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Proper screening, behavioral support address emotional burdens of youths with type 1 diabetes
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Adolescents with type 1 diabetes often face multiple emotional burdens that affect diabetes management, and selecting the right screening tools and behavioral interventions can increase health-related quality of life and improve outcomes, according to a literature review published in Pediatric Diabetes.
“Multiple sources of burden for youth with [type 1 diabetes] and their families impact key diabetes outcomes including quality of life, self-management and glycemic control,” Marisa E. Hilliard, PhD, assistant professor of pediatrics at Baylor College of Medicine, and colleagues wrote. “Thus, there is a need to more effectively and routinely screen for these challenges and support youth with diabetes. Indeed, clinical guidelines from the American Diabetes Association and International Society for Pediatric and Adolescent Diabetes (ISPAD) explicitly call for routine assessment and treatment of psychosocial burdens for people with diabetes.”
Depression is common in youths with type 1 diabetes, the researchers wrote, as are diabetes-specific stressors, such as fear of hypoglycemia, which are associated with lower engagement in diabetes self-management. Family conflict, parental involvement, low social support and socioeconomic status also influence self-management.
Screening tools
Providers should decide which constructs to measure in a screening protocol when considering which instrument to use.
“To assist with selecting measures, the ADA published recommendations for validated screening and assessment instruments for use in diabetes care settings,” the researchers wrote. “Some brief instruments that have been used to assess for depressive symptoms in youth include the 9-item Patient Health Questionnaire, the Patient Health Questionnaire for Adolescents, the Children's Depression Inventory (CDI), the Center for Epidemiological Studies Depression Scale, the Short Mood and Feelings Questionnaire, and the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric depression measures.”
Brief instruments that have been used to assess for anxiety symptoms in this population include the Generalized Anxiety Disorder 7-item scale, the Penn State Worry Questionnaire for Children, and the PROMIS pediatric anxiety measures.
Behavioral strategies
Full-scale behavioral intervention approaches are not feasible for most diabetes care providers to deliver during clinical care, the researchers noted, but common components of these approaches may provide strategies that can be used by diabetes care team members. The researchers recommended approaches that target “realistic expectations” for youth self-management, focus on parent-child communication and promote parental involvement in diabetes management. Any intervention materials should accommodate lower literacy and health literacy skills, they wrote.
“Providers and patients may have different priorities for diabetes management and outcomes — for providers the priority may be to optimize glycemic outcomes to minimize the risk of complications later in life, and for youth and families their priority may be quality of life,” the researchers wrote. “Discussion and understanding of these different priorities or goals may help diabetes care approaches meet everyone's needs.”
Overcoming barriers
Regardless of the screening approach or behavioral intervention used, the researchers noted that effectiveness depends on the level of integration into routine health care. Clinic and institutional organization, as well as the communication process within care teams, can all serve as potential barriers to successful implementation, they wrote.
To minimize disruption to clinical staff, the researchers recommended using online screening platforms or coordinating with medical assistant staff. When available, they wrote, providers should consult with mental health professionals to score and interpret screening measures and learn how to best implement behavioral strategies.
“This requires a patient-centered care approach that emphasizes supportive communication strategies and promotes engagement and a mutual understanding among the diabetes care provider, youth and family,” the researchers wrote. “Diabetes care providers are well-positioned to foster conversation about the burdens of living with [type 1 diabetes] with patients and families, and using brief behavioral strategies for screening and emotional support may facilitate this process.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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