Adolescent Psychiatric Comorbidities Contribute to Diabetes-Related Emergency Health Care Visits
adolescent mental health, diabetes
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.
Flynn M, Ode SB. Adolescent psychiatric comorbidities contribute to diabetes-related emergency health care visits. J Patient Cent Res Rev. 2016;3:216.