Mental health comorbidity and youth onset type 2 diabetes: A systematic review of the literature

Abstract

Background Type 2 diabetes (T2D) is a burgeoning epidemic in children and adolescents. Adult T2D doubles the risk of depression and mental health comorbidity makes it more difficult to make the lifestyle, medication adherence and health behavior changes needed to optimize outcomes. There is limited research on the impact of depression and depressive symptoms on youth T2D. Methods A search of the literature in the last 10 years regarding youth with depression and T2D was conducted. Abstracts were screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by a third author. Selected full-text articles were divided among all authors for review. Results 13 publications from 8 studies (N=2244, age 6–17) were included. 6 of 13 publications utilized Treatment Options for Type 2 Diabetes in Youth (TODAY) study data. While studies included evaluation of depressive symptoms, most did not formally assess for major depressive disorder (MDD) and excluded participants with a previous diagnosis of MDD. Depressive symptoms were common in this population and were associated with negative T2D outcomes. Conclusions While there is a growing body of adult literature highlighting the extensive relationship between T2D and mental health, there is a dearth of data in youth. Future studies are needed that include, 1.) youth with diagnosed MDD, 2.) treatment studies of both T2D and MDD, 3.) larger, more racially diverse samples of youth with T2D, and 4.) studies that evaluate the impact of social determinants of health, including mental health comorbidity on outcomes of T2D.

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

“…This is due, in part, to exposure to psychosocial factors including adverse childhood experiences, poverty 173,174 and mental health disorders 175–180 . Mental health disorders are common among adolescents with T2D, 181,182 reducing quality of life and readiness to adopt regular daily PA 46 . For example, the odds of being ready to adopt new health behaviors (including daily PA) are ~14% lower for every unit increase in anxiety, depression, and emotional distress among adolescents with T2D 46 .…”

“… 171 , 172 This is due, in part, to exposure to psychosocial factors including adverse childhood experiences, poverty 173 , 174 and mental health disorders. 175 , 176 , 177 , 178 , 179 , 180 Mental health disorders are common among adolescents with T2D, 181 , 182 reducing quality of life and readiness to adopt regular daily PA. 46 For example, the odds of being ready to adopt new health behaviors (including daily PA) are ~14% lower for every unit increase in anxiety, depression, and emotional distress among adolescents with T2D. 46 In contrast, adolescents with T2D who reported having more resilient characteristics, particularly a connection to others and a sense of mastery over their lives, were 5%–10% more likely to be in the action and maintenance stage of change.…”

Progression of early kidney injury in youth with type 2 diabetes: a follow-up analysis from the iCARE Cohort

“…A recent systematic review concluded that there is a paucity of research in mental health and youth with T2D. Available studies primarily focus on prevalence of depressive symptoms [30,31]. In the TODAY study at baseline 14.8% had clinically signi cant symptoms [32].…”

“…A population based Canadian study demonstrated that youth with T2D had a higher likelihood of having a mood or anxiety disorder before and after diagnosis compared to matched youth without diabetes and children with T1D [36]. A systematic review also showed that higher rates of depression were associated with lower social support [30]. Analysis of the TODAY cohort showed that clinically signi cant symptoms of depression in youth with type 2 diabetes were associated with lower adherence to medication [37].…”

Mental health comorbidity is common in children with type 2 diabetes

“…There are few reports focusing on the mental health of children with T2D. 21 In the TODAY study, 15% of youth scored at or above the cutoff for clinically significant depressive symptoms using screening questionnaires at baseline. This is a rate similar to that reported in adolescents from the general US population without diabetes.…”