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Diabetic Children Should Be Screened for Depressive Symptoms

Poor glycemic control and frequent ER visits are among the signs that a child or adolescent with diabetes may have a depressed mood, according to the results of a study published in the April issue of Pediatrics. This study is not the first to investigate depressive symptoms in children with diabetes, states lead author Dr. Jean M. Lawrence, from Kaiser Permanente Southern California in Pasadena. However, most of the other studies were small, included only type 1 diabetics or used a rigid psychiatric definition of depression, she said.

"The SEARCH for Diabetes in Youth is actually the largest study of diabetes in kids in the United States to date," Dr. Lawrence said.

The analysis involved 2672 SEARCH subjects, between 10 and 21 years of age, who had diabetes for an average duration of 5 years. Most had a diagnosis of type 1 diabetes (n=2266), while 371 had type 2 diabetes and 35 subjects had diabetes of unknown origin.

During a study visit, the subjects provided information about demographic characteristics and recent diabetes-related outcomes and HbA1c levels were measured. In addition, their mood was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D).

Based on CES-D scores, 14% of the subjects had a mildly depressed mood and 8.6% had a moderately or severely depressed mood, the report indicates. Females had higher mean scores (more depressed) than their male counterparts.

Higher average HbA1c levels and more frequent ER visits were both associated with depressed mood, the authors note.
In male subjects, type 2 diabetes was more closely linked to depressed mood than type 1 diabetes, after accounting for diabetes duration and demographic factors. In female subjects, the presence of comorbidities was predictive of depressed mood.

In contrast to findings from other studies, the authors found no increased risk of depressed mood in their diabetic subjects compared with rates reported in nondiabetic populations. Dr. Lawrence said this may reflect the fact that the study subjects were assessed for depressed mood using a rapid screening test rather than for depression using a formal psychiatric evaluation.

The results suggest that "as a pediatrician or other healthcare provider, you might want to consider screening for depressed mood" in young diabetic patients with poor blood sugar control, Dr. Lawrence said.
Pediatrics 2006;117:1348-1358.

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