Suicide rates sharply higher than average in young adults with diabetes

Canada: Young people with diabetes are at greater risk than peers without the disease of developing mental health problems or attempting suicide as they transition into adulthood, a Canadian study suggests.

Based on data for more than 1 million young people born in Quebec, researchers found that being diagnosed with diabetes is associated with increased odds of being diagnosed in an emergency room or hospital with a mood disorder like depression. It's also linked to higher odds of being admitted to a hospital for a suicide attempt, according to the report in Diabetes Care.

Between the ages of 15 and 25, adolescents and young adults with diabetes are 325% as likely to attempt suicide as their same-age peers, and 133% as likely to suffer from a mood disorder, said Dr. Marie-Eve Robinson, a pediatric endocrinologist at the Children's Hospital of Eastern Ontario, in Ottawa, Canada, who led the study.

Past research has explored risks for psychiatric disorders in individuals with and without type-1 diabetes, Robinson and her colleagues write in Diabetes Care, but the risks during the transition from adolescence to adulthood have not been assessed.

"In addition to challenges inherent to adolescence, young adults with diabetes who transition to adult care need to adapt to a new adult-care provider and a treatment facility," Robinson told Reuters Health.

Young adults tend to perceive pediatricians as more family-centered and less formal compared to adult-care providers and this can sometimes make the transition difficult, she explained.

Type-1 diabetes, formerly known as juvenile diabetes, occurs when the pancreas makes little or no insulin; the disease typically emerges in childhood or adolescence. Type-2 diabetes, the more common form of the illness, is associated with aging and overweight and occurs when the body becomes less responsive to insulin.

Young people with type-1 diabetes must also take full responsibility for managing their diabetes, Robinson said, which includes injecting insulin multiple times a day, monitoring their glucose and paying close attention to diet and physical activity.

"This can be overwhelming, especially when their previous caregivers were providing significant support during childhood and adolescence."

To assess the mental health toll of these burdens, the researchers used Quebec registries to identify people born between April 1982 and December 1998 without any mental illness diagnosed before age 15. The final analysis included 3,544 adolescents diagnosed with diabetes between ages 1 and 15, and nearly 1.4 million young people without diabetes.

The study team followed the youths from age 15 to 25 and found that in addition to increased risks for a mood disorder diagnosis or a suicide attempt, youth with diabetes were almost twice as likely to visit a psychiatrist, compared to peers without diabetes.

With diabetes, young people also had a 29% higher risk of being diagnosed with any psychiatric disorder. However, there were no differences between the groups in the schizophrenia diagnoses.

Even without a diagnosis of diabetes, there is a lot of anxiety and depression nowadays in the adolescent population, said Dr. Anastassios G. Pittas, co-director of the Diabetes and Lipid Center, at Tufts Medical Center in Boston.

"To be diagnosed, on top of that, with a chronic, incurable medical condition that affects essentially every minute of one's life has a huge impact," Pittas, who was not involved in the current study, told Reuters Health in a phone interview.

However, depending on the age of the child, a major medical diagnosis need not always have a negative impact, he added.

For Pittas, one major limitation of the study was the large range in ages at which diabetes was diagnosed, and he would have liked to see if there were differences in mental health risk on that basis.

"Children diagnosed with diabetes at age 1 or 2 do not know life without diabetes," said Pittas, adding that kids diagnosed before ages 7 or 8 tend to do better than those diagnosed in the middle of adolescence.

Even so, the study authors note in their report, endocrinologists who treat young adults rarely receive a patient's psychosocial summary as part of their referral documents from their pediatric colleagues.

"As children with diabetes will inevitably transfer to adult care, pediatric and adult healthcare providers should be aware of the increased risk of developing mental health problems," Robinson said. 

For more details click on the link: https://doi.org/10.2337/dc19-1487