Recurrent depression relates to worse outcomes than single episode depression among Hispanic adolescents with diabetes.

BACKGROUND: Adolescents with type 1 diabetes (T1D) are at increased risk for depression. A history of recurrent depression (HRD) may relate to worse health outcomes than single-episode depression. However, no study has explored this issue among T1D adolescents. PARTICIPANTS AND PROCEDURE: We examined differences in psychosocial and diabetes-related outcomes between T1D adolescents with (G1; n = 33) and without (G2; n = 18) HRD. Participants were 51 youths (aged 12-17 years) enrolled in a depression treatment study. Youths and one caregiver each completed several measures. Using MANOVA, followed by individual ANOVAs, and chi-square tests, we compared groups in continuous and categorical variables, respectively. RESULTS: MANOVA results were significant, F(7, 43) = 3.97, p = .002. Adolescents from G1 obtained higher scores than youths in G2 in self-esteem/guilt problems, cognitive alterations, and sadness due to T1D. Their caregivers reported more burden and rated their offspring as having more internalizing problems, facing more barriers to complying with T1D treatment, and using a medical ID less frequently than their counterparts did. A higher percentage of G1 participants presented clinical anxiety and inadequate glycemic control, and reported a history of major depression. According to caregivers, a higher proportion of G1 members had experienced multiple diabetes-related hospitalizations, were non-compliant with insulin treatment, and lived in homes with a conflictive environment. CONCLUSIONS: Our study documents important differences in outcomes between T1D youths with vs. without any HRD. Clinicians may need an intensive and integrative approach to treat mental and physical aspects of health among these patients.

Comorbid Chronic Physical Illnesses in Type 1 Diabetes Adolescents: Personal, Caregiver, and Family Functioning.

Having diabetes and comorbid chronic physical illnesses (CCPIs) suggests a higher risk for depression and lower health-related quality of life and treatment adherence. Caring for these patients is often overwhelming. Although CCPIs affect youths with type 1 diabetes (T1D), no study has examined the psychosocial or health-related impact of CCPIs in this population. We examined individual, caregiver, and family functioning differences among T1D adolescents with (G1; n = 25) and without (G2; n = 26) CCPIs. Participants were 51 youth (aged 12-17 years) enrolled in a depression treatment study. We administered diagnostic interviews and rating scales to assess each domain of interest. Using MANOVA, followed by individual univariate analyses, and Chi-square tests, we compared groups in continuous and categorical variables, respectively. MANOVA results were significant, F(4, 46) = 2.62, p = .047. Participants from G1 obtained lower global functioning scores compared to G2. Caregivers whose offspring had CCPIs were more depressed and reported higher burden but lower family functioning scores than their counterparts did. A higher percent of youths with CCPIs needed reminders about insulin use and met the criteria for major depression, but a lower proportion had access to insulin pumps. Taking care of youths from G1 was associated with a lifetime history of depressive disorder or suicidality. Our findings support the existence of individual, caregiver, and family functioning differences between T1D adolescents with vs. without CCPIs. Psychosocial interventions should consider the incremental burden that CCPIs may pose over these youth and their families.

Tener diabetes y enfermedades físicas crónicas comórbidas (EFCCs) sugiere mayor riesgo de depresión, menor calidad de vida relacionada con la salud y menos adherencia al tratamiento. Cuidar tales pacientes suele ser agobiante. Aunque las EFCCs afectan a jóvenes con diabetes tipo 1 (DT1), no existen estudios sobre su impacto psicosocial o en la salud en esta población. Examinamos diferencias en funcionamiento individual, familiar y entre personas cuidadoras de 51 adolescentes (12­17 años) que presentaban DT1 con (G1; n = 25) y sin (G2; n = 26) EFCCs y participaron en un estudio de tratamiento para la depresión. Administramos entrevistas diagnósticas y cuestionarios para evaluar cada dominio de interés. Utilizando MANOVA, seguido de análisis univariados, y el Chi-cuadrado, comparamos los grupos en variables continuas y categóricas. El MANOVA fue significativo, F(4, 46) = 2.62, p = .047. El G1 mostró un funcionamiento global menor que el G2. Quienes cuidaban adolescentes del G1 reportaron más sintomatología depresiva, una carga parental mayor y un funcionamiento familiar menor que sus contrapartes. Un porcentaje mayor de jóvenes con EFCCs necesitó recordatorios para usar insulina y cumplió criterios de depresión mayor, pero una proporción menor accedió a bombas de insulina. Cuidar adolescentes del G1 se asoció con presentar un trastorno depresivo o tendencias suicidas alguna vez. Nuestros hallazgos respaldan que existen diferencias en funcionamiento individual, familiar y de personas cuidadoras de adolescentes con DT1 con y sin EFCCs. Las intervenciones psicosociales deben considerar la carga incremental que las EFCCs representan para tales jóvenes y familias.