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Licensed Unlicensed Requires Authentication Published by De Gruyter January 5, 2018

Identifying depressive symptoms among diabetes type and the impact on hemoglobin A1c

  • Bethany A. Glick EMAIL logo , K. Ming Chan Hong , Kathryn Obrynba , Manmohan K. Kamboj and Robert P. Hoffman



This study was designed to determine the effects of diabetes type and gender on depression risk determined by a highly sensitive screening questionnaire in adolescents. Glycemic control and counseling affect were also studied.


A retrospective chart review of patients seen between 2013 and 2015 was performed. Five hundred and thirty adolescents with type 1 (T1DM) or 2 (T2DM) diabetes mellitus completed the Patient Health Questionnaire-9 (PHQ-9) to identify depressive symptoms. Hemoglobin A1c (HbA1c) was measured when the PHQ-9 was given, and at 1 year. Patients with increased depression risk were referred for counseling and comparisons were made between those who did and did not attend.


Females with T2DM, but not males, had increased depression compared to T1DM. Females had increased depression compared to males in T1DM (p = 0.046) and a near significant increase in T2DM (p = 0.069). In T1DM, but not T2DM, HbA1c levels were increased in high and moderate, compared to low, risk depression risk groups (p = 0.007). Follow-up HbA1c was unchanged 1 year later and there were no differences between those involved in counseling and those who refused to attend. Sex and type of diabetes had no effect on response to counseling.


These results demonstrate increased depression in adolescents with T2DM compared to T1DM and in females compared to controls. Glycemic control did not change in adolescents who reported moderate to severe symptoms of depression and received counseling intervention compared to adolescents who declined counseling.

Corresponding author: Bethany A. Glick, MSSA, LISW-S, Nationwide Children’s Hospital, Pediatric Endocrinology, 700 Children’s Drive,Columbus, OH 43205, USA, Phone: +614-722-4425, Fax: +614-722-4440


A special acknowledgment to the endocrinology social workers Megan Meade, MSW, LSW, and Marcie McNary, MSW, LISW and staff at the Pediatric Endocrinology Division at the Nationwide Children’s Hospital, Columbus, OH, USA.

  1. Author contributions: The authors declare no relevant conflict of interest. The authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


1. Cameron FJ, Northam EA, Ambler GR, Daneman D. Routine psychological screening in youth with type 1 diabetes and their parents. A notion whose time has come? Diabetes Care 2007;30:2716–24.10.2337/dc07-0603Search in Google Scholar

2. Helgeson VS, Siminerio L, Escobar O, Becker D. Predictors of metabolic control among adolescents with diabetes: a 4-year longitudinal study. J Pediatr Psychol 2009;34:254–70.10.1093/jpepsy/jsn079Search in Google Scholar

3. Winkley K. The epidemiology of depression in diabetes. European Diabetes Nursing 2008;5:91–6.10.1002/edn.117Search in Google Scholar

4. Grey M, Whittemore R, Tamborlane W. Depression in type 1 diabetes in children: natural history and correlates. J Psychosom Res 2002;53:907–11.10.1016/S0022-3999(02)00312-4Search in Google Scholar

5. Kanner S, Hamrin V, Grey M. Depression in adolescents with diabetes. J Child Adolesc Psychiatr Nurs 2003;16:15–24.10.1111/j.1744-6171.2003.tb00342.xSearch in Google Scholar PubMed

6. Stewart S, Rao U, Emslie G, Klein D, White P. Depressive symptoms predict hospitalizations for adolescents with type 1 diabetes mellitus. Pediatrics 2005;115:1315–9.10.1542/peds.2004-1717Search in Google Scholar PubMed

7. Hains AA, Berlin KS, Davies WH, Parton EA, Alemzadeh R. Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control. Diabetes Care 2006;29:818–22.10.2337/diacare.29.04.06.dc05-1828Search in Google Scholar PubMed

8. Corathers SD, Kichler J, Jones N-H, Houchen A, Jolly M, et al. Improving depression screening for adolescents with type 1 diabetes. Pediatrics 2013;132:e1395–402.10.1542/peds.2013-0681Search in Google Scholar PubMed

9. Northam EA, Lin A, Finch S, Werther GA, Cameron FJ. Psychosocial well-being and functional outcomes in youth with type 1 diabetes 12 years after disease onset. Diabetes Care 2010;33:1430–7.10.2337/dc09-2232Search in Google Scholar PubMed PubMed Central

10. Smaldone A, Honig J, Arons R, Weinger K. Comorbid hospitalizations for children with single and recurrent ketoacidosis. Diabetes Care 2005;53:A425.Search in Google Scholar

11. McGrady ME, Laffel L, Drotar D, Repaske D, Hood KK. Depressive symptoms and glycemic control in adolescents with type 1 diabetes: mediational role of blood glucose monitoring. Diabetes Care 2009;32:804–6.10.2337/dc08-2111Search in Google Scholar PubMed PubMed Central

12. Bernstein CM, Stockwell MS, Gallagher MP, Rosenthal SL, Soren K. Mental health issues in adolescents and young adults with type 1 diabetes: prevalence and impact on glycemic control. Clin Pediatr 2013;52:10–5.10.1177/0009922812459950Search in Google Scholar

13. Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. Psychosomatics 2011;52:1–18.10.1016/j.psym.2010.11.007Search in Google Scholar

14. Delamater AM. Psychological care of children and adolescents with diabetes. Pediatric Diabetes 2009;10:175–84.10.1111/j.1399-5448.2009.00580.xSearch in Google Scholar

15. Silverstein JH, Klingensmith G, Copeland K, Plotnick L, Kaufman F, et al. Care for children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 2005;28:186–212.10.2337/diacare.28.1.186Search in Google Scholar

16. Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complications 2005;19:113–22.10.1016/S1056-8727(04)00004-2Search in Google Scholar

17. Hood KK, Beavers DP, Yi-Frazier J, Bell R, Dabelea D, et al. Psychosocial burden and glycemic control during the first six years of diabetes: results from the SEARCH for diabetes in youth study. J Adolesc Health 1014;55:498–504.10.1016/j.jadohealth.2014.03.011Search in Google Scholar PubMed PubMed Central

18. Korbel CD, Wiebe DJ, Berg CA, Palmer DL. Gender difference in adherence to type 1 diabetes management across adolescence: the mediating role of depression. Children’s Healthcare 2007;36:83–93.10.1080/02739610701316936Search in Google Scholar

19. Cullum K, Howland LC, Instone S. Depressive symptoms and social support in adolescents with type 2 diabetes. J Pediatr Health Care 2015;30:57–64.10.1016/j.pedhc.2015.06.008Search in Google Scholar PubMed

20. Helgeson VS, Snyder PR, Escobar O, Siminerio L, Becker D. Comparison of adolescents with and without diabetes on indices of psychosocial functioning for three years. J Pediatr Psychol 2007;32:794–806.10.1093/jpepsy/jsm020Search in Google Scholar PubMed

21. La Greca AM, Swales T, Klemp S, Madigan S, Skyler J. Adolescents with diabetes: gender differences in psychosocial functioning and glycemic control. Children’s Health Care 1995;24:61–78.10.1207/s15326888chc2401_6Search in Google Scholar

22. Inoue T, Tanaka T, Nakagawa S, Nakato Y, Kamyeyama R, et al. Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care. BMC Psychiatry 2012;12:23.10.1186/1471-244X-12-73Search in Google Scholar PubMed PubMed Central

23. Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the patient health questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med 2007;22:1596–602.10.1007/s11606-007-0333-ySearch in Google Scholar PubMed PubMed Central

24. Kroenke K, Spitzer RL, Williams JB. The PHQ-9. J Gen Intern Med 2001;16:606–13.10.1046/j.1525-1497.2001.016009606.xSearch in Google Scholar PubMed PubMed Central

25. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes. A meta-analysis. Diabetes Care 2001;24:1069–78.10.2337/diacare.24.6.1069Search in Google Scholar PubMed

26. Pinhas-Hamiel O, Zeitler P. “Who is the wise man? – The one who foresees consequences:” childhood obesity, new associated comorbidity and prevention. Prev Med 2000;31:702–5.10.1006/pmed.2000.0752Search in Google Scholar PubMed

27. Pickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care 2004;27:813–23.10.2337/diacare.27.3.813Search in Google Scholar PubMed

28. Nicole Vogelzangs MS, Beekman AT, Newman AB, Satterfield S, Simonsick EM, et al. Depressive symptoms and change in abdominal obesity in older persons. Arch Gen Psychiatry 2008;65:1386–93.10.1001/archpsyc.65.12.1386Search in Google Scholar PubMed PubMed Central

29. Bonnet F, Irving K, Terra J-L, Nony P, Berthezene F, et al. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis 2005;178:339–44.10.1016/j.atherosclerosis.2004.08.035Search in Google Scholar PubMed

30. Nabkasorn C, Miyai N, Sootmongkol A, Junprasert S, Yamamoto H, et al. Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms. Eur J Public Health 2006;16:179–84.10.1093/eurpub/cki159Search in Google Scholar PubMed

31. Polonsky WH, Fisher L, Earles J, Dudl JR, Lees J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care 2005;28:626–31.10.2337/diacare.28.3.626Search in Google Scholar PubMed

32. Weissberg-Benchell J, Antisdel-Lomaglio J. Diabetes-specific emotional distress among adolescents: feasibility, reliability, and validity of the problem areas in diabetes-teen version. Pediatr Diabetes 2011;12:341–4.10.1111/j.1399-5448.2010.00720.xSearch in Google Scholar PubMed

Received: 2017-6-19
Accepted: 2017-11-10
Published Online: 2018-1-5
Published in Print: 2018-1-26

©2018 Walter de Gruyter GmbH, Berlin/Boston

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