Research: Diabetic teens should be screened for depression with caution
Florida, September 18: In order to more effectively identify depression in teenagers with Type 1 diabetes mellitus, a new study published in the American Diabetes Association journal Diabetes Care recommended that the score findings of widely used depression-screening techniques be carefully modified (T1D).
Previous studies have shown that adolescents with T1D are more prone to experience depression than their non-diabetic peers. Researchers have found that sadness can also compromise blood glucose monitoring, alter glycemic control, and lead to more frequent hospitalizations. For these reasons, both national and international standards recommend that all diabetic teenagers undergo routine depression screening.
"Depression screening is crucial for youth with Type 1 diabetes since depression treatment is likely to keep them healthier now and in the long run," said the paper's lead author, Arwen M. Marker, PhD, a pediatric psychology fellow at Primary Children's Hospital of Salt Lake City. "We need to know which screening tools perform best and how best to use them in this population, so we do not fail to identify depressed kids and get them the support they need."
Clinical interviews, which are regarded as the gold standard for diagnosing depression, were completed with each of the 100 T1D youth (ages 12 to 17). The participants were also given five commonly used depression screening measures, each of which took one to three minutes to complete. The results of each screening tool were compared to those of the interviews after that. They noted that it startled them that the bulk of the screeners' typical diagnostic cut-off values had to be decreased in order to increase their sensitivity for T1D-affected adolescent patients.
"We thought we might need to increase the cut-off scores for accuracy with this population, thinking that symptoms common to diabetes and depression would inflate the number of depression diagnoses, suggesting more were depressed when actually diabetes symptoms were the cause," said Marker. "However, we generally found the opposite - we needed to lower cut-off scores to most accurately identify youth with depressive symptoms."
The study's screening instruments were designed primarily with adults in mind. None have previously been reliably shown to distinguish teenage depression, and none were created especially for people with T1D. The CDI-2 Short, PHQ-9A, and SMFQ, which have been demonstrated to have the maximum accuracy in this population, were recommended for use by diabetes care professionals.
A principal research scientist at Nemours Children's Health in Jacksonville and co-author Susana Patton, PhD, ABPP, CDE, asserts that "without the right sensitivity cut-offs, even great screening tools will miss some teens with depression, resulting in their failure to receive mental health services and possibly continuing to experience depression." This implies that some adolescent T1Ds might experience more difficulty managing their diabetes.
Type 1 diabetes is an autoimmune disease that develops when the body's immune system accidentally destroys insulin-producing cells in the pancreas. There is presently no known treatment for it, and its origins are unknown. This condition, which is thought to afflict 244,000 children and teenagers in the US, can cause serious health problems both early on in life and later on in life.
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