Short-Term Effects of COVID-19 Lockdown in Italian Children and Adolescents with Type 1 Diabetes Mellitus: The Role of Separation Anxiety

Abstract

In March 2020, the Italian Government imposed mandatory home confinement to limit the spread of COVID-19. Few studies assessed the psychophysical impact of COVID-19 on chronically ill children. This study examined these effects on children with Type 1 Diabetes Mellitus (T1D) and their caregivers. Seventy-one patients (7–13 years) with T1D and their caregivers were administered a survey created ad hoc and some standardized questionnaires, assessing psychological well-being and anxiety. Medical data (physical and biochemical characteristics) were recorded before (T0, January–February) and after (T1, May–June) the lockdown. Paired Student t-test, Spearman two-tailed correlations, and a linear regression model were used for statistical analysis. Children at T1 showed higher BMI (body mass index), daily total and basal insulin dose, and time spent in therapeutic range, and they showed lower HbA1c (glycated hemoglobin), time spent above the therapeutic range, and standard deviations of the mean glucose values than at T0. A total of 32.9% scored in the clinical range for separation anxiety. The increase in separation anxiety was predicted by younger age, female gender, more recent T1D diagnosis, less time spent in therapeutic range at T1, and higher perceived fear of COVID-19 infection. In a pandemic context, separation anxiety may be stronger in younger females, with more recent T1D diagnosis and poor metabolic control, thus affecting the parent’s ability to manage diabetes and to support children’s autonomy.

Early Evidence of the Interplay between Separation Anxiety Symptoms and COVID-19-Related Worries in a Group of Children Diagnosed with Cancer and Their Mothers

“…As to the children, patients with cancer did not significantly differ from healthy peers in COVID-19-related worries, general psychological functioning, and anxiety symptoms, in line with the literature that reports unchanged psychological functioning for children with chronic diseases such as diabetes and asthma in the first lockdown [13,14]. A study on Dutch children with cancer observed no differences in health-related quality of life and fatigue between the pre-and early-COVID-19 periods; authors referred to children's experience in dealing with medical traumatic events and adequate care and support received to explain these results [38].…”

“…Scarce and inconsistent literature is available about the interplay between COVID-19-related worries and separation anxiety in chronically ill children. Italian studies on diabetic children report normative levels of psychological symptoms, but an increase in children's separation anxiety symptoms during the first lockdown, also associated with higher perceived fear of COVID-19 infection [13]. No differences in psychological functioning emerged when comparing Italian asthmatic children to their healthy peers during the first lockdown, except for higher worry about COVID-19 contagion.…”

“…Research on pediatric cancer patients during the COVID-19 pandemic revealed the risk of worse outcomes from infection because of immunosuppression [10], less treatment adherence [11], and parents' increased stress and anxiety [10,12]. Among the main psychological issues related to the COVID-19 pandemic in pediatric patients, particularly concerning are separation anxiety symptoms and COVID-19-related worries [13]. The COVID-19 worries are not supposed to induce separation anxiety symptoms, but to play a crucial role in increasing them [13].…”

“…Among the main psychological issues related to the COVID-19 pandemic in pediatric patients, particularly concerning are separation anxiety symptoms and COVID-19-related worries [13]. The COVID-19 worries are not supposed to induce separation anxiety symptoms, but to play a crucial role in increasing them [13]. Intense worrying about safety of both children and their close relatives due to the pandemic may lead to difficulties in separation, increased separation anxiety symptoms [13], and a worsening effect on general psychological wellbeing and medical outcomes [13].…”

Weight Gain Associated with COVID-19 Lockdown in Children and Adolescents: A Systematic Review and Meta-Analysis

“…Children with type 1 diabetes mellitus are another unique population. During lockdown, they had evident mood deterioration and required a higher daily total insulin dose, making glycemic control challenging [ 11 , 20 ]. However, the net effect on body weight or BMI could not be demonstrated in our analysis.…”