Effects of Trauma and Anxiety on Adherence in Pediatric Type 1 Diabetes

Abstract

Background Psychiatric factors such as depression, anxiety, and life stressors have been shown to negatively affect diabetes self-management and A1C in children and adolescents. However, less is known about how trauma exposure and symptoms of post-traumatic stress disorder (PTSD) may affect type 1 diabetes. Objectives To determine the rates of trauma exposure and PTSD symptoms in patients aged 7–21 years with type 1 diabetes and to examine the relationships among trauma exposure, PTSD, anxiety, depression, and diabetes self-management. Methods Patients underwent standardized psychiatric screening questionnaires during clinic visits. A1C at goal was defined as <7.0%, and behavioral adherence was defined as specific parameters of blood glucose monitoring. χ2 and Fisher exact tests were used to assess the relationships among trauma, PTSD, anxiety, and behavioral adherence. ANOVA was conducted to examine group differences between A1C and the presence of suicidal ideation. Results Of the participants, 38.4% (n = 99, mean age 13.8 ± 3.5 years, 51.5% female) had trauma symptoms and functional impairment concerning for PTSD. Rates of trauma secondary to accidental injury, medical traumatic stress, natural disaster, and witness to family violence were 28.3, 22.2, 10.1, and 6.1%, respectively. Neither PTSD, anxiety, nor depression symptoms were associated with behavioral nonadherence (P = 0.546, P = 0.337 and P = 0.697, respectively), but the subscales for significant school avoidance and generalized anxiety disorders were associated with behavioral nonadherence (P = 0.023 and P = 0.032, respectively). Those who reported suicidal ideation had higher mean A1C than those who did not (A1C 8.9 vs. 8.3, P = 0.047). Conclusion Although trauma was common among youth with type 1 diabetes, neither trauma nor PTSD was associated with changes to self-management. However, certain forms of anxiety and suicidal ideation were associated with poor self-management and higher A1C, respectively.

Suicidal Ideation, Suicide Attempts, and Suicide Deaths in Adolescents and Young Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis

“…Of the 31 included studies, 14 included only participants within the target age range of 10-24 years (18,23,26,28,(35)(36)(37)(38)(39)(40)42,45,46,48). For 23 studies investigators used random probabilistic sampling techniques or incorporated the inclusion of all consecutive individuals within the sampling frame (18)(19)(20)(21)(22)(23)(24)(27)(28)(29)(30)(31)(32)(33)35,36,(38)(39)(40)(41)44,46,47). A sample size calculation was performed in only one study (26).…”

“…Twenty studies provided all the data needed to determine pooled prevalence for any of the suicide-related outcomes and thus were included in the quantitative analysis (18-20,22,23,25,27-29, 32,35,37-39,42-45,47,48). Twenty studies had a response rate considered adequate (19,(21)(22)(23)(24)26,28,(30)(31)(32)(33)35,38,40,41,(43)(44)(45)(46)(47) and four did not but investigators conducted an analysis to compare the characteristics of diabetesjournals.org/care responders and nonresponders (18,25,27,42). Three studies had a low response rate without appropriate explanation (20,36,37), and for four the response rate was not clearly reported (29,34,39,48).…”

“…Of the 31 studies included in this review, 20 were crosssectional studies (18)(19)(20)(21)23,25,26,28,29,32,(35)(36)(37)39,42,43,(45)(46)(47)(48), 8 were retrospective cohort studies (22,30,31,33,34,40,41,44), 2 were prospective cohort studies (27,38), and 1 was a case-control study (24). The years of publication ranged from 1977 to 2023, with 20 studies published since 2011 (18,(20)(21)(22)(23)25,26,32,(35)(36)(37)(38)(39)(40)(43)(44)(45)(46)(47)(48). Overall, 16 studies included ana...…”

“…The years of publication ranged from 1977 to 2023, with 20 studies published since 2011 (18,(20)(21)(22)(23)25,26,32,(35)(36)(37)(38)(39)(40)(43)(44)(45)(46)(47)(48). Overall, 16 studies included analysis of data from North America (21, 23,[27][28][29]32,[35][36][37][38][39][43][44][45][46][47], 12 from European countries (18,20,22,24,25,30,31,33,34,(40)(41)(42), and 3 from the African continent (19,26,48). Sample sizes of youth with T1D ranged from 6 to 28,887.…”