Psychiatric morbidity risk high after childhood diabetes diagnosis
medwireNews: Results of a population-based study suggests that children may be vulnerable to developing psychiatric disorders in the years following a diagnosis of type 1 diabetes.
The researchers found that, during follow-up of around 8–9 years after diabetes diagnosis, the rate of psychiatric diagnoses was 15.0 per 1000 person–years among 5084 children and adolescents with type 1 diabetes, compared with 10.7 per 1000 person–years among 35,588 without diabetes.
Grete Teilmann (Nordsjællands Hospital, Hillerød, Denmark) and study co-authors also report that patients’ risk for psychiatric diagnoses increased over time, at a 23% increase relative to the risk in controls during the first year after diagnosis and a 26% increase between 1 and 5 years, rising to 55% from more than 5 years after diagnosis.
The researchers say that this increase could “suggest that the challenges of coping with a chronic disease may increase the emotional stress on the child in a way that accumulates rather than diminishes over time.”
They also found that the increased risk for psychiatric diagnoses varied according to children’s age at the time of diabetes diagnosis, with a peak at the ages of 10–14 years in keeping with previous research.
However, the team also notes that the higher rate of psychiatric diagnoses among the diabetes patients versus the controls could partly result from their more frequent healthcare provider contact, leading to increased identification of symptoms and referral.
Of the individual psychiatric diagnoses, eating disorders were the most strongly associated with diabetes, with the risk for these being increased 2.02-fold in girls and 3.73-fold in boys.
The risk for mood disorders was also increased in both sexes, by 55% in girls and 95% in boys with versus without diabetes. By contrast, the risk for personality disorders was increased in girls only, by 72%, and the risk for substance abuse disorders was elevated in boys only, by 43%.
“Clinicians need to be aware of the early symptoms of anxiety and depression, and the symptoms of disturbed eating patterns, body dissatisfaction, and an obsessional preoccupation with weight in both boys and girls,” the researchers write in Diabetologia.
And they warn: “Eating disorders may be particularly difficult to identify if omission of insulin is misinterpreted as non-adherence to treatment for other reasons.
“In addition, clinicians should be aware that mental health problems in young people with type 1 diabetes may present with atypical emotional and reactive symptoms including substance misuse and behavioural problems, which may mask depression, suicidal behaviour and personality disorders.”
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