ESPE Yearbook of Paediatric Endocrinology

Can J Diabetes. 2021 Jan 22:S1499–2671(21)00018-6. doi: 10.1016/j.jcjd.2021.01.011. PMID: 33722492.

In brief: The presence of depressive symptoms was assessed in 197 adolescents and young adults (ages 12 to 24 years) with T2DM. 19% reported elevated depressive symptoms and 19% admitted thoughts of self-harm. Older age, shorter diabetes duration, higher HbA1c level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were associated with more depressive symptoms.

Comment: The Patient Health Questionnaire (PHQ) is a brief tool for screening, diagnosing and monitoring the severity of depression. It rates the frequency of depressive symptoms over the previous 2 weeks. PHQ-9 is composed of nine items that align with the diagnostic criteria for major depressive disorders and includes a question on the presence and duration of suicide ideation. A further, unscored question assesses the degree to which depressive problems affect functioning. The PHQ is also available in a brief 2-item version to use in screening; higher scores prompt the need to administer the other 7 PHQ-9 items.

Of 197 individuals with T2DM, 63% reported minimal depressive symptoms, 18% had mild, 13% moderate, 5% moderately severe and 1% had severe symptoms. 19% reported thoughts of self-harm. The rates of depressive symptoms in adolescents and young adults with T2DM were twice those of youth with type 1 diabetes assessed in the same clinics. Older age and poor glycaemic control were clinical clues for a higher depressive symptoms.

Most important, only 50% of youth with elevated PHQ scores and only 20% of youth endorsing the harm-to-self item were referred for mental health treatment, and only 10% were in active mental health therapy. These findings corroborate evidence on the lack of identification by primary care clinicians, of up to two-thirds of youth with depression, and the consequent absence of proper care (1). Even when diagnosed, only half the youth were treated appropriately. Moreover, rates were low of completion of specialty mental health referral for youth with a recognized emotional disorder from general medical settings. Major depression in adolescents is recognized as a serious psychiatric illness with extensive acute and chronic morbidity and mortality. It is therefore of utmost importance that paediatricians and paediatric endocrinologists embrace depression screening of all adolescents.

Reference: 1. Zuckerbrot RA, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics. 2018 Mar;141(3):e20174081. doi: 10.1542/peds.2017-4081. PMID: 29483200.81.