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Alazmi A, Viktor S, Erjavec M. Changes in health, lifestyle, and wellbeing of children with type 1 diabetes and their parents during the pandemic. BMC Psychol 2024; 12:593. [PMID: 39462390 PMCID: PMC11514897 DOI: 10.1186/s40359-024-02102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/21/2024] [Indexed: 10/29/2024] Open
Abstract
OBJECTIVE The COVID-19 pandemic restrictions have substantially affected people's health and rapidly changed their daily routines. This is a prospective study that investigated the impact of the pandemic on primary school children with Type 1 diabetes and their parents during the first lockdown in Kuwait. METHODS A questionnaire battery related to mental health, well-being, and lifestyle was administered at baseline in Summer 2019 (face-to-face, at a diabetes outpatient clinic) and at follow-up during lockdown in Summer 2020 (via telephone, in adherence with COVID-19 restrictions). Data were collected for 70 dyads with children aged 9-12 years. RESULTS Significant differences were found in most scores for both children and parents. Their mental health worsened to a higher level of depression, anxiety, stress, and a poor level of wellbeing. The average scores on the follow-up tests fell within a clinical range on these measures. Significant differences in their lifestyle, compared to before the lockdown, included decreased levels of physical activity and lower healthy core nutritional intake. CONCLUSIONS Our findings indicate that the COVID-19 lockdown has had a significant psychological and possibly physiological impact on children with Type 1 diabetes and their parents. We conclude that there is a need for mental health support services focusing on these groups. Although full lockdown restrictions will have stopped in the past year, post-pandemic stressors may be expected to continue to adversely affect this cohort.
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Affiliation(s)
- Afrah Alazmi
- School of Human and Behavioural Science, Bangor University, Bangor, Gwynedd, UK.
| | - Simon Viktor
- School of Human and Behavioural Science, Bangor University, Bangor, Gwynedd, UK
| | - Mihela Erjavec
- School of Human and Behavioural Science, Bangor University, Bangor, Gwynedd, UK
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Formánek T, Chen D, Šumník Z, Mladá K, Hughes J, Burgess S, Wareham NJ, Murray GK, Jones PB, Perry BI. Childhood-onset type 1 diabetes and subsequent adult psychiatric disorders: a nationwide cohort and genome-wide Mendelian randomization study. NATURE. MENTAL HEALTH 2024; 2:1062-1070. [PMID: 39263363 PMCID: PMC11383797 DOI: 10.1038/s44220-024-00280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 06/05/2024] [Indexed: 09/13/2024]
Abstract
Childhood-onset type 1 diabetes (T1D) is associated with substantial psychiatric morbidity in later life, but it remains unknown whether these associations are due to common underlying biological mechanisms or the impacts of living with the condition and its treatment. Here, using Czech national register data, we identified children with T1D aged ≤14 years between 1994 and 2007 and estimated the risk of psychiatric disorders up to 24 years later. We found that children diagnosed with T1D had an elevated risk of developing substance use, mood, anxiety and personality disorders, and behavioral syndromes. Conversely, we found that children with T1D had a lower risk of developing psychotic disorders. In Mendelian randomization analysis, we found an association with schizophrenia, which, however, did not persist following multiple testing adjustment. The combined observational and Mendelian randomization evidence suggests that T1D diagnosis in childhood predisposes to far-reaching, extensive psychiatric morbidity, which is unlikely to be explicable by common underlying biological mechanisms. The findings of this study highlight that monitoring and addressing the mental health needs of children with T1D is imperative, whereas glucose dysregulation and/or inflammation implicated in schizophrenia pathogenesis warrants future research.
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Affiliation(s)
- Tomáš Formánek
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Danni Chen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Zdeněk Šumník
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czechia
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - James Hughes
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Benjamin I Perry
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Emerson E, Llewellyn G. Parental Report of Signs of Anxiety and Depression in Children and Adolescents with and Without Disability in Middle- and Low-Income Countries: Meta-analysis of 44 Nationally Representative Cross-Sectional Surveys. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01608-8. [PMID: 37794308 DOI: 10.1007/s10578-023-01608-8] [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] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
Population-based studies undertaken in high-income countries have indicated that children and adolescents with disabilities are more likely than their non-disabled peers to experience emotional difficulties such as anxiety and depression. Very little is known about the association between disability and emotional difficulties among children growing up in low and middle-income countries (LMICs). We aimed to estimate the strength of association between disability and two forms of emotional difficulties (anxiety, depression) in a range of LMICs and to determine whether the strength of this relationship was moderated by child age and gender. Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys undertaken in 44 LMICs (combined n = 349,421). Data were aggregated across countries by both mixed effects multi-level modelling and restricted maximum likelihood meta-analysis. Young people with disabilities, when compared with their non-disabled peers, were approximately two and a half times more likely to be reported by parents to show daily signs of either anxiety or depression. The level of risk among young people with disabilities was highest in upper middle-income countries and lowest in low-income countries. We estimated that approximately 20% of young people with frequent anxiety or depression also had a disability. All approaches to mental health interventions (from primary prevention to clinical interventions) need to make reasonable accommodations to their services to ensure that the young people with emotional difficulties who also have a disability are not 'left behind'.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- Centre of Research Excellence in Disability and Health, University of Melbourne, Melbourne, VIC, 3010, Australia
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Pecoli PFG, Rosa ADS, Gabbay MAL, Dib SA. Psycho-Behavioral Characteristics Perceived as Facilitators by Brazilian Adults with Type 1 Diabetes Mellitus in a Public Health Service. Healthcare (Basel) 2023; 11:2300. [PMID: 37628498 PMCID: PMC10454162 DOI: 10.3390/healthcare11162300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18-57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.
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Affiliation(s)
| | | | - Mônica Andrade Lima Gabbay
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Sérgio Atala Dib
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
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Alazmi A, Viktor S, Erjavec M. Exploring the determinants of mental health, wellbeing, and lifestyle in 8-11 year old children with type 1 diabetes and their healthy counterparts in Kuwait. PLoS One 2022; 17:e0272948. [PMID: 36508408 PMCID: PMC9744296 DOI: 10.1371/journal.pone.0272948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022] Open
Abstract
Type 1 diabetes is a chronic disease with an early onset, but little is known about its psychological effects in middle childhood. The present study was the first to explore the relationship between mental health, wellbeing, and lifestyle of 8-11 years old children with Type 1 diabetes and their parents, and a healthy comparison group. A total of 200 parent-child dyads were recruited in diabetic clinics and from primary schools in Kuwait. Both groups completed a series of behavioural and physical assessments relating to health, wellbeing, and lifestyle. A significant relationship was found between higher Body Mass Index (BMI) and poorer mental health, including low academic self-esteem, depression, and anxiety, in the diabetes group. This group had significantly higher mean scores in mental health problems, and lower scores in wellbeing, compared with control group. Both groups had poor dietary habits and low levels of physical activity. Unlike previous studies, no differences were found between parents' mental health for children with Type 1 diabetes and parents of the control group. Although elevated problem scores on a variety of indices remained within normal range, the pattern of results indicates that children with diabetes would profit from early screening and preventative intervention to reduce the likelihood of psychological and behavioural difficulties later on.
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Affiliation(s)
- Afrah Alazmi
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kindom
| | - Simon Viktor
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kindom
| | - Mihela Erjavec
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kindom
- * E-mail:
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Yao Y, Xu Y, Guo H, Han K, Dai Z. Effect of Integrated Psychobehavioral Care on Emotional-Behavioral Responses, Cognitive Changes in Outpatients with Schizophrenia Followed Up: Based on a Prospective Randomized Controlled Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1862396. [PMID: 35756401 PMCID: PMC9225882 DOI: 10.1155/2022/1862396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 12/28/2022]
Abstract
Background In recent years, influenced by the continuous improvement and development of the medical service model and the increasing demands of modern people for the quality of clinical care, the clinical treatment of schizophrenic groups has also received widespread attention and importance from all sectors of society. Psychobehavioral care is administered to patients during active antipsychotic treatment, which can maximize the patient's cooperation with clinical work and thus play an auxiliary role in treatment. Aims To investigate the impact of emotional-behavioral responses, cognitive changes in outpatient follow-up of schizophrenic patients with integrated psychobehavioral care. Materials and Methods One hundred cases of schizophrenia patients with outpatient follow-up in our hospital from March 2017 to March 2019 were selected as prospective study subjects and divided into a comparison group and an observation group of 50 cases each according to a random number table. Among them, the comparison group implemented conventional psychobehavioral care, and the observation group implemented integrated psychobehavioral care. The differences in compliance behavior, negative emotions, cognitive behavioral changes, and pain scores before and after care of schizophrenia patients in the outpatient follow-up were compared between the two groups. Results After care, the compliance behavior, negative emotions, cognitive behavioral changes, and pain scores of schizophrenia patients in both groups with outpatient follow-up were significantly improved and significantly higher in the observation group than in the comparison group, and statistics showed that this difference was statistically significant (P < 0.05). Conclusion Integrated psychobehavioral care combined with conventional psychobehavioral care can effectively enhance the compliance behavior of outpatient follow-up schizophrenia patients, improve the negative emotions and pain of patients, and facilitate the active treatment of patients to improve their prognosis. It has some reference value for outpatient follow-up schizophrenia patient care.
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Affiliation(s)
- Yao Yao
- Department of Outpatient, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Yali Xu
- The Sixth Stationed Outpatient Department, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Hongyan Guo
- Department of Health Medicine, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Kunxiu Han
- Department of Invasive Technology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Zhuo Dai
- Department of Burn and Plastic Surgery, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
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Chatterjee S, Bakhla AK, Biswas P, Singha S, Dubey S, Sharma CB, Chowdhury S. Psychosocial morbidity among children with type-1 diabetes mellitus. J Family Med Prim Care 2020; 9:652-656. [PMID: 32318398 PMCID: PMC7114057 DOI: 10.4103/jfmpc.jfmpc_1216_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/21/2020] [Accepted: 01/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Although the psychosocial impact of type-1 diabetes mellitus (T1DM) patients is well recognized, data about its prevalence in India is scant. Hence, this study was undertaken to determine the prevalence and spectrum of psychosocial morbidities among pediatric T1DM patients and factors associated with psychosocial distress. Methods: Among 39 pediatric T1DM patients, a cross-sectional questionnaire-based study was carried out. Psychological distress was measured by applying a childhood psychopathological measurement schedule (CPMS) questionnaire. Psychosocial distress was analyzed across various sociodemographic factors and disease-specific variables by applying the Chi-square test using the statistical package for social sciences (SPSS) version 16. Results: The mean age of the study sample was 11.59 + 2.65 years (range: 6–16 years). Out of a total 39 patients, 21 (53.85%) were found to be psychologically distressed. The mean CPMS score was 12.74 + 9.54. Mean scores among psychologically distressed and nondistressed patient groups were 19.19 + 8.5 and 5.22 + 2.74, respectively. Anxiety, conduct disorder, and depression were the most common problems identified. Psychosocial distress was more prevalent among those who were postpubertal, males, Muslims, residing in rural areas, living in a nuclear family, having no sibling, and from the upper-lower socioeconomic background. Psychosocial distress was significantly associated with an increased number of insulin injections per day (P = 0.041) and dietary and drug regimen noncompliance (P = 0.001). Conclusion: The present study revealed a very high prevalence (53.85%) of psychosocial morbidity among T1DM patients. Psychosocial distress was significantly more among patients taking an increased number of insulin injections per day and patients who were noncompliant with the dietary and drug regimen.
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Affiliation(s)
- Subhankar Chatterjee
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ajay K Bakhla
- Department of Psychiatry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Payel Biswas
- Department of Radiodiagnosis, Nagarmal Modi Seva Sadan, Ranchi, Jharkhand, India
| | - Souvik Singha
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Chandra Bhushan Sharma
- Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Haidar-Elatrache S, Wolf M, Fabie NAV, Sahai S. Approach to Children with Aggressive Behavior for General Pediatricians and Hospitalists: Part 1-Epidemiology and Etiology. Pediatr Ann 2018; 47:e402-e407. [PMID: 30308676 DOI: 10.3928/19382359-20180918-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children and adolescents are increasingly presenting to the hospital and emergency department with aggressive behavior and psychiatric emergencies. The rise in pediatric mental health problems, coupled with a lack of much needed resources, necessitates that pediatricians safely diagnose and treat patients presenting with aggressive behavior. In this article, we discuss the broad differential diagnosis that should be considered when initially evaluating a patient presenting with aggression or altered mental status; underlying causes include predisposing factors, comorbid conditions, and acute organic causes involving almost every organ system. Emergency and hospital physicians should tailor their examination and testing individually based on the patient's history and presentation. [Pediatr Ann. 2018;47(10):e402-e407.].
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Agrawal J, Kumar R, Malhi P, Dayal D. Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India. J Pediatr Endocrinol Metab 2016; 29:893-9. [PMID: 27226095 DOI: 10.1515/jpem-2015-0335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children with type 1 diabetes mellitus (T1DM) are on intensive treatment regimen with the stress of maintaining normal sugars which may predispose them to psychological problems. The study aimed to assess the prevalence of psychosocial problems and to study their correlates in children with T1DM in India. METHODS The study was conducted on 97 T1DM children (59 boys and 38 girls) between 4 and 15 years of age with at least 6 months of illness. Psychosocial problems were assessed using childhood psychopathological measurement schedule (CPMS) questionnaire. Information regarding glucose control and various demographic factors was recorded. Factors significantly associated with psychosocial problems were further analysed using multiple linear regression. RESULTS Mean age of patients was 9.6 years. The prevalence of psychosocial problems was found to be 20%. Most common problems were conduct disorders (24.5%), special symptoms (24%), physical illness (23%), anxiety (10%) and depression (7%). Depression had the strongest correlation (r=0.316 and p=0.002) with glycosylated haemoglobin (HbA1c), followed by behavioural problems/low intelligence (r=0.236 and p=0.02). CPMS score had a strong positive correlation with number of hyperglycaemic episodes, number of hospitalisations in last 6 months and HbA1c value. HbA1c over last 6 months and total number of hospitalisations were significant independent predictors in determining psychosocial problems. CONCLUSIONS Psychosocial problems were seen in 20% children with T1DM from India. Poor glycaemic control and increased number of hospitalisations are significantly associated with increased psychosocial problems in T1DM.
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