Date Available

4-25-2019

Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Leslie Scott

Committee Member

Dr. Diana Inman

Co-Director of Graduate Studies

Debra Howard

Abstract

Depression can significantly affect how adolescents with T1DM self-manage their disease. The combination of depression and diabetes is closely linked to reduction in self-care behaviors, poor treatment adherence, and sub-optimal metabolic control.

PURPOSE: The purpose of this study was to evaluate current screening for depression in adolescents with T1DM and determine the need for additional support or services to improve the quality of routine, follow-up diabetes care.

METHODS: A cross-sectional, retrospective review of electronic medical records was used to evaluate current practice of depression screening for adolescents with T1DM (11-21years) bring followed at a local pediatric diabetes center between April 1, 2018 and September 20, 2018. A Depression Screening Information Sheet was used to collect demographic and diabetes treatment information from the electronic medical records meeting inclusion criteria for enrollment into the study. The data were analyzed to explore relationships between demographic information, treatment information, and Patient Health Questionnaire-9, modified for adolescents (PHQ-A) depression scores. Descriptive and correlational statistics were used to analyze collected data.

RESULTS: Diabetes center staff reviewed 528 medical records for inclusion into the study. Eighty-four of the electronic medical records reviewed met inclusion criteria for enrollment in the study. Data analysis showed several findings. The age at diagnosis was significant to the PHQ-A depression scores. The older the age at diagnosis (mean=9.46), the more likely the score of at least moderately depressed (PHQ-A >9; p=0.02). Higher HgbA1C levels (mean=10.54) related to higher depression scores on the PHQ-A (p=0.02). Patients who did not utilize the continuous-glucose monitoring (CGM) were more likely to be depressed; 95.7% of patients with a PHQ-A score >9 did not wear a CGM device. High school patients were significantly more moderately depressed (p=0.006) than younger patients. These findings highlight the importance of screening for depression as part of routine diabetes care.

CONCLUSION: Screening for depression is a very important part of routine care for adolescents with T1DM. The American Academy of Pediatrics (AAP) and American Diabetes Association (ADA) recommend adolescent screening for depression at least annually. This study supports the need for incorporating routine depression screening of adolescents with T1DM as a part of on-going diabetes care. Several clinical indicators were found that could assist providers in identifying those adolescents with T1DM at greatest risk for depression.

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