medwireNews: Routine psychosocial screening of adolescents with type 1 diabetes reveals a significant proportion who could benefit from additional support, researchers say.
The data come from 232 adolescents with type 1 diabetes who carried out a psychosocial screening on a tablet in the waiting room before their appointment. Most (96%) participants were able to fill out the screen completely while they waited for their appointment.
Overall, more than three quarters of the adolescents were positive for at least one of the 10 areas examined, report Alan Delamater (Miller School of Medicine, University of Miami, Florida, USA) and co-researchers.
There was significant overlap between mild or moderate depression and the other points, which ranged from 21.7% to 71.4%. Overall, however, only 27.2% of those who tested positive for any of the other items had mild depression and only 5.0% had moderate depression.
This underscores “the importance of screening for other psychosocial problems,” write the researchers in Pediatric Diabetes.
“Based on our results, hospitals can only register a relatively small number of people with psychosocial concerns if they only report adolescents who report at least moderate symptoms of depression,” they say.
The most commonly identified problem was low intrinsic motivation for diabetes self-care, found in 52%, followed by inconsistent use of insulin in 36%. Around 20% had diabetes stress, mild anxiety or stress when measuring blood sugar, 10% had family conflicts, 7% had eating disorders and 6% were at risk of suicide.
Delamater and his team point out that they are a “diverse clinical population” with nearly 60% identified as Hispanic and 20% as Black.
“Psychosocial check-ups can be particularly critical in clinics that serve different patient groups, as minority youths have far less access to psychiatric services,” they note.
Positive screening for psychosocial variables was generally associated with higher glycated hemoglobin levels and inconsistent use of insulin. Notable among those in the multivariate analysis were family conflicts, which predicted both outcomes; intrinsic motivation that predicted inconsistent use of insulin; and eating disorders and diabetes, which predicted increased glycated hemoglobin levels.
The researchers say, “These findings re-emphasize the need for comprehensive screening: when clinics only screen for depression, they can overlook other concerns that affect critical diabetes outcomes.”
They add: “Given that more than half of the sample had low intrinsic motivation and almost a quarter had high diabetes stress, these appear to be particularly important for inclusion in a screening program.”
Finally, the team found that the implementation of routine psychosocial screening “appeared to affect overall clinical care” as the number of referrals to psychology had increased 25% in the ten months after it was carried out, compared to before.
The largest increase of 72% was due to mental health issues, and there was also a 63% increase in patient admissions while non-psychological referrals did not change.
“This suggests that the screening program may help doctors more easily identify when it is appropriate to refer to psychology,” the researchers conclude.
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Pediatr Diabetes 2021; doi: 10.1111 / pedi.13193
