medwireNews: Routine psychosocial screening of adolescents with type 1 diabetes uncovers a sizable proportion who could benefit from additional support, say researchers.
The data come from 232 adolescents with type 1 diabetes who completed a psychosocial screen on a tablet in the waiting room before their appointment. Most (96%) participants were able to complete the screen in full while waiting for their appointment.
In all, more than three-quarters of the adolescents were positive for at least one of the 10 areas screened, report Alan Delamater (University of Miami Miller School of Medicine, Florida, USA) and co-researchers.
There was considerable overlap between mild or moderate depression and the other items, ranging from 21.7% to 71.4%. But overall, only 27.2% of those who screened positive for one of the other items also had mild depression, and just 5.0% had moderate depression.
This underlines “the importance of screening for other psychosocial concerns,” write the researchers in Pediatric Diabetes.
“Based on our results, if clinics only flag adolescents reporting at least moderate symptoms of depression, they may only capture relatively few of those with psychosocial concerns,” they say.
The most common issue identified was low intrinsic motivation for diabetes self-care, identified in 52%, followed by inconsistent use of insulin, at 36%. Around 20% had diabetes stress, mild anxiety, or blood glucose monitoring stress, 10% experienced family conflict, 7% had disordered eating, and 6% were at risk for suicide.
Delamater and team highlight that theirs was “a diverse clinic population,” with nearly 60% identifying as Hispanic, and 20% as Black.
“Psychosocial screening may be particularly critical in clinics that serve diverse patient populations, as minority youth are considerably less likely to access mental health services,” they note.
Screening positive for psychosocial variables was generally associated with higher glycated hemoglobin levels, and with inconsistent use of insulin. Notable among these in multivariate analysis were family conflict, which predicted both outcomes; intrinsic motivation, which predicted inconsistent use of insulin; and disordered eating and diabetes distress, which predicted elevated glycated hemoglobin levels.
The researchers say: “These findings again underscore the need for comprehensive screening: when clinics screen for depression alone, they may miss other concerns that impact critical diabetes outcomes.”
They add: “Given that over half the sample reported low intrinsic motivation and nearly one-quarter had high diabetes stress, these seem particularly important to include in a screening program.”
Finally, the team found that implementing routine psychosocial screening “appeared to impact clinical care as a whole,” as there was a 25% increase in psychology referrals during the 10 months after, compared with before, its implementation.
The largest increase, of 72%, was for mental health concerns, and there was also a 63% increase in new patient introductions, whereas non-psychology referrals did not change.
“This suggests that the screening program can help physicians more readily identify when it is appropriate to make a referral to psychology,” the researchers conclude.
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