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Higher Prevalence of Suicide Attempts in Adolescent Type 1 Diabetes Patients

Feb 20, 2015

However, advancement in medications and better controlled regimens may be contributing to a decline in psychiatric disorders among this population…

We know from previous studies and research that there is a increased risk and prevalence for depression in the diabetic population. Other trials have also linked diabetes with different subtypes of anxiety. This is why it is important to further investigate psychiatric disorders and suicide risk in this population.

Swedish researchers assessed the risk of psychiatric disorders and suicide in adolescent type 1 diabetes patients and their healthy siblings. The subjects had to be born in Sweden between 1973 to 2009. The two arms in this study were children with type 1 diabetes (n=17,122), and the control group of healthy siblings (n=18,847). For every patient with childhood onset type 1 diabetes, 100 control subjects (unexposed individuals n=1,696,611) were randomly selected from the Total Population Register.

Probands (Patients with T1DM) and unexposed individuals were matched by sex, year, and county of birth. The unexposed individuals had to be born in Sweden after 1972, not have diabetes of any type before the age of 18 years, and be alive and living in Sweden at the time of diagnosis of diabetes. Statistics test used were X2 test or Student t tests was used for mean values. The risk of psychiatric disorders related to the diagnosis of type 1 diabetes was estimated with the Cox proportional hazards model.

The total number of psychiatric disorders recognized were in 1,428 (8.3%) probands, 259 had more than one disorder. After adjustment were made for different factors, probands were 2.1 times more likely to receive psychiatric diagnoses and 1.7 times more likely to attempt suicide than control subjects. Probands had an increased risk for mood disorders, anxiety disorders, eating disorders, substance misuse, ADHD, behavioral disorders, autism spectrum disorder, and intellectual disability, compared with healthy peers. This was significant from an inpatient and outpatient setting. Overall, the risk of psychiatric disorders increased with age at onset of type 1 diabetes (age of onset, 7 years vs. age of onset ≥12 years). The highest risk of psychiatric disorder in all age groups was noted within the first 6 months after diagnosis of type 1 diabetes and declined with time.

The overall prevalence of psychiatric disorders in the probands was 11.4%, 10 years after the onset of type 1 diabetes in the entire sample. The 10-year prevalence of psychiatric disorders was 3 times as great over the period of the study when analyzed as a cohort. Psychiatric disorders were observed in 1,059 (5.6%) siblings of probands. When analyses were conducted separately for different categories of psychiatric disorders, none of the categories were shown to be statistically significant. This may indicate that the relationship between type 1 diabetes and psychiatric disorders are due to biological and/or psychological effects of diabetes opposed to genetic or environmental factors.

Findings in this study support previous clinical observations that these patients are at an increased risk for psychiatric morbidity. Results from this study validate prior observations as high risk for psychiatric disorders within the first 6 months of diabetes diagnosis.

Practice Pearls:

  • Children recently diagnosed with type 1 diabetes or thereafter, should be evaluated for mental and psychiatric conditions.
  • There was a decline in the the relative risk of psychiatric disorders in this study group, which could be related to advancement in medications and better controlled regimens.
  • Although children with T1DM show more risk for psychiatric disorders, there is such a broad list of these disorders that there may need to be more focus on diabetes with more specific psychiatric disorders.

Agnieszka Butwicka, Louise Frisen, Catarina Almqvist, et al. “Risks of Psychiatric Disorders and Suicide Attempts in Children and Adolescents With Type 1 Diabetes: A Population-Based Cohort Study”. Diabetes Care. 2015 Feb