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Article Title

Adolescent Psychiatric Comorbidities Contribute to Diabetes-Related Emergency Health Care Visits

Publication Date

8-15-2016

Keywords

adolescent mental health, diabetes

Abstract

Background/Aims: Type 1 diabetes (T1D) is a chronic illness involving failure to produce insulin, and requires a demanding management regime to protect against serious ailments including stroke and cardiovascular disease. Although psychiatric diagnoses hinder self-care, less is known about the impact of three relatively common psychiatric diagnoses (i.e. depression, anxiety, attention deficit disorder) on the management of T1D during adolescence, a developmental stage at which risk for psychiatric diagnoses is heightened, metabolic control declines and enduring health habits are established. The goal of this study was to examine whether the co-occurrence (i.e. comorbidity) of psychiatric diagnoses interferes with the management of T1D, specifically by contributing to a higher number of T1D-related emergency health care visits across three years in adolescence.

Methods: Health insurance claims records were extracted for a sample of 145 adolescents (age 10–19 years; 52% female) diagnosed with T1D who had continuous enrollment in a regional health plan across the three study years. Diagnostic grouping software identified diagnoses of depression, anxiety and attention deficit disorder, and their comorbidities. Place of service codes captured T1D-related emergency department and urgent care visits.

Results: A random effect logistic regression was used to examine whether psychiatric comorbidities increased the probability of T1D-related emergency health care visits within a study year. Potential covariates (i.e. gender, age, insurance policy type, months of enrollment) were included; the no psychiatric diagnosis group was used for comparison. Although single psychiatric diagnoses did not increase the probability of an emergency health care visit (P > 0.50), psychiatric comorbidities significantly positively predicted emergency health care visits (P < 0.001). Follow-up analysis revealed a marginal effect of +22%, indicating that the presence of psychiatric comorbidities substantially increased the likelihood of an emergency health care visit.

Conclusion: Results supported the hypothesis that psychiatric diagnoses have a synergistic effect on adolescents’ ability to successfully manage T1D. These findings highlight the need to consider the complex interplay between psychological health and chronic illness management across adolescence.

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Submitted

July 5th, 2016

Accepted

August 12th, 2016