Adolescents with diabetes often not getting the psychotherapy services they need
medwireNews: Only a very small proportion of adolescents and young adults (AYAs) with diabetes who are referred for outpatient psychotherapy actually receive these services, even when there is an integrated pediatric psychologist in the clinic, research shows.
Of 100 ethnically diverse AYAs aged 11–21 years who were seen at a multidisciplinary diabetes clinic, 59 were referred for psychotherapy on the basis of their response to a semi-structured interview and the Patient Health Questionnaire (PHQ), which screens for depressive symptoms, but only nine were treated.
The majority (79%) of patients had type 1 diabetes, 19% had type 2 diabetes, and 2% had maturity onset diabetes of the young. The mean glycated hemoglobin was 9.3%.
More than half (58%) of participants reported no or minimal depression (score of 0–4) on the PHQ, 26% reported mild depression (score of 5–9), 11% had moderate depression (score of 10–14), 3% had moderately severe depression (score of 15–19), and 2% were severely depressed (score of 20–27).
The proportions of patients referred for psychotherapy were 48%, 74%, and 100% for patients with no or minimal, mild, and moderate-to-severe depression, respectively.
Reasons for referral included depression, anxiety, behavioral health difficulties, family conflict, and diabetes management challenges.
Risa Wolf, from Johns Hopkins University School of Medicine in Baltimore, Maryland, USA, explained that families with diabetes management-related concerns were offered on-site outpatient psychotherapy, while others were given community referrals.
Among the 59 patients referred for psychotherapy, 37 (63%) had a psychotherapy follow-up at their next diabetes clinic, a mean 122 days after their referral. It was at this visit that the researchers realized just 15% of referred patients were receiving mental health services.
Barriers to receiving services included transportation, organization (such as losing referral), and stigma.
Speaking at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA, Risa concluded: “Despite patient access to a pediatric psychologist in clinic, a large discrepancy between referral and follow-up rates remains.
“This disparity highlights the importance of identifying and reducing barriers to follow-up care for AYAs with diabetes.”
By Laura Cowen
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