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 “We suspected that we would find higher risk of common psychiatric
disorders such as depression or anxiety, as observed among adults
with diabetes,” said lead author Agnieszka Butwicka of the
Department of Medical Epidemiology and Biostatistics at the
Karolinska Institute in Stockholm.
“What was surprising was that risk was high for many different
psychiatric disorders,” which may mean that applying the results of
adult studies to kids is too simplistic, she told Reuters Health by
email.
More than 200,000 kids in the U.S. had diabetes in 2012, according
to the National Diabetes Education Program, and most of them had
type 1, which results from the body not producing enough insulin.
The condition, previously known as juvenile diabetes, is often
diagnosed early in life. People with type 1 diabetes must use
insulin injections every day to regulate their blood sugar, and past
research has shown that managing the disease is stressful for kids,
especially in the period right after they are diagnosed.
Butwicka and her colleagues used a national register to compare more
than 17,000 children with diabetes born in Sweden between 1973 and
2009 with more than 1,000,000 similar but healthy kids, as well as
with the healthy siblings of the diabetic group. They looked in
medical records for diagnoses of common psychiatric disorders, such
as depression, suicide attempt, anxiety, eating disorder,
attention-deficit hyperactivity disorder (ADHD), autism or other
behavioral problems.
About 8 percent of kids with type 1 diabetes were diagnosed with a
psychiatric disorder. Those with diabetes were twice as likely to
receive a psychiatric diagnosis by age 18 as kids without the
condition, and 1.7 times more likely to attempt suicide, according
to the results in Diabetes Care.
The increased risk for psychiatric disorders was highest for kids
born between 1973 and 1986, and then declined. That may indicate
that progress in diabetes care and offering more flexible life
styles and more effective metabolic control may also lower the
psychological burden in diabetes, Butwicka said.
Some have argued that the increased incidence of autism among kids
with diabetes may be genetic, so their siblings would also be more
likely to have the disorder. However the researchers found only a
slight increased risk for psychiatric disorders among siblings, and
no significant increase in any specific category of disorder.
That suggests the psychological disorders among kids with diabetes
may be a result of physiological effects of coping with diabetes
rather than a genetic risk factor or family environment, the authors
write.
“I think our results could be replicable in other countries with
similar access to pediatric diabetes and mental health care with the
possibility of access to those data,” Butwicka said.
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Most doctors probably don’t tell parents of kids with diabetes that
their child may be at risk for mental health issues, she said.
A previous study in Norway found that teens with type 1 diabetes are
twice as likely to die before age 30 compared to the general
population, and accidents and suicides caused most of the deaths,
according to Dr. Maurizio Pompili, director of the Suicide
Prevention Center at Sant'Andrea Hospital and Sapienza University of
Rome in Italy.
“Patients with (type 1 diabetes) have almost doubled risk of
depression compared to the general population, and psychiatric
symptoms are frequent in patients with (type 1 diabetes) and other
autoimmune diseases,” Pompili, who was not involved in the research,
told Reuters Heath by email.
Kids with diabetes should be screened for depression, though not all
will need treatment, he said.
Physiological changes in the chronic course of type 1 diabetes,
including weight gain, pain, hypertension, heart disease, loss of
motor skills, or blindness directly affect the emotional state, said
Ana Claudia Ornelas, a psychologist at the Institute of
Psychiatry/Federal University of Rio de Janeiro in Brazil, who also
was not involved in the new study.
“Children with diabetes and their parents are already afraid of many
other complications,” Butwicka said. Parents should know that type 1
diabetes may include psychological implications, and know where to
seek help if needed.
But more than 80 percent of kids in the youngest cohort of the new
study had no psychiatric diagnosis, she noted.
“Having diabetes does not immediately mean that one has a
psychiatric disorder and requires mental health treatment,” she
said. “Amazingly, most children and their parents actually do well.”
SOURCE: http://bit.ly/16ZclvY
Diabetes Care, online February 3, 2015.
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