'Teens with diabetes should be screened for depression'

JACKSONVILLE: According to a recent study published in the American Diabetes Association journal Diabetes Care, the score results of commonly used depression-screening methods should be carefully altered to better detect the illness in teenagers with Type 1 diabetes mellitus (T1D).

The study is the first to extensively evaluate the efficacy of such screeners for this population when compared to diagnostic interviews. Researchers from Primary Children's Hospital and Nemours Children's Health in Jacksonville led the study.

Data were gathered in conjunction with Children's Mercy Kansas City when both researchers were affiliated with the University of Kansas Medical Center, which provided funding for the experiment.

According to earlier research, teenagers with T1D are more likely than counterparts without diabetes to develop depression. Additionally, depression, according to researchers, can affect glycemic control, cause poor blood glucose monitoring, and result in more frequent hospitalizations.

For these reasons, regular depression screening is advised by national and international standards for all diabetic teenagers. "Depression screening is crucial for youth with Type 1 diabetes since depression treatment is likely to keep them healthier now and in the long run," said the paper's lead author, Arwen M. Marker, PhD, a pediatric psychology fellow at Primary Children's Hospital of Salt Lake City.

"We need to know which screening tools perform best and how best to use them in this population, so we do not fail to identify depressed kids and get them the support they need."

The research team gathered 100 T1D teenagers (aged 12 to 17) and conducted clinical interviews with each one of them, which are regarded as the gold standard for identifying depression. Five regularly used depression screening tools, each of which took one to three minutes to complete, were also given to the participants.

The outcomes of each screening instrument were then contrasted with those of the interviews. The majority of the screeners' usual diagnostic cut-off scores had to be lowered in order to maximise their sensitivity for T1D-affected adolescent patients, they claimed, which shocked them.

"We thought we might need to increase the cut-off scores for accuracy with this population, thinking that symptoms common to diabetes and depression would inflate the number of depression diagnoses, suggesting more were depressed when actually diabetes symptoms were the cause," said Marker.

"However, we generally found the opposite - we needed to lower cut-off scores to most accurately identify youth with depressive symptoms."

Most of the screening tools evaluated in the study were made with adults in mind. None were designed expressly for people with T1D, and none had been demonstrated to identify adolescent depression in the past reliably.

Researchers suggested that diabetes care professionals employ the CDI-2 Short, PHQ-9A, and SMFQ, which have been shown to have the highest accuracy in this population.

According to co-author Susana Patton, PhD, ABPP, CDE, a principal research scientist at Nemours Children's Health in Jacksonville, "without the right sensitivity cut-offs, even great screening tools will miss some teens with depression, meaning they will not receive mental health services and could continue to experience depression."

That also means that some T1D teenagers may have more difficulty controlling their diabetes. An autoimmune condition known as type 1 diabetes occurs when the body's immune system unintentionally kills insulin-producing cells in the pancreas.

There is currently no known cure, and its causes are unclear. This disorder, which affects an estimated 244,000 kids and teenagers in the United States, can lead to major health issues either early in life or later in life.