Extreme caution should be exercised while screening depressed adolescents with type 1 diabetes

Scoring results for widely used depression screening tools must be carefully modified to better detect the condition in adolescents with type 1 diabetes (T1D), according to a new study published in the Journal of the American Diabetes Association. Diabetes care.

This study is the first of its kind to assess the accuracy of these assays on a large scale, compared to diagnostic interviews for this population. The study was led by investigators from Nemours Children’s Health, Jacksonville and Primary Children’s Hospital. The data was collected while both investigators were at the University of Kansas Medical Center, which funded the project, and in collaboration with Children’s Mercy Kansas City.

Previous studies show that adolescents with T1D are more likely to develop depression than their non-diabetic peers. Furthermore, the researchers said, depression can inhibit proper self-management of diabetes and lead to inadequate blood glucose control, poor blood sugar levels, and frequent hospitalizations. For these reasons, national and international guidelines recommend ongoing depression screening for all adolescents with diabetes.

Depression screening is essential for young people with type 1 diabetes, as depression treatment is likely to help keep them healthy now and in the long term. We need to know which screening tools work best and how best to use them in this population, so we don’t fail to identify children with depression and provide them with the support they need.”

Arwen M.Marker, Ph.D., the paper’s lead author, is a fellow in pediatric psychology at Children’s Basic Hospital in Salt Lake City.

The research team recruited 100 adolescents (ages 12-17) with T1D and met each with a clinical interview, which is considered the gold standard for diagnosing depression. Participants were also asked to complete five commonly used depression screening tools, each of which took one to three minutes to complete. The researchers then compared the results of each screening tool with the interview results. They said they were surprised to find that in most examiners, they needed to lower the standard diagnostic cut-off scores in order to improve their sensitivity for adolescents with T1D.

“We thought we might need it a plus Marker said the cut-off scores for accuracy with this population, believing that common symptoms of diabetes and depression would inflate the number of depression diagnoses, suggesting that more people with depression when symptoms of diabetes were the cause. The opposite – we needed to lower the cut-off scores to more accurately identify young people with depressive symptoms. “

Most of the screening tools evaluated in the study were designed for adults. None have been created specifically for individuals with T1D, and none have been previously confirmed to accurately detect depression in adolescents. The researchers recommended that diabetes care providers use the tools that have been shown to have the most accuracy in this population, which they identified as CDI-2 Short, PHQ-9A, and SMFQ.

Co-author Susanna Patton, Ph.D., ABPP, CDE, Principal, School Research Scientist at Nemours Children’s Health, Jacksonville said. “For teens with T1D, this also means that some will have more problems managing their diabetes.”

Type 1 diabetes is an autoimmune disease in which the body’s immune system mistakenly destroys the insulin-producing cells in the pancreas. Its causes are not fully understood, and there is currently no cure. An estimated 244,000 children and teens in the United States have this condition, which can cause serious health problems at an early age or later in life.

For future research, the authors note that the adjusted cutoff scores identified in this study must be confirmed by other studies before they can be widely applied.

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Journal reference:

Marker, AM, et al. (2022) Adjusted cutoff scores increase sensitivity of depression screening procedures in adolescents with type 1 diabetes. Diabetes care. doi.org/10.2337/dc22-0275.