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. 2024 May 16;49(5):356-364.
doi: 10.1093/jpepsy/jsae016.

Screening for diabetes distress and depression in routine clinical care for youth with type 1 diabetes

Dana Albright  1 , Joseph Wardell  2 , Annalise Harrison  1 , Kara Mizokami-Stout  3   4 , Emily Hirschfeld  2 , Ashley Garrity  2   5 , Inas Thomas  5 , Joyce Lee  2   5
Affiliations

Screening for diabetes distress and depression in routine clinical care for youth with type 1 diabetes

Dana Albright et al. J Pediatr Psychol. .

Abstract

Objective: The purpose of this study is to examine diabetes distress as a potential mediator of the relationship between depression symptoms and diabetes outcomes, including hemoglobin A1c (hemoglobin A1c [HbA1c]) and diabetes management behaviors in a clinical sample of adolescents and young adults.

Methods: In a pediatric diabetes clinic, 716 youth (ages 12-21 years) completed measures of diabetes distress (Problem Areas in Diabetes-Teen [PAID-T]), a single-item of diabetes distress, and depression (Patient Health Questionnaire [PHQ-9]) as part of standard care. Electronic health records were extracted for the "Six Habits" and glycemic management (HbA1c).

Results: Overall, 3.6% (n = 26) of adolescents had clinically elevated diabetes distress and depression symptoms, 5.0% had diabetes distress alone, 8.7% had depression symptoms alone, and 82.7% had neither clinical elevation of diabetes distress nor depression symptoms. Results of mediation analysis demonstrated diabetes distress (both full and single-item measures) fully mediated the relationship between depression symptoms and HbA1c (p < .001). Also, mediation analysis results showcase incomplete mediation of the effect of the Six Habits score on HbA1c appears by PAID-T Diabetes Distress.

Conclusions: In a clinical sample of youth with type 1 diabetes, both depressive symptoms and diabetes distress are associated with HbA1c. Furthermore, diabetes distress fully mediates the relationship between depressive symptoms and HbA1c. As part of standard clinical care, the single-item screener for diabetes distress captured similar results as the full-scaled PAID-T. With limited clinical resources, providers may consider focusing assessment and interventions on the psychological factor of diabetes distress within the diabetes clinic to maximize the impact on glycemic control and consider the use of single-item screening to identify distress.

Keywords: coping skills and adjustment; depression; diabetes; diabetes distress; evidence-based practice; screening.

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Figures

Figure 1.
Figure 1.
Model with PAID-T Diabetes Distress, Depression Symptoms, and Glycemic Outcomes.
Figure 2.
Figure 2.
Model with Single-Item Diabetes Distress, Depression Symptoms, and Glycemic Control.
Figure 3:
Figure 3:
Model with PAID-T Diabetes Distress, Six Habits, and Glycemic Control.
See this image and copyright information in PMC

References

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