|
1
|
Verkest M, Logghe K, Van Loocke M. Persistent Hypoglycemia in Diabetes Type 1 Patient with Medtronic 780 G Insulin Pump: A Case Report. Horm Res Paediatr 2024:1-5. [PMID: 38964298 DOI: 10.1159/000539486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/17/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION In this article, the importance of holistic care is highlighted trough the case of a 10-year-old female with diabetes type 1 presenting with recurrent severe hypoglycemia. CASE PRESENTATION A 10-year-old female, with type 1 diabetes mellitus for 2 years, was hospitalized because of persistent hypoglycemia. At time of presentation, the patient was getting her insulin through an automated insulin delivery device. She came to the emergency room because of severe hypoglycemia despite adequate administration of glucagon intranasal and oral sugar solutions. The patient was hospitalized to resolve the hypoglycemia and to investigate the cause of the persistent hypoglycemia. Extensive further investigation was performed without result. CONCLUSION After several conversations with psychologists, the patient admitted having manipulated the insulin pump resulting in auto-induced persistent and recurrent life-threatening hypoglycemia. Through camera monitoring, the team was able to confirm the manipulation.
Collapse
Affiliation(s)
- Maïté Verkest
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Karl Logghe
- Department of Pediatric Endocrinology, AZ Delta, Roeselare, Belgium
| | | |
Collapse
|
|
2
|
Renaud-Charest O, Stoljar Gold A, Mok E, Kichler J, Nakhla M, Li P. Suicidal Ideation, Suicide Attempts, and Suicide Deaths in Adolescents and Young Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care 2024; 47:1227-1237. [PMID: 38900947 DOI: 10.2337/dc24-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/13/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Evidence is lacking on the risk of suicide-related behaviors (suicidal ideation, suicide attempt, suicide death) in youth with type 1 diabetes (T1D). PURPOSE We aimed to 1) determine the prevalence of suicidal ideation, suicide attempts, and suicide deaths in adolescents and young adults (AYA) with T1D aged 10-24 years; 2) compare suicide-related behavior prevalence in youth with and without T1D; and 3) identify factors associated with suicide-related behaviors. DATA SOURCES A systematic search was conducted in MEDLINE, Embase, and PsycInfo up to 3 September 2023. STUDY SELECTION We included observational studies where investigators reported the prevalence of suicide-related behaviors among AYA aged 10-24 years with T1D. DATA EXTRACTION We collected data on study characteristics, data on prevalence of suicide-related behaviors, and data on associated factors. DATA SYNTHESIS We included 31 studies. In AYA with versus without T1D, pooled prevalence of suicidal ideation was 15.4% (95% CI 10.0-21.7; n = 18 studies) vs. 11.5% (0.4-33.3; n = 4), respectively, and suicide attempts 3.5% (1.3-6.7; n = 8) vs. 2.0% (0.0-6.4; n = 5). Prevalence of suicide deaths ranged from 0.04% to 4.4% among youth with T1D. Difficulties with T1D self-management were frequently reported to be associated with higher rates of suicide-related behaviors. However, findings on the association of glycemic levels and suicide-related behaviors were inconsistent. LIMITATIONS There was a considerable level of heterogeneity in meta-analysis of both suicidal ideation and suicide attempts. CONCLUSIONS Suicidal ideation and suicide attempts are prevalent in AYA with T1D. Current evidence does not suggest that these rates are higher among AYA with T1D than rates among those without.
Collapse
Affiliation(s)
| | | | - Elise Mok
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jessica Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Meranda Nakhla
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Patricia Li
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of General Pediatrics, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
|
3
|
Narindrarangkura P, Alafaireet PE, Khan U, Kim MS. Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset. Int J Psychiatry Med 2023:912174231162477. [PMID: 36872916 DOI: 10.1177/00912174231162477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE People with diabetes have a higher risk of suicidal behaviors than the general population. However, few studies have focused on understanding this relationship. We investigated risk factors and predicted suicide attempts in people with diabetes using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. METHOD Data was retrieved from Cerner Real-World Data™ and included over 3 million diabetes patients in the study. Least absolute shrinkage and selection operator regression was applied to identify associated factors. Gender-, diabetes-type-, and depression-specific LASSO regression models were analyzed. RESULTS There were 7764 subjects diagnosed with suicide attempts with an average age of 45. We found risk factors for suicide attempts in diabetes patients, such as being an American Indian or Alaska Native (β = 0.637), atypical agents (β = 0.704), benzodiazepines (β = 0.784), and antihistamines (β = 0.528). Amyotrophy had a negative coefficient for suicide attempts in males with diabetes (β = -2.025); in contrast, it had a positive coefficient in females with diabetes (β = 3.339). Using MAOI had a negative coefficient for suicide attempts in T1DM patients (β = -7.304). Aged less than 20 had a positive coefficient for suicide attempts in depressed (β = 2.093) and non-depressed patients with diabetes (β = 1.497). The LASSO model had 94.4% AUC and 87.4% F1 score. CONCLUSIONS To our knowledge, this is the first study using LASSO regression to identify risk factors for suicide attempts and diabetes. The shrinkage technique successfully reduced the number of variables in the model to improve overfitting. Further research is needed to study cause-and-effect relationships. The results may help providers identify high-risk groups of suicide attempters among diabetes patients.
Collapse
Affiliation(s)
| | - Patricia E Alafaireet
- Department of Health Management and Informatics, 14716University of Missouri, Columbia, MO, USA
| | - Uzma Khan
- Cosmopolitan International Diabetes and Endocrinology Center, Columbia, MO, USA.,Department of Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Min Soon Kim
- Institute for Data Science and Informatics, 14716University of Missouri, Columbia, MO, USA.,Department of Health Management and Informatics, 14716University of Missouri, Columbia, MO, USA
| |
Collapse
|
|
4
|
Sharif H, Jan SS, Sharif S, Seemi T, Naeem H, Jawed Z. Depression and suicidal ideation among individuals with type-2 diabetes mellitus, a cross-sectional study from an urban slum area of Karachi, Pakistan. Front Public Health 2023; 11:1135964. [PMID: 36908405 PMCID: PMC9997841 DOI: 10.3389/fpubh.2023.1135964] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Background Suicidal thoughts and depression are associated with patients with diabetes, especially patients with low socioeconomic backgrounds and prolonged illness. Objective We aimed to estimate suicidal thoughts and depression among patients with type 2 diabetes (T2D) in the slums of Karachi. Methods This cross-sectional study was conducted across 38 locations in the slums of Karachi to understand depression, suicidal thoughts, and other supporting factors of depression associated with T2D. The three-item Oslo Social Support Scale, the Patient Health Questionnaire-9 (PHQ-9) scale, and the Ask Suicide Screening Questions were used to screen the patients. Results A total of 504 study participants were interviewed, with a response rate of 98%. The prevalence of depression among patients with diabetes was 30.83%, and suicidal ideation was 20.39%. In the final multivariate analysis, being socioeconomically poor, physically disabled, and having poor social support were independent predictors of depression. Conclusion Diabetes, low socioeconomic level, a lack of social support, and physical disability were all linked to depression. Therefore, trained health providers should conduct an early depression-focused routine screening for patients with diabetes.
Collapse
Affiliation(s)
- Hina Sharif
- Research and Publication Department, SINA Health and Education Welfare Trust, Karachi, Pakistan
| | - Shah Sumaya Jan
- Department of Anatomy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Sana Sharif
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tooba Seemi
- Research and Publication Department, SINA Health and Education Welfare Trust, Karachi, Pakistan
| | - Hira Naeem
- Research and Publication Department, SINA Health and Education Welfare Trust, Karachi, Pakistan
| | - Zahida Jawed
- SINA Health Education and Welfare Trust, Karachi, Pakistan
| |
Collapse
|
|
5
|
Barnard KD, Majidi S, Clements MA, Battelino T, Renard E, Close KL, Novak L, Kar P, Wu Y. RESCUE Collaborative Community: A New Initiative to Reduce Rates of Intended Self-Injury and Suicide Among People with Diabetes. Diabetes Technol Ther 2022; 24:583-587. [PMID: 35238618 DOI: 10.1089/dia.2021.0474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Suicide is the leading cause of death among young people aged 20-34 and the second leading cause of death in adolescents aged 15-19. In the general population, among those attempting suicide 7% die by suicide and 23% reattempt with nonfatal consequences. Depression, closely associated with suicidal ideation, is diagnosed in 7%-25% of the United States and European populations. Individuals with type 1 diabetes (T1D) have a two to three times higher prevalence of depression and approximately double the rate of suicide compared to the general population. Rates of self-harm and suicide among people with diabetes are likely to be considerably underestimated due to poor identification. This information is critical to create interventions to decrease rates of suicide and self-harm. This is particularly important in the setting of advanced technologies in T1D, which offer both easier methods of self-injurious behaviors through insulin misuse and can act as identification tools to identify risk insulin behaviors and provide opportunities to develop interventions and prevention efforts in those with depression and suicidal ideation/behavior/acts. To this end, our goal was to identify any literature on coding diabetes correctly in individuals who die by suicide or engage in intentional self-harm. Furthermore, to describe the Reducing Suicide Rates Among Individuals with Diabetes (RESCUE) Collaborative Community and its goals of using multiple approaches to reduce rates of intended self-injury and suicide among people with diabetes. These include detection of cases, understanding support needs, identification of risk factors, and early intervention for individuals at risk.
Collapse
Affiliation(s)
- Katharine D Barnard
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
- BHR Limited, Hampshire, United Kingdom
| | | | | | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | | | - Lucia Novak
- Diabetes Consulting Services, North Bethesda, Maryland, USA
| | - Partha Kar
- Portsmouth Hospitals NHS Trust, NHS England, United Kingdom, USA
| | - Yiduo Wu
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| |
Collapse
|
|
6
|
AbdElmageed RM, Mohammed Hussein SM. Risk of Depression and Suicide in Diabetic Patients. Cureus 2022; 14:e20860. [PMID: 35145767 PMCID: PMC8803388 DOI: 10.7759/cureus.20860] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
Although mental disorders in diabetics are more prevalent than in the general population, an increased prevalence of depression, frequently leading to suicide, has been reported in individuals with diabetes mellitus. Therefore, the purpose of this review is to assess the risk of depression and suicide in diabetic patients. The prevalence of depression and suicide is high among diabetic individuals. Risk factors including history of depression, presence of comorbidity, younger age, lower education, low social support, presence of diabetic complications, poor glycemic control, and physical impairment, all increase the risk of depression among diabetics. On the other hand, female sex, the intensity of childhood trauma, a history of alcohol misuse, depression, lower level of education, comorbidities, higher blood glucose levels, and previous history of suicide, all increase the risk of suicide among diabetics. Additionally, a bidirectional relationship exists between depression and diabetes. For example, depression can cause diabetes due to the disease's psychological and psychosocial impact, microvascular brain lesions, higher glutamate levels, poor glycemic control, and medication adherence. On the other hand, diabetic patients develop depression due to the stress associated with disease management. This paper concluded that depression and suicide are both prevalent conditions among diabetic patients. The higher risk of depression and suicidality in diabetic patients emphasizes the critical need of integrating depression screening and treatment into primary healthcare settings to avoid fatal conditions in the future. However, more research is required in this area.
Collapse
|
|
7
|
Kirič B, Leben Novak L, Lušicky P, Drobnič Radobuljac M. Suicidal Behavior in Emergency Child and Adolescent Psychiatric Service Users Before and During the 16 Months of the COVID-19 Pandemic. Front Psychiatry 2022; 13:893040. [PMID: 35633784 PMCID: PMC9130484 DOI: 10.3389/fpsyt.2022.893040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Slovenia is among the countries with the highest suicide rates in the world. The COVID-19 pandemic has had a significant impact on the mental health of children and adolescents. Our hypothesis is that the school closure during the pandemic with a gradual transfer to virtual schooling had an important impact on children's and adolescents' suicidal behavior. Therefore, we aimed to determine possible changes in the frequency of assessments as well as frequency and severity of suicidal behavior in the population of Slovene children and adolescents seeking emergency psychiatric help in correlation with the progression of the pandemic and online schooling. METHODS We performed a retrospective observational analysis of medical records of all children and adolescents referred to the only 24-h emergency in- and outpatient child and adolescent psychiatry service in Slovenia from March 2019 through the end of July 2021. We extracted number of assessments, number of patients with suicidal ideation and with attempted suicide. A comparison between the same periods prior to the pandemic and during the pandemic was made. The months of school closure due to the COVID-19 restriction measures and the months without closures were also compared. RESULTS During this period, 1966 children and adolescents were assessed. There was no statistically significant difference in the observed frequency of emergency visits when we compared all the months with to all the months without school closures, or when individual corresponding months with and without school closures were compared. However, there were statistically significantly more patients with suicidal ideation [t(16) = -2.739, p = 0.015; W = 25.0, p = 0.016] and patients who had attempted suicide [t(16)= -3.412, p= 0.004; W = 14.5, p =0.006] during the pandemic as individually compared to the corresponding pre-pandemic months. CONCLUSIONS Our results show that the number of Slovene children and adolescents who required emergency psychiatric help with suicidality and attempted suicide increased during the COVID-19 pandemic. The increase was shown only after the first year of the pandemic. The observed increase did not appear to directly correspond to the school closures, but was more likely related to the duration of the pandemic.
Collapse
Affiliation(s)
- Barbara Kirič
- Center for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Lara Leben Novak
- Center for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Maja Drobnič Radobuljac
- Center for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
|
8
|
Turin A, Drobnič Radobuljac M. Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review. World J Diabetes 2021; 12:1518-1529. [PMID: 34630904 PMCID: PMC8472498 DOI: 10.4239/wjd.v12.i9.1518] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic diseases in children and adolescents worldwide. Its etiopathogenesis results from the interplay of genetic and environmental variables. Among the latter, psychological stress has been implicated in disease onset as well as disease management. Various studies, including large population-based studies, have highlighted the role of stressful life events in the etiopathogenesis of T1D. In this article, we also emphasize the importance of attachment in the early child-caregiver relationship, which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation. It serves as a model for all subsequent relationships in one's life. We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management. T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications. In addition to psychological stress, psychological factors such as family functioning, developmental adjustment, autonomy, mental health problems and other factors have been found to relate to metabolic control. Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.
Collapse
Affiliation(s)
- Anja Turin
- Department for Child Psychiatry, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Maja Drobnič Radobuljac
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
- Unit for Intensive Child and Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana 1000, Slovenia
| |
Collapse
|
|
9
|
Turin A, Dovč K, Klemenčič S, Bratina N, Battelino T, Lipovšek JK, Uršič K, Shmueli-Goetz Y, Drobnič-Radobuljac M. Carer's Attachment Anxiety, Stressful Life-Events and the Risk of Childhood-Onset Type 1 Diabetes. Front Psychiatry 2021; 12:657982. [PMID: 34140900 PMCID: PMC8205563 DOI: 10.3389/fpsyt.2021.657982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background/Objective: Type 1 diabetes (T1D) is among the most common chronic diseases in children/adolescents, and the incidence continues to rise worldwide. Different environmental factors have been evaluated in the etiology. In the present study, we investigated the role of attachment examining whether insecure attachment to carers or carers' own attachment insecurity was related to a higher risk of T1D in children. Methods: We included 101 children with T1D (mean age 11.8 years), 106 healthy controls (11.6 years), and one of their carers. We assessed children's attachment using the Child Attachment Interview and carers' attachment using the Relationship Structures Questionnaire. We constructed binary multinomial logistic regression models using attachment to mothers, carers' attachment representations, and stressful life-events as T1D predictors. Results: Higher carer attachment anxiety was associated with the child's T1D diagnosis (p < 0.05; R 2 = 0.0613) while security of attachment to mothers showed no significant association. When mothers' education was included in the model, both attachment anxiety in higher educated mothers and stressful life events showed a significant association with the child's T1D (p < 0.001; R 2 = 0.293). Conclusions: Our findings suggest that higher attachment-related anxiety in carers with high education and stressful life events are associated with T1D in children.
Collapse
Affiliation(s)
- Anja Turin
- Centre for Mental Health, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovč
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Simona Klemenčič
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jasna Klara Lipovšek
- Centre for Mental Health, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| | - Katarina Uršič
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Yael Shmueli-Goetz
- Anna Freud National Centre for Children and Families and Psychoanalysis Unit, University College London, London, United Kingdom
| | - Maja Drobnič-Radobuljac
- Centre for Mental Health, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
|
10
|
Uršič K, Bucik V, Klemenčič S, Bratina N, Battelino T, Dovč K, Drobnič Radobuljac M. Validation of the Lifetime Incidence of Traumatic Events (LITE-S/P) Questionnaires in Children and Adolescents in Slovenia. Front Psychiatry 2021; 12:665315. [PMID: 34276439 PMCID: PMC8280467 DOI: 10.3389/fpsyt.2021.665315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: A traumatic event is an extremely threatening and frightening experience in an individual's life. Children who are exposed to traumatic events are twice as likely to develop a mental disorder. Screening can provide insight into the traumatic experience of children, identifying those eligible for further evaluation, and support. With this aim, we evaluated the psychometric properties of the Lifetime Incidence of Traumatic Events questionnaire (LITE) in Slovene by calculating retest reliabilty, construct validity (cross-informant agreement) and external validity, where we calculated the correlation of the number of differenet traumatic events with psychopathological symptoms. Methods: 280 child-parent pairs (children aged 11.3 ± 2.2 years) from various Slovenian primary schools participated in the study. They were divided into two groups: 180 healthy primary school students and 100 children with Type 1 Diabetes (our study was a part of a larger study The Influence of Psychobiological Adversity on Children and Adolescents with Type 1 Diabetes Study). Two versions of the LITE questionnaire were used. Children completed the child report (LITE-S) and parents the parent report (LITE-P) version. After 4 weeks, 117 children, and 114 parents filled out the LITEs again. External validity was assessed using the Youth Self Report and Child Behaviour Checklist syndrome-oriented scales. Results: Retest reliability for individual scales was r = 0.469-0.639 (ρ = 0.443-0.636; p < 0.001), but higher for individual items (κ = 0.263-0.821; p < 0.001). Correlations between reports from parents and children were r = 0.313-0.345 (ρ = 0.317-0.348; p < 0.001). The number of different events experienced by children correlated significantly with the measured depressive-anxiety, and posttraumatic stress disorder symptoms. Conclusions: Based on our results, the LITE-S and LITE-P "All events" scale have acceptable psychometric properties for use in research and in clinical practise screening. We recommend looking at single items, taking into consideration the responses from both the child and the parent for more precise information. To improve the precision of the psychodiagnostic capacity of the questionnaire, further research on various populations should be performed.
Collapse
Affiliation(s)
- Katarina Uršič
- Department for Haematology and Oncology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Valentin Bucik
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Klemenčič
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovč
- Department for Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Drobnič Radobuljac
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Unit for Intensive Child and Adolescent Psychiatry, Department for Mental Health, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
|
11
|
Barnard-Kelly KD, Naranjo D, Majidi S, Akturk HK, Breton M, Courtet P, Olié E, Lal RA, Johnson N, Renard E. Suicide and Self-inflicted Injury in Diabetes: A Balancing Act. J Diabetes Sci Technol 2020; 14:1010-1016. [PMID: 31801353 PMCID: PMC7645123 DOI: 10.1177/1932296819891136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Glycemic control in type 1 diabetes mellitus (T1DM) remains a challenge for many, despite the availability of modern diabetes technology. While technologies have proven glycemic benefits and may reduce excess mortality in some populations, both mortality and complication rates remain significantly higher in T1DM than the general population. Diabetes technology can reduce some burdens of diabetes self-management, however, it may also increase anxiety, stress, and diabetes-related distress. Additional workload associated with diabetes technologies and the dominant focus on metabolic control may be at the expense of quality-of-life. Diabetes is associated with significantly increased risk of suicidal ideation, self-harm, and suicide. The risk increases for those with diabetes and comorbid mood disorder. For example, the prevalence of depression is significantly higher in people with diabetes than the general population, and thus, people with diabetes are at even higher risk of suicide. The Center for Disease Control and Prevention reported a 24% rise in US national suicide rates between 1999 and 2014, the highest in 30 years. In the United Kingdom, 6000 suicides occur annually. Rates of preventable self-injury mortality stand at 29.1 per 100 000 population. Individuals with diabetes have an increased risk of suicide, being three to four times more likely to attempt suicide than the general population. Furthermore, adolescents aged 15 to 19 are most likely to present at emergency departments for self-inflicted injuries (9.6 per 1000 visits), with accidents, alcohol-related injuries, and self-harm being the strongest risk factors for suicide, the second leading cause of death among 10 to 24 year olds. While we have developed tools to improve glycemic control, we must be cognizant that the psychological burden of chronic disease is a significant problem for this vulnerable population. It is crucial to determine the psychosocial and behavioral predictors to uptake and continued use of technology in order to aid the identification of those individuals most likely to realize benefits of any intervention as well as those individuals who may require more support to succeed with technology.
Collapse
Affiliation(s)
- Katharine D. Barnard-Kelly
- Faculty of Health and Social Science, Bournemouth University, UK
- BHR Limited, Fareham, Hampshire, UK
- Katharine D. Barnard-Kelly, PhD, Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK.
| | | | - Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | - Marc Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Philippe Courtet
- Psychiatric Emergency and Acute Care, Lapeyronie Hospital, University of Montpellier, France
| | - Emilie Olié
- Psychiatric Emergency and Acute Care, Lapeyronie Hospital, University of Montpellier, France
| | | | | | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, France
| |
Collapse
|
|
12
|
Pintar Babič M, Bregar B, Drobnič Radobuljac M. The attitudes and feelings of mental health nurses towards adolescents and young adults with nonsuicidal self-injuring behaviors. Child Adolesc Psychiatry Ment Health 2020; 14:37. [PMID: 32973922 PMCID: PMC7508242 DOI: 10.1186/s13034-020-00343-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Attitudes towards patients with self-harm behaviors are decisive for the quality of the relationship of healthcare professionals towards them, which is further linked to successful treatment. In mental health settings, nurses are the ones spending the longest time caring for these patients. Nurses often experience negative emotions while delivering care which may lead to professional burnout and suboptimal patient care. The purpose of this study was to explore the feelings and attitudes of nurses working in different psychiatric hospital settings toward adolescents and young adults with non-suicidal self-injury (NSSI). SUBJECTS AND METHODS The subjects were nurses from the tertiary psychiatric hospital who deliver mental health care to patients with NSSI on a daily basis (n = 76; 20 males, 56 females; average age 42 ± 8 years; average working experience 20 ± 9 years). Data were collected via a self-report questionnaire consisting of three parts (sociodemographic data, Emotional Burden, Adapted Self-Harm Antipathy-Scale). In the latter two parts of the questionnaire, the subjects rated their level of agreement with the emotions and statements on a five-point Likert scale. Nonparametric tests were used for statistical analysis. The statistical significance was set to p < 0.05. RESULTS The emotions of nurses towards patients with NSSI were not very negative and the attitudes were positive. Powerlessness was the most prevalent (3.55 ± 1.038) of the studied emotions, followed by uncertainty (3.21 ± 1.225). The subjects disagreed with feeling anger (2.34 ± 1.17) and despair (2.07 ± 1.09) and were undecided about being afraid (3.07 ± 1.2). The nurses with higher education felt more negative emotions than those with medium education. Education did not affect nurses' attitudes. The nurses from non-psychotherapeutic units felt more negative emotions and less positive attitudes than those from psychotherapeutic units. Gender did not affect the emotions felt towards patients, but the female nurses held more positive and less negative attitudes. CONCLUSIONS The respondents expressed low levels of negative emotions and positive and caring attitudes towards patients with NSSI, indicating a good predisposition for empathetic work and long-term burnout prevention. However, the differences observed with regards to education, gender and especially working environment indicate the different needs for environmental, educational and supervisory support.
Collapse
Affiliation(s)
- Matejka Pintar Babič
- grid.440807.fCenter for Mental Health, University Psychiatric Hospital Ljubljana, Grablovičeva 44a, 1000, Ljubljana, Slovenia
| | - Branko Bregar
- grid.440807.fCenter for Mental Health, University Psychiatric Hospital Ljubljana, Grablovičeva 44a, 1000, Ljubljana, Slovenia ,grid.445204.30000 0004 6046 8094Angela Boškin Faculty of Health Care, Jesenice, Slovenia
| | - Maja Drobnič Radobuljac
- grid.440807.fCenter for Mental Health, University Psychiatric Hospital Ljubljana, Grablovičeva 44a, 1000, Ljubljana, Slovenia ,grid.8954.00000 0001 0721 6013Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
|
13
|
Berger G, Waldhoer T, Barrientos I, Kunkel D, Rami‐Merhar BM, Schober E, Karwautz A, Wagner G. Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria. Pediatr Diabetes 2019; 20:127-136. [PMID: 30267464 PMCID: PMC7379731 DOI: 10.1111/pedi.12784] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to systematically assess the association of insulin-manipulation (intentional under- and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. METHODS Two diagnostic interviews (Diabetes-Self-Management-Patient-Interview and Children's-Diagnostic-Interview for Psychiatric Disorders) were conducted with 241 patients (age 10-22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records. RESULTS Psychiatric comorbidity was found in nearly half of the patients with insulin-manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin-manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non-adherence to insulin therapy. Insulin-manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin-manipulation. CONCLUSIONS This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under- and/or overdosing. Internalizing psychiatric disorders were associated with insulin-manipulation, especially in female patients and insulin-manipulation was associated with deteriorated metabolic control and diabetes complications.
Collapse
Affiliation(s)
- Gabriele Berger
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Thomas Waldhoer
- Department of Public Health, EpidemiologyMedical University ViennaViennaAustria
| | - Irene Barrientos
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Daniela Kunkel
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Birgit M. Rami‐Merhar
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Edith Schober
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Andreas Karwautz
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Gudrun Wagner
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| |
Collapse
|
|
14
|
Risk of Depression and Suicidality among Diabetic Patients: A Systematic Review and Meta-Analysis. J Clin Med 2018; 7:jcm7110445. [PMID: 30453557 PMCID: PMC6262418 DOI: 10.3390/jcm7110445] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients. METHODS Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression. RESULTS In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36⁻1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73⁻2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36⁻2.63), 1.45 (95% CI: 1.07⁻1.96), and 1.85 (95% CI: 0.97⁻3.52), respectively. All findings were statistically significant except for completed suicide. CONCLUSIONS The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed.
Collapse
|
|
15
|
Gómez-Peralta TG, González-Castro TB, Fresan A, Tovilla-Zárate CA, Juárez-Rojop IE, Villar-Soto M, Hernández-Díaz Y, López-Narváez ML, Ble-Castillo JL, Pérez-Hernández N, Rodríguez-Pérez JM. Risk Factors and Prevalence of Suicide Attempt in Patients with Type 2 Diabetes in the Mexican Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1198. [PMID: 29880751 PMCID: PMC6025580 DOI: 10.3390/ijerph15061198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND It has been proposed that the risk of death by suicide is higher in patients with diabetes than in the general population. Therefore, it is necessary to investigate the risk factors of suicidal behavior in patients with type 2 diabetes. The aim of the present study was to analyze the prevalence of suicide attempt and determine the risk factors of suicide attempt, in patients with type 2 diabetes in a Mexican population. METHODS Clinic characteristics, anthropometric measurements, biochemical levels, depression, and suicidal behavior were evaluated in 185 Mexican patients with type 2 diabetes. A multivariate logistic regression analysis was performed to find predictive factors of suicide attempt. RESULTS 11.4% of patients reported previous suicide attempts n = 21). Younger patients (OR: 3.63, 95% CI: 1.29⁻10.19), having depression (OR: 3.33, 95% CI: 1.13⁻9.76) and normal BMI (OR: 3.14, 95% CI: 1.11⁻8.83), were predictive factors of suicide attempt. No other variables in the study showed statistical significance. CONCLUSIONS Our results showed a high prevalence of suicidal behavior in patients with type 2 diabetes. We found that younger age, depression and normal BMI could be risk factors of suicide attempt in these patients. Therefore, psychiatric interventions to prevent depression and suicidal behavior in this population are necessary. New studies using larger samples are necessary to replicate and confirm these results.
Collapse
Affiliation(s)
- Tania Guadalupe Gómez-Peralta
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86025, Tabasco, Mexico.
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86200, Tabasco, Mexico.
| | - Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de Mexico 14370, Mexico.
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86025, Tabasco, Mexico.
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86140, Tabasco, Mexico.
| | - Mario Villar-Soto
- Hospital de Alta Especialidad "Gustavo A. Rovirosa Pérez", Secretaría de Salud, Villahermosa 86140, Tabasco, Mexico.
| | - Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez 86200, Tabasco, Mexico.
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. Manuel Velasco Suarez", Secretaría de Salud, Yajalón 29930, Chiapas, Mexico.
| | - Jorge L Ble-Castillo
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa 86140, Tabasco, Mexico.
| | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico 14080, Mexico.
| | - José Manuel Rodríguez-Pérez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico 14080, Mexico.
| |
Collapse
|
|
16
|
Conti C, Mennitto C, Di Francesco G, Fraticelli F, Vitacolonna E, Fulcheri M. Clinical Characteristics of Diabetes Mellitus and Suicide Risk. Front Psychiatry 2017; 8:40. [PMID: 28348533 PMCID: PMC5346593 DOI: 10.3389/fpsyt.2017.00040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/27/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a chronic illness with impaired health-related quality of life and a high risk of psychiatric disorders. We carried out a systematic review analyzing the relationship between DM and suicide by providing a qualitative data synthesis of the studies. METHODS We conducted, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of the literature in PubMed, Scopus, ISI Web of Science, PsycINFO, Google Scholar, and ScienceDirect. Search terms were "suicid*" combined with the Boolean "AND" operator with "diabetes." RESULTS The initial search identified 568 citations. A total of 17 research reports met the predefined inclusion criteria and were analyzed. DM was found to be significantly associated with a marked increase in suicidal behaviors and suicidal ideation (SI), especially in patients with depressive symptoms. Insulin therapy, DM of long duration, and unsatisfactory glycemic control were identified as risk factors for SI in Type 1 (T1DM) and Type 2 (T2DM). CONCLUSION Health-care professionals need to be aware of the higher suicidal risk in patient subgroups based on the clinical characteristics of DM; thus, patients with these characteristics warrant special attention. In this regard, clinical management should include efforts to manage emotional distress in DM care.
Collapse
Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Chiara Mennitto
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Giulia Di Francesco
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Federica Fraticelli
- Department of Medicine and Aging, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
|
17
|
Major depressive disorder, suicidal behaviour, bipolar disorder, and generalised anxiety disorder among emerging adults with and without chronic health conditions. Epidemiol Psychiatr Sci 2016; 25:462-474. [PMID: 26347304 PMCID: PMC7137593 DOI: 10.1017/s2045796015000700] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite the considerable physical, emotional and social change that occurs during emerging adulthood, there is little research that examines the association between having a chronic health condition and mental disorder during this developmental period. The aims of this study were to examine the sex-specific prevalence of lifetime mental disorder in an epidemiological sample of emerging adults aged 15-30 years with and without chronic health conditions; quantify the association between chronic health conditions and mental disorder, adjusting for sociodemographic and health factors; and, examine potential moderating and mediating effects of sex, level of disability and pain. METHOD Data come from the Canadian Community Health Survey-Mental Health. Respondents were 15-30 years of age (n = 5947) and self-reported whether they had a chronic health condition. Chronic health conditions were classified as: respiratory, musculoskeletal/connective tissue, cardiovascular, neurological and endocrine/digestive. The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess the presence of mental disorder (major depressive disorder, suicidal behaviour, bipolar disorder and generalised anxiety disorder). RESULTS Lifetime prevalence of mental disorder was significantly higher for individuals with chronic health conditions compared with healthy controls. Substantial heterogeneity in the prevalence of mental disorder was found in males, but not in females. Logistic regression models adjusting for several sociodemographic and health factors showed that the individuals with chronic health conditions were at elevated risk for mental disorder. There was no evidence that the level of disability or pain moderated the associations between chronic health conditions and mental disorder. Sex was found to moderate the association between musculoskeletal/connective tissue conditions and bipolar disorder (β = 1.71, p = 0.002). Exploratory analyses suggest that the levels of disability and pain mediate the association between chronic health conditions and mental disorder. CONCLUSIONS Physical and mental comorbidity is prevalent among emerging adults and this relationship is not augmented, but may be mediated, by the level of disability or pain. Findings point to the integration and coordination of public sectors - health, education and social services - to facilitate the prevention and reduction of mental disorder among emerging adults with chronic health conditions.
Collapse
|
|
18
|
Snyder LL, Truong YKN, Law JR. Evaluating Substance Use and Insulin Misuse in Adolescents With Type 1 Diabetes. DIABETES EDUCATOR 2016; 42:529-37. [PMID: 27480524 DOI: 10.1177/0145721716659149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Substance use behaviors often emerge during adolescence, and adolescents with type 1 diabetes (T1D) may be at risk for engaging in traditional substance use (eg, alcohol, tobacco, and illicit substances) as well as a unique form of substance use: insulin misuse. The purpose of this exploratory study was to examine substance use and insulin misuse in adolescents with T1D. METHODS Sixty adolescents aged 12 to 20 years with T1D (n = 60) completed surveys on substance use, insulin misuse, and diabetes self-management during a routine diabetes appointment. Demographic measures were summarized by mean (SD) or percentage. Prevalence of substance use and insulin misuse was calculated and stratified by demographic and clinical characteristics. Two-sample t test (continuous variables) and chi-square analysis (categorical variables) determined statistically significant differences. RESULTS The prevalence of ever using substances was 36.7%, and that for ever misusing insulin was 19%. Older participants (17.1 ± 1.8 vs 15.6 ± 1.9 years; P < .01) and those with depression (31.8% vs 7.9%; P = .02) were more likely to use substances. Disordered eating behaviors were the most frequently reported reason for insulin misuse. Self-harm intent was reported by one-third of insulin misusers. Substance use and insulin misuse were not related to glycemic control or diabetes self-management behaviors. CONCLUSIONS The diabetes care team should be aware that substance use and insulin misuse are common in adolescents with T1D. Screening for these risky behaviors is critical in those who are older or have mental health disorders. Effective education, prevention, and treatment strategies targeted at these behaviors are needed to improve the overall health of this population.
Collapse
Affiliation(s)
- Lydia L Snyder
- Division of Pediatric Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Snyder, Dr Law)
| | - Young Kinh-Nhue Truong
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Truong)
| | - Jennifer R Law
- Division of Pediatric Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Snyder, Dr Law)
| |
Collapse
|
|
19
|
Lee JY, Park YK, Cho KH, Kim SM, Choi YS, Kim DH, Nam GE, Han KD, Kim YH. Suicidal ideation among postmenopausal women on hormone replacement therapy: The Korean National Health and Nutrition Examination Survey (KNHANES V) from 2010 to 2012. J Affect Disord 2016; 189:214-9. [PMID: 26451506 DOI: 10.1016/j.jad.2015.09.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicide is a major public health problem around the world. Some studies have found that hormone replacement therapy (HRT) is associated with depression in postmenopausal women. Depression is a well-known risk factor for suicide; therefore, we investigated the relationship between HRT and suicidal ideation in postmenopausal Korean women. METHODS We included 2286 postmenopausal women with or without HRT from the Korean National Health and Nutrition Examination Survey 2010-2012. The use and duration of HRT and mental health status, including stress, depressive mood, and suicidal ideation and attempts, were assessed by self-report questionnaires. RESULTS The proportion of participants with depressive mood and suicidal ideation was higher in the HRT group than the non-HRT group (all p values<0.05). As the duration of HRT increased, the percentage of participants with suicidal ideation increased (p for trend=0.006). After adjusting for all covariates, the odds ratio (95% confidence intervals) for suicidal ideation was 1.742 (1.223-2.482) in the women with HRT, compared to women without HRT. HRT duration longer than 10 years was associated with suicidal ideation (odds ratio=2.089 and 95% confidence intervals=1.069-4.084). LIMITATIONS The cross-sectional design, a possibility of incorrect answer about menopausal status, and no assessment of the type of HRT are the main limitations of this study. CONCLUSION Postmenopausal women receiving HRT, especially for more than 10 years, showed increased suicidal ideation compared with postmenopausal women without HRT. Physicians should pay attention to mood symptoms and suicidal ideation in postmenopausal women with HRT.
Collapse
Affiliation(s)
- Ji-Yoon Lee
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yong-Kyu Park
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seon-Mee Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Youn-Seon Choi
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ga-Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyung-Do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea.
| |
Collapse
|
|
20
|
KLEMENČIČ S, de WIT M, RUTAR M, BATTELINO T, BRATINA N. Annual Psychological Screening in Youth and Young Adults with Type 1 Diabetes. Zdr Varst 2015; 54:103-11. [PMID: 27646916 PMCID: PMC4820162 DOI: 10.1515/sjph-2015-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/14/2015] [Indexed: 11/15/2022] Open
Abstract
Aim Youth and young adults with type 1 diabetes are at a great risk for developing depression and diabetes specific distress, therefore, systematic psychological screening is recommended. Routine psychological screening was implemented in Slovene diabetes clinic for children, adolescents and young adults in 2012. One-year results are presented. Methods Adolescents and young adults (N = 159, aged 11 – 25 years), attending the obligatory yearly educational outpatient visit at University Children’s Hospital, Ljubljana, Slovenia, were examined using questionnaires measuring depression (depression scale from Slovene version of Trauma Symptom Checklist for Children) and diabetes distress (Diabetes Distress Screening Scale). Six additional items were included to assess the fear of hypoglycemia and family support. Socio-demographic and diabetes-related data were collected. Questionnaires were analyzed by a psychologist, and the patients that scored above cut-off point were invited to an individual psychological assessment. Results Of the sample, 1.3 % reached the threshold for elevated depressive symptoms, and 32.7 % reported significant diabetes distress. The need for psychological support from a specialist was expressed by 5.0 %. There were statistically significant associations between all psychological variables; moreover, better glycemic control was associated with lower diabetes distress and better family support. Nine patients (5.7 %) started with psychological treatment according to the referrals after screening. Conclusions The results after one year of psychological screening in Slovene type 1 diabetes population displayed small rates of depression and a large proportion of diabetes distress. Only a small percentage of patients attended the offered individual psychological assessment.
Collapse
Affiliation(s)
- Simona KLEMENČIČ
- University Medical Centre Ljubljana, University Children’s Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia
- Corresponding author: Tel: +386 1 522 92 32; E-mail:
| | - Maartje de WIT
- Diabetes Psychology Research Group, Department of Medical Psychology, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Miha RUTAR
- University Medical Centre Ljubljana, University Children’s Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Tadej BATTELINO
- University Medical Centre Ljubljana, University Children’s Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Nataša BRATINA
- University Medical Centre Ljubljana, University Children’s Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia
| |
Collapse
|
|
21
|
Bratina N, Shalitin S, Phillip M, Battelino T. Type 1 Diabetes in the Young: Organization of Two National Centers in Israel and Slovenia. Zdr Varst 2015; 54:139-45. [PMID: 27646921 PMCID: PMC4820167 DOI: 10.1515/sjph-2015-0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/03/2015] [Indexed: 01/25/2023] Open
Abstract
Type 1 diabetes is a chronic autoimmune disease that affects mainly young people. In the last 50 years, a steady increase of the T1D incidence in the young is reported worldwide, with an average 4 % increase annually. In addition, the mean age at the diagnosis is decreasing. Studies show that good metabolic control is important not only for delaying the chronic complications of diabetes but also for improving the quality of life of patients and their families. Continuous education, together with modern technology, is crucial in achieving these goals. Longitudinal data on glycated hemoglobin (HbA1c), along with the data on severe hypoglycemia and severe diabetic ketoacidosis, can describe the quality of care in a defined population. Two national reference diabetes centres taking care of children, adolescents and young adults with diabetes in Israel and Slovenia are described.
Collapse
Affiliation(s)
- Nataša Bratina
- University Children's Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Shlomit Shalitin
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel,14 Kaplan Street, Petah Tikva 4920235, Israel
| | - Moshe Phillip
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel,14 Kaplan Street, Petah Tikva 4920235, Israel
| | - Tadej Battelino
- University Children's Hospital, Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, Bohoriceva 20, 1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia
| |
Collapse
|
|
22
|
Bolton JM, Walld R, Chateau D, Finlayson G, Sareen J. Risk of suicide and suicide attempts associated with physical disorders: a population-based, balancing score-matched analysis. Psychol Med 2015; 45:495-504. [PMID: 25032807 DOI: 10.1017/s0033291714001639] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders. METHOD Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3:1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1-90, 91-364, ⩾ 365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923). RESULTS Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03-1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71-9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73). CONCLUSIONS People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.
Collapse
Affiliation(s)
- J M Bolton
- Department of Psychiatry,University of Manitoba,Winnipeg, Manitoba,Canada
| | - R Walld
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - D Chateau
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - G Finlayson
- Manitoba Centre for Health Policy,Winnipeg, Manitoba,Canada
| | - J Sareen
- Department of Psychiatry,University of Manitoba,Winnipeg, Manitoba,Canada
| |
Collapse
|
|
23
|
Suicidal ideation and suicide attempts among diabetes mellitus: the Korea National Health and Nutrition Examination Survey (KNHANES IV, V) from 2007 to 2012. J Psychosom Res 2014; 77:457-61. [PMID: 25258359 DOI: 10.1016/j.jpsychores.2014.08.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/08/2014] [Accepted: 08/19/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study evaluated the mental health of patients with diabetes mellitus (DM) in Korea and compared it with mental health in the general Korean population. METHODS All data included in the final analyses were collected from 34,065 subjects (20years of age or older) who participated in the 2007-2012 Korea National Health and Nutrition Examination Survey (KNHANES). The mental health of 3846 DM patients were compared with that of 30,219 controls. RESULTS A depressed mood for 2 or more continuous weeks was reported by 13.6% of subjects with normal glucose tolerance (NGT), 14.3% of those with impaired glucose intolerance (IFG), and 17.6% of DM patients. Suicidal thoughts were reported by 15.3% of individuals with NGT, 15.6% of participants with IFG, and 17.6% of DM patients. Suicidal attempts were reported by 0.8% of people with NGT, 1.0% of those with IFG, and 1.3% of DM patients. In DM patients, the crude odds ratio (OR) for depressive mood was 1.376 (95% confidence interval [CI]: 1.258-1.504), the OR for suicidal ideation was 1.481 (95% CI: 1.361-1.611) and the OR for suicidal attempts was 1.413 (95% CI: 1.021-1.956). A multivariate analysis revealed that the ORs for depression, suicidal ideation, and suicidal attempts in DM patients were 1.178 (95% CI: 1.070-1.297), 1.152 (95% CI: 1.050-1.263), and 1.413 (95% CI: 1.021-1.956), respectively. CONCLUSIONS The present study found that DM was associated with a marked increase in suicidal behaviors.
Collapse
|
|
24
|
Abstract
Relationship of diabetes mellitus (DM) with metal health disorders such as depression has been explored extensively in the published literatures. However, association of diabetes mellitus with suicidal tendencies has been evaluated less extensively. The present narrative review aimed to assess the literature relating to diabetes mellitus and suicide. As a part of the review, Pubmed and Google Scholar databases were searched for English language peer reviewed published studies with keywords relating to diabetes and suicide. Additional references were identified using cross-references. The available literature suggests that suicidal ideas and attempts are more frequent in patients with diabetes mellitus than healthy or medically ill controls. Although, a few studies report evidence to the contrary. Suicide accounts for a large proportion of deaths in patients with diabetes mellitus type I (T1DM), and their mortality rate is higher than that of age matched control population. Psychological morbidity, including depression, precedes suicidal ideas and attempts; though many other factors can be hypothesized to impact and modulate this association. A common method of suicide attempt in patients with diabetes includes uses of high doses of insulin and its congeners or medications to treat the disease. Regular screening and prompt treatment of depression and suicidality is suggested for patients with DM.
Collapse
Affiliation(s)
- Siddharth Sarkar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
|
25
|
Pompili M, Forte A, Lester D, Erbuto D, Rovedi F, Innamorati M, Amore M, Girardi P. Suicide risk in type 1 diabetes mellitus: A systematic review. J Psychosom Res 2014; 76:352-360. [PMID: 24745775 DOI: 10.1016/j.jpsychores.2014.02.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 02/20/2014] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research has shown that suicide risk is often present in patients suffering from type 1 diabetes mellitus (DM-1). OBJECTIVES The aim of the present paper was to investigate whether there was a relationship between DM-1 and suicidal behavior and to determine whether or not people affected by DM-1 are at an increased risk of completed suicide, attempted suicide, and suicidal ideation. DATA SOURCES We performed a careful MedLine, ExcerptaMedica, PsycLit, PsycInfo and Index Medicus search to identify all papers on the topic for the period 1970 to 2013 written in English. The following search terms were used: (suicide OR suicide attempt OR ideation) AND (diabetes mellitus). Where a title or abstract seems to describe a study eligible for inclusion, the full article was examined. ELIGIBILITY CRITERIA We included only original articles published in English peer-reviewed journals. We excluded meta-analyses and systematic reviews, studies that were not clear about follow-up times, the method of statistical analysis, diagnostic criteria or the number of patients included, and studies only on patients affected by type 2 diabetes mellitus (DM-2). RESULTS The research reviewed indicated that patients with DM-1 are at an increased risk for suicide, although no clear consensus exists regarding the level of the increased risk. LIMITATIONS The studies used different measurement techniques and different outcomes, and they assessed patients at different time points. CONCLUSIONS AND IMPLICATIONS Our findings support the recommendation that a suicide risk assessment of patients with DM-1 should be part of the routine clinical assessment. The assessment of patients at risk should consist of the evaluation of current and previous suicidal behaviors (both suicidal ideation and attempted suicide).
Collapse
Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
| | - Alberto Forte
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | | | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Fabiana Rovedi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Marco Innamorati
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| |
Collapse
|
|
26
|
Williams C, Sharpe L, Mullan B. Developmental challenges of adolescents with type 1 diabetes: the role of eating attitudes, family support and fear of negative evaluation. PSYCHOL HEALTH MED 2013; 19:324-34. [PMID: 23786542 DOI: 10.1080/13548506.2013.808750] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Young people with chronic illnesses including type 1 diabetes mellitus (T1DM) are at increased risk of developing psychological problems during adolescence. The aim of the present study was to explore whether a relationship exists between developmental challenges of adolescence (eating attitudes, family support and fear of negative evaluation) and psychopathology in adolescents with T1DM, and the nature of such a relationship. Sixty-one adolescents with T1DM completed a series of questionnaires assessing illness beliefs, eating attitudes, family support, Fear of Negative Evaluation (FNE) and psychopathology. The study was of a correlational design, and also included a seven-day diabetes management diary in order to collect blood glucose levels over this time. Results demonstrated the relevance of all three developmental challenges. In multiple regression analyses, FNE and eating attitudes independently predicted current levels of depressive symptomatology. Current levels of anxiety were predicted by FNE and family support, but not eating attitudes. The results support the relevance of all three developmental challenges of adolescence to psychopathology in young people with diabetes. These results suggest that in working with adolescents who are having difficulty coping with diabetes; it may be beneficial to focus on the developmental issues that commonly face adolescents.
Collapse
|
|
27
|
Harjutsalo V, Forsblom C, Groop PH. Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. BMJ 2011; 343:d5364. [PMID: 21903695 PMCID: PMC3169676 DOI: 10.1136/bmj.d5364] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine short and long term time trends in mortality among patients with early onset (age 0-14 years) and late onset (15-29 years) type 1 diabetes and causes of deaths over time. DESIGN Population based nationwide cohort study. SETTING Finland. PARTICIPANTS All Finnish patients diagnosed as having type 1 diabetes below age 30 years between 1970 and 1999 (n = 17,306). MAIN OUTCOME MEASURES Crude mortality, standardised mortality ratios, time trends, and cumulative mortality. RESULTS A total of 1338 deaths occurred during 370,733 person years of follow-up, giving an all cause mortality rate of 361/100,000 person years. The standardised mortality ratio was 3.6 in the early onset cohort and 2.8 in the late onset cohort. Women had higher standardised mortality ratios than did men in both cohorts (5.5 v 3.0 in the early onset cohort; 3.6 v 2.6 in the late onset cohort). The standardised mortality ratio at 20 years' duration of diabetes in the early onset cohort decreased from 3.5 in the patients diagnosed in 1970-4 to 1.9 in those diagnosed in 1985-9. In contrast, the standardised mortality ratio in the late onset cohort increased from 1.4 in those diagnosed in 1970-4 to 2.9 in those diagnosed in 1985-9. Mortality due to chronic complications of diabetes decreased with time in the early onset cohort but not in the late onset cohort. Mortality due to alcohol related and drug related causes increased in the late onset cohort and accounted for 39% of the deaths during the first 20 years of diabetes. Accordingly, mortality due to acute diabetic complications increased significantly in the late onset cohort. CONCLUSION Survival of people with early onset type 1 diabetes has improved over time, whereas survival of people with late onset type 1 diabetes has deteriorated since the 1980s. Alcohol has become an important cause of death in patients with type 1 diabetes, and the proportion of deaths caused by acute complications of diabetes has increased in patients with late onset type 1 diabetes.
Collapse
Affiliation(s)
- Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Haartmaninkatu 8, PO Box 63, FIN-00014, Helsinki, Finland.
| | | | | |
Collapse
|
|
28
|
Lange K. Depressive Stimmung und Depression bei Kindern und Jugendlichen mit Diabetes. DIABETOLOGE 2010. [DOI: 10.1007/s11428-009-0533-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
|
29
|
Current literature in diabetes. Diabetes Metab Res Rev 2010; 26:i-xi. [PMID: 20474064 DOI: 10.1002/dmrr.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
|
30
|
Wood J, Rami B. Report of the 35th ISPAD-Meeting, Ljubljana, Slovenia, 2-5 September 2009. Pediatr Diabetes 2010; 11:74-80. [PMID: 19958459 DOI: 10.1111/j.1399-5448.2009.00623.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jamie Wood
- Center for Endocrinology, Diabetes, and Metabolism, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, USA.
| | | |
Collapse
|
|
31
|
Brent D. Choosing life. Pediatr Diabetes 2009; 10:422-3. [PMID: 19886930 DOI: 10.1111/j.1399-5448.2009.00602.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|