Both children with type 1 diabetes and their immediate family members are at increased risk of mental health problems compared to those without the disease, according to a large study by researchers at the Karolinska Institutet in Sweden, published in the journal Diabetes Care. The findings highlight the need for psychological counseling for both children and their families in diabetes care.
Research shows that children and adolescents with type 1 diabetes are at increased risk for mental health problems such as depression, anxiety, and stress-related disorders, and that these comorbidities can interfere with optimal care.
Current International Society of Pediatric and Adolescent Diabetes (ISPAD) guidelines recommend screening for mental health problems in children with type 1 diabetes, but do not adequately address the needs of family members who are also at increased risk of mental health problems . Furthermore, the reasons for the association between familial mental health problems and type 1 diabetes are not fully understood.
“Many clinicians intuitively assume that diabetes in a child negatively affects the mental health of both the patient and family members,” says Agnieszka Butuicka, assistant professor in the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and the last senior author of the study. “But we think the answer is not so simple. Our study shows that there may also be a genetic component behind this link.”
The study linked around 3.5 million people born in Sweden between 1973 and 2007 with their biological parents, full and half siblings and cousins. More than 20,000 people were diagnosed with type 1 diabetes in childhood and were found to have almost double the risk of depression and about 1.6 times the risk of anxiety and stress-related disorders compared to those without the disease.
Their parents and full siblings also had somewhat increased risk of anxiety and stress-related disorders, although to a lesser extent, while their half-siblings and cousins did not or had only marginally higher risk for some states.
“These results are of great clinical importance, because they mean that the therapeutic intervention should also include close family members, not only patients,” says Agnieszka Butuicka.
Because parent-child and full siblings share more genetic material (about 50 percent) than half-siblings (about 25 percent) and cousins (less than 12.5 percent), the researchers say the result supports the idea that genes may be a contributing factor to mental health problems in type 1 diabetes.
However, because this is only an observational study, they cannot definitively say what is causing the associations.
More studies are needed to fully understand the underlying genetic and environmental contributions leading to psychiatric disorders in type 1 diabetes.”
Shengxin Liu, PhD student at Karolinska Institutet and corresponding author of the study
source:
Journal reference:
Liu, S., et al. (2022) Association and familial coaggregation of childhood-onset type 1 diabetes with depression, anxiety, and stress-related disorders: a population-based cohort study. Diabetes care. doi.org/10.2337/dc21-1347.
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