Kids with type 1 diabetes at risk for mental health problems

A person receives a test for diabetes during Care Harbor LA free medical clinic in Los Angeles, California September 11, 2014. REUTERS/Mario Anzuoni

In a new Swedish study, kids diagnosed with type 1 diabetes were more likely than their healthy siblings to develop a psychiatric disorder or to attempt suicide.

“We suspected that we would find higher risk of common psychiatric disorders such as depression or anxiety, as observed among adults with diabetes,” said lead author Agnieszka Butwicka of the Department of Medical Epidemiology and Biostatistics at the Karolinska Institute in Stockholm.

“What was surprising was that risk was high for many different psychiatric disorders,” which may mean that applying the results of adult studies to kids is too simplistic, she told Reuters Health by email.

More than 200,000 kids in the U.S. had diabetes in 2012, according to the National Diabetes Education Program, and most of them had type 1, which results from the body not producing enough insulin.

The condition, previously known as juvenile diabetes, is often diagnosed early in life. People with type 1 diabetes must use insulin injections every day to regulate their blood sugar, and past research has shown that managing the disease is stressful for kids, especially in the period right after they are diagnosed.

Butwicka and her colleagues used a national register to compare more than 17,000 children with diabetes born in Sweden between 1973 and 2009 with more than 1,000,000 similar but healthy kids, as well as with the healthy siblings of the diabetic group. They looked in medical records for diagnoses of common psychiatric disorders, such as depression, suicide attempt, anxiety, eating disorder, attention-deficit hyperactivity disorder (ADHD), autism or other behavioral problems.

About 8 percent of kids with type 1 diabetes were diagnosed with a psychiatric disorder. Those with diabetes were twice as likely to receive a psychiatric diagnosis by age 18 as kids without the condition, and 1.7 times more likely to attempt suicide, according to the results in Diabetes Care.

The increased risk for psychiatric disorders was highest for kids born between 1973 and 1986, and then declined. That may indicate that progress in diabetes care and offering more flexible life styles and more effective metabolic control may also lower the psychological burden in diabetes, Butwicka said.

Some have argued that the increased incidence of autism among kids with diabetes may be genetic, so their siblings would also be more likely to have the disorder. However the researchers found only a slight increased risk for psychiatric disorders among siblings, and no significant increase in any specific category of disorder.

That suggests the psychological disorders among kids with diabetes may be a result of physiological effects of coping with diabetes rather than a genetic risk factor or family environment, the authors write.

“I think our results could be replicable in other countries with similar access to pediatric diabetes and mental health care with the possibility of access to those data,” Butwicka said.

Most doctors probably don’t tell parents of kids with diabetes that their child may be at risk for mental health issues, she said.

A previous study in Norway found that teens with type 1 diabetes are twice as likely to die before age 30 compared to the general population, and accidents and suicides caused most of the deaths, according to Dr. Maurizio Pompili, director of the Suicide Prevention Center at Sant'Andrea Hospital and Sapienza University of Rome in Italy.

“Patients with (type 1 diabetes) have almost doubled risk of depression compared to the general population, and psychiatric symptoms are frequent in patients with (type 1 diabetes) and other autoimmune diseases,” Pompili, who was not involved in the research, told Reuters Heath by email.

Kids with diabetes should be screened for depression, though not all will need treatment, he said.

Physiological changes in the chronic course of type 1 diabetes, including weight gain, pain, hypertension, heart disease, loss of motor skills, or blindness directly affect the emotional state, said Ana Claudia Ornelas, a psychologist at the Institute of Psychiatry/Federal University of Rio de Janeiro in Brazil, who also was not involved in the new study.

“Children with diabetes and their parents are already afraid of many other complications,” Butwicka said. Parents should know that type 1 diabetes may include psychological implications, and know where to seek help if needed.

But more than 80 percent of kids in the youngest cohort of the new study had no psychiatric diagnosis, she noted.

“Having diabetes does not immediately mean that one has a psychiatric disorder and requires mental health treatment,” she said. “Amazingly, most children and their parents actually do well.”