Mental health resources critical in caring for children with diabetes
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The COVID-19 pandemic highlighted some of the disparities children face in diabetes prevention and care, according to a presenter at the American Diabetes Association Scientific Sessions.
Cynthia E. Muñoz, PhD, MPH, 2021 American Diabetes Association President of Health Care and Education, assistant professor of clinical pediatrics at University of Southern California Keck School of Medicine, and pediatric diabetes psychologist at Children’s Hospital Los Angeles, said the pandemic exposed several worrying trends in the mental health of children with diabetes and emphasized the importance of support programs and resources as part of comprehensive diabetes care.
“During the pandemic, we learned that disparities impact children, not only adults,” Muñoz told Healio. “It is vitally important that we provide comprehensive care, including mental health care, to address the disparities and optimally support all persons with diabetes.”
Worrying pediatric diabetes trends
The demographics of diabetes among children have changed in recent years. Incidences of type 2 diabetes have been on the rise since 2004, especially in non-Hispanic Black, Hispanic and Native American populations. Type 1 diabetes has been on the rise among Asian, non-Hispanic Black and Hispanic children. Girls have seen a large increase in type 2 diabetes, and boys have had a more rapid increase in type 1 diabetes incidences.
“Thanks to the discovery of insulin, we all know that diabetes is no longer a death sentence,” Muñoz said during her president’s address. “Unfortunately, the trend of higher HbA1c in youth is ongoing despite advances in therapy and technology. Misdiagnosis and diabetic ketoacidosis also continue to be issues. The COVID-19 pandemic further exacerbated these trends.”
Muñoz said DKA rates with new-onset type 2 diabetes at Children’s Hospital Los Angeles doubled in 2020 compared with 2018. Hesitancy to attend medical appointments, decreases in physical activity due to stay-at-home orders, lack of access to school-based health support due to school closures, and an inability for families to purchase supplies and food due to a lack of employment opportunities are all factors negatively affecting children during the pandemic.
All these factors helped lead to an increase in psychosocial and mental health issues since the start of the pandemic.
“During the last week of May 2021, the CEO from Children’s Hospital Colorado declared the first ‘pediatric mental health state of emergency’ because their pediatric emergency departments and inpatient units were overrun with children and youth attempting suicide and suffering from other forms of major mental health illness,” Muñoz told Healio. “Acute behavioral health presentations had increased 90% in 2021 compared to 2019. It is conceivable that other hospital systems across the country are seeing the same frightening trend.”
During the pandemic, children have reported decreases in quality of life and more mental health problems compared with before the pandemic, with those in lower socioeconomic classes and migrant children more affected. Children with diabetes have reported more diabetes distress, more time in hyperglycemia and more depression and anxiety compared with before the pandemic.
Mental health crucial to diabetes care
To help care for children with diabetes who are experiencing mental health concerns, the Comprehensive Childhood Diabetes Center at Children’s Hospital Los Angeles offers psychological care that includes individual and family psychotherapy, crisis intervention, depression screening and a psychotherapy group called Teen Power, where small groups of families gather for socioemotional and peer support.
Data from Children’s Hospital Los Angles show children in Teen Power reported decreases in severity of depressive symptoms after participating in the program compared with before, as well as increases in self-efficacy and improved diabetes-specific quality of life. Parents and guardians taking part in the program reported a decrease in severity of stress after the program compared with before.
Mental health has also been a larger focus for the ADA. Resources such as the Mental Health Diabetes Education Program, Mental Health Provider Directory, Project Power after school programs and Imagine Camps, and the Safe at School Campaign are all aimed at promoting the emotional well-being of children and adults with pre-diabetes as well as type 1 and type 2 diabetes. In addition, psychosocial care was integrated into the ADA Standards of Care in 2016 when the organization published a position statement on the psychosocial care of people with diabetes.
“We need to provide psychological support that addresses the unique and diverse needs of children with diabetes,” Muñoz told Healio. “It is important for diabetes care teams to include a mental health professional. To meet the mental health needs of our growing diabetes population, we need to train more mental health professionals who work in outpatient, inpatient and residential behavioral health treatment centers about the care of people with diabetes.”
In her closing words, Muñoz said, “All people deserve optimal whole person care. All people must have access to the tools they need to optimally manage their health.”
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Muñoz CE. HCE-01. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).
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