Authors (including presenting author) :
(1) Dr Antony Fu, (1) Dr Cindy Chan
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
Introduction :
Diabetes mellitus is a life-long endocrine illness that requires high patient effort and compliance over diet, medications, regular blood sugar level monitoring and frequent hospital follow-ups. Debilitating acute and chronic complications occur especially with poor glycaemic control. According to the SEARCH for Diabetes in Youth Study, up to 14% of DM adolescents reported mild depressed mood, while 8.6% reported moderate to severe depressed mood. To present, assessment of depression is not usually included in our local metabolic risk assessment module (MRAM) designed for diabetes complication screening.
Objectives :
We sought to evaluate the prevalence and severity of depressive symptoms in paediatric patients with diabetes mellitus, and identify factors associated with the development of depressive symptoms.
Methodology :
The Patient Health Questionnaire-9 (PHQ-9), that served as the instrument for evaluating the severity of depressive symptoms, was completed by 90 paediatric patients with diabetes from year 2020- 2022 who received regular follow up in Princess Margaret Hospital. Data including demographics, clinical and laboratory work of patients were collected and analysed.
Result & Outcome :
90 patients, with 46 being male (51.1%) and 82 being Chinese (91.1%), were recruited. Sixteen (17.8%, 95% CI: 9.9%- 25.7%) reported moderate or above severity of depressive symptoms as defined by a PHQ-9 score ≥10. 13.7% and 12.2% of patients had a PHQ-9 score ≥10 in year 2021 and 2022 respectively, compared to none in year 2020. Higher body mass index (BMI) (p = 0.048), presence of diabetic-related complications (p= 0.049), greater number of hospital admissions related to poor diabetic control (p= 0.003), poor family dynamics with parental marital conflicts (p= 0.002) and parent-child relationship problems (p< 0.001), known psychological or behavioural problems (p< 0.001) were identified as factors associated with increased risk for developing depressive symptoms. Patients who used continuous glucose monitoring system (CGMS) (p= 0.014) and had more frequent blood sugar monitoring (p= 0.002) were associated with less risk for developing depressive symptoms. A higher HbA1c value (p= 0.023) was found to be positively related to depressive symptoms in the subgroup analysis for patients with type 1 DM but not type 2.
Depressive symptoms are common in paediatric diabetes patients. Regular mental health screening by using a validated self-reported questionnaire is a cost-effective and reliable method that should be advocated in all eligible paediatric diabetes patients. Timely referral, diagnosis and management of depression will lead to better disease control and quality of life in these patients.
