 months, might be targets for intervention, the authors wrote.
Ms. Grady and Dr. Hood, who are affiliated with the Cincinnati Children's Hospital Medical Center, looked at 144 patients, aged 13–18 years, who were treated at the hospital's pediatric diabetes clinic. Most of the participants were white (87%), female (69%), and from households with two caregivers (76%). They were asked to fill out the 27-item Children's Depression Inventory (CDI), in which individual symptoms are rated on a scale of 0 (no symptoms) to 2 (distinct symptoms). Total scores of 13 or greater on the validated scale are deemed to be portents of clinically significant depression, indicating a need for more comprehensive evaluation. The patients also filled out follow-up questionnaires 6 months after the baseline visit.
The investigators correlated the symptoms scores with data on BGM frequency obtained from downloads of blood glucose meter data taken at the time of clinic visit, and with A1c values measured by a standard point-of-care analyzer.
At baseline, 33 patients (23%) had CDI scores of 13 or greater (mean score for all participants: 7.92 ± 7.14). The most frequently reported symptoms were ineffectiveness (mean score 0.38 ± 0.41), negative mood (0.34 ± 0.36), anhedonia (0.32 ± 0.30), negative self-esteem (0.24 ± 0.30), and interpersonal problems (0.15 ± 0.23).
Both total CDI scores (P less than .001) and all subscale scores listed above were significantly correlated with lower frequency of BGM at baseline. Higher baseline A1c scores were significantly related to CDI total score (P less than .01), negative mood (P less than .01), interpersonal problems (P less than .05), and ineffectiveness (P less than .0001).
At 6-months' follow-up, BGM frequency retained a significant correlation with total CDI scores and with the negative mood, ineffectiveness, and negative self-esteem subscales (P less than .05 for all). No significant correlations were found between A1c values and either total scores of any of the subscale scores at 6 months, however.
“Symptoms of negative mood include sadness and indecisiveness, while anhedonia is characterized by a loss of energy and appetite disturbances. These symptoms may inhibit adolescents from initiating and following through with diabetes management. Ineffectiveness indicates feelings of poor self-efficacy, which has been linked to decreased adherence,” the authors wrote.
The study, which the authors said was the “first to examine the responses on CDI subscales in adolescents with type 1, had several limitations. Depressive symptoms were self-reported, and it is difficult to generalize the results to other samples because of the sociodemographic characteristics of the adolescents studied. Future studies should examine depressive symptoms over time, they said.
The study was supported by a career development award to Dr. Hood. The authors reported that they had no conflicts of interest.