Improving Depression Screening for Adolescents With Type 1 Diabetes

Abstract

OBJECTIVE: Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation. METHODS:To provide a model for depression screening of youth with chronic health conditions, a standard process using a selfadministered electronic version of the Children' s Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes. RESULTS:Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from ,5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores ($16) were found in 8% of the sample; moderate scores (10-15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population.CONCLUSIONS: Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions. Pediatrics

Depressive Symptoms in Youth With Type 1 or Type 2 Diabetes: Results of the Pediatric Diabetes Consortium Screening Assessment of Depression in Diabetes Study

“…These results provide strong support for routine screening for depressive symptoms and depression in 10-to 17-year-olds with T1D and T2D and appropriate referral for treatment when needed. The results also underscore the need for more time-efficient methods of screening that can be adopted by busy diabetes practices, such as the selfadministered electronic version of the CDI developed by Corathers et al (15).…”

12. Children and Adolescents: Standards of Medical Care in Diabetes—2018

“…A Rapid and dynamic cognitive, developmental, and emotional changes occur during childhood, adolescence, and emerging adulthood. Diabetes management during childhood and adolescence places substantial burdens on the youth and family, necessitating ongoing assessment of psychosocial status and diabetes distress during routine diabetes visits (10)(11)(12)(13)(14). Early detection of depression, anxiety, eating disorders, and learning disabilities can facilitate effective treatment options and help minimize adverse effects on diabetes management and disease outcomes (15).…”

Prevalence and Factors Influencing Depression among Adolescents with Type-1 Diabetes – A Cross-Sectional Study

“…6 Sarah D also reports that there was a statistically significant correlation between HbA1C levels and depression. 13 This relationship between metabolic control and depression may be attributed to the vicious nature of the two conditions. A depressed adolescent may not have behavioral modifications and insulin intake leading to poor glycemic control and poor glycemic control in turn increase the psychological stress leading to precipitation of depression.…”