Anxiety in Children and Adolescents With Type 1 Diabetes

Abstract

Although anxiety is a normal and developmentally appropriate experience of childhood and anxiety disorders are among the most commonly diagnosed disorders, the prevalence of anxiety symptomatology and anxiety disorders in children with type 1 diabetes (T1D) is not well documented. Most studies have focused on anxiety-related syndromes associated with T1D including fear of hypoglycemia, specific phobia of needles (i.e., needle anxiety), and anxiety related to uptake of new and sophisticated diabetes technology (e.g., continuous glucose monitors, continuous subcutaneous infusion therapy), but the extant literature is sparse, and more research is greatly needed. Identification, prevention, and treatment of anxiety are critical to providing comprehensive diabetes care and management. This review provides a summary of the literature focused on anxiety in children and adolescents with T1D with suggestions for future research and clinical implications.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.••

    Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56:345–65. This article provides an up to date overview of the worldwide prevalence of mental disorders in youth with estimates of 6.5 % for anxiety, 2.6 % for depression, and 3.4 % for ADHD.

    PubMed  Article  Google Scholar 

  2. 2.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2014.

    Google Scholar 

  3. 3.

    March JS, Parker JD, Sullivan K, Stallings P, Conners CK. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. 1997;36:554–65.

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. 1999;38:1230–6.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Kaufman J, Birmaher B, Brent DA, Ryan ND, Rao U. K-Sads-Pl. J Am Acad Child Adolesc Psychiatry. 2000;3910:1208.

    Article  Google Scholar 

  6. 6.

    Seligman LD, Ollendick TH, Langley AK, Baldacci HB. The utility of measures of child and adolescent anxiety: a meta-analytic review of the revised children’s manifest anxiety scale, the state-trait anxiety inventory for children, and the child behavior checklist. J Clin Child Adolesc Psychol. 2004;33:557–65.

    PubMed  Article  Google Scholar 

  7. 7.

    Bomyea J, Amir N, Lang AJ. The relationship between cognitive control and posttraumatic stress symptoms. J Behav Ther Exp Psychiatry. 2012;43:844–8.

    PubMed Central  PubMed  Article  Google Scholar 

  8. 8.

    Adal E, Onal Z, Ersen A, Yalcin K, Onal H, Aydin A. Recognizing the psychosocial aspects of type 1 diabetes in adolescents. J Clin Res Pediatr Endocrinol. 2015;7:57–62.

    PubMed  Article  Google Scholar 

  9. 9.

    American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015;38(Supplement 1):S70–6.

    Article  Google Scholar 

  10. 10.

    Plener PL, Molz E, Berger G, Schober E, Monkemoller K, Denzer C, et al. Depression, metabolic control, and antidepressant medication in young patients with type 1 diabetes. Pediatr Diabetes. 2015;16:58–66.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Hilliard ME, Herzer M, Dolan LM, Hood KK. Psychological screening in adolescents with type 1 diabetes predicts outcomes one year later. Diabetes Res Clin Pract. 2011;94:39–44.

    PubMed Central  PubMed  Article  Google Scholar 

  12. 12.••

    Hood KK, Beavers DP, Yi-Frazier J, Bell R, Dabelea D, McKeown RE, et al. Psychosocial burden and glycemic control during the first 6 years of diabetes: results from the SEARCH for Diabetes in Youth study. J Adolesc Health. 2014;55:498–504. This study demonstrated that in a large sample of youth with type 1 diabetes, significant deterioration in glycemic control occurs in the first 6 years and that poor diabetes-specific quality of life is a significant contributor.

    PubMed  Article  Google Scholar 

  13. 13.

    Stewart SM, Rao U, Emslie GJ, Klein D, White PC. Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus. Pediatrics. 2005;115:1315–9.

    PubMed  Article  Google Scholar 

  14. 14.

    Clayton KM, Stewart SM, Wiebe DJ, McConnel CE, Hughes CW, White PC. Maternal depressive symptoms predict adolescent healthcare utilization and charges in youth with type 1 diabetes (T1D). Health Psychol. 2013;32:1013–22.

    PubMed  Article  Google Scholar 

  15. 15.

    Pollock M, Kovacs M, Charron-Prochownik D. Eating disorders and maladaptive dietary/insulin management among youths with childhood-onset insulin-dependent diabetes mellitus. J Am Acad Child Adolesc Psychiatry. 1995;34:291–6.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Kovacs M, Goldston D, Obrosky DS, Bonar LK. Psychiatric disorders in youths with IDDM: rates and risk factors. Diabetes Care. 1997;20:36–44.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Northam EA, Matthews LK, Anderson PJ, Cameron FJ, Werther GA. Psychiatric morbidity and health outcome in type 1 diabetes—perspectives from a prospective longitudinal study. Diabet Med. 2005;22:152–7.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Sivertsen B, Petrie KJ, Wilhelmsen-Langeland A, Hysing M. Mental health in adolescents with type 1 diabetes: results from a large population-based study. BMC Endocr Disord. 2014;14:83.

    PubMed Central  PubMed  Article  Google Scholar 

  19. 19.

    Dantzer C, Swendsen J, Maurice-Tison S, Salamon R. Anxiety and depression in juvenile diabetes: a critical review. Clin Psychol Rev. 2003;23:787–800.

    PubMed  Article  Google Scholar 

  20. 20.

    Herzer M, Hood KK. Anxiety symptoms in adolescents with type 1 diabetes: association with blood glucose monitoring and glycemic control. J Pediatr Psychol. 2010;35:415–25.

    PubMed Central  PubMed  Article  Google Scholar 

  21. 21.

    Nixon R, Pickup JC. Fear of hypoglycemia in type 1 diabetes managed by continuous subcutaneous insulin infusion: is it associated with poor glycemic control? Diabetes Technol Ther. 2011;13:93–8.

    CAS  PubMed  Article  Google Scholar 

  22. 22.••

    Hawkes CP, McDarby V, Cody D. Fear of hypoglycemia in parents of children with type 1 diabetes. J Paediatr Child Health. 2014;50:639–42. This study found that fear of hypoglycemia was highest among parents of children ages 6–11 years.

    PubMed  Article  Google Scholar 

  23. 23.

    Gonder-Frederick LA, Cox DJ, Ritterband LM. Diabetes and behavioral medicine: the second decade. J Consult Clin Psychol. 2002;70:611–25.

    PubMed  Article  Google Scholar 

  24. 24.

    Shepard JA, Vajda K, Nyer M, Clarke W, Gonder-Frederick L. Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes. J Pediatr Psychol. 2014;39:1115–25.

    PubMed  Article  Google Scholar 

  25. 25.

    Gonder-Frederick LA, Fisher CD, Ritterband LM, Cox DJ, Hou L, DasGupta AA, et al. Predictors of fear of hypoglycemia in adolescents with type 1 diabetes and their parents. Pediatr Diabetes. 2006;7:215–22.

    PubMed  Article  Google Scholar 

  26. 26.

    Al Hayek AA, Robert AA, Braham RB, Issa BA, Al Sabaan FS. Predictive risk factors for fear of hypoglycemia and anxiety-related emotional disorders among adolescents with type 1 diabetes. Med Princ Pract. 2015.

  27. 27.

    Patton SR, Dolan LM, Henry R, Powers SW. Fear of hypoglycemia in parents of young children with type 1 diabetes mellitus. J Clin Psychol Med Settings. 2008;15:252–9.

    PubMed Central  PubMed  Article  Google Scholar 

  28. 28.••

    Barnard K, Thomas S, Royle P, Noyes K, Waugh N. Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review. BMC Pediatr. 2010;10:50. This review article demonstrated that parents of children with type 1 diabetes experience high levels of fear of hypoglycemia, which impacts parental physical health and quality of life. Parents engage in hypoglycemic avoidance behaviors, which impacts glycemic control.

    PubMed Central  PubMed  Article  Google Scholar 

  29. 29.

    Freckleton E, Sharpe L, Mullan B. The relationship between maternal fear of hypoglycaemia and adherence in children with type-1 diabetes. Int J Behav Med. 2014;21:804–10.

    PubMed  Article  Google Scholar 

  30. 30.

    Haugstvedt A, Wentzel-Larsen T, Graue M, Sovik O, Rokne B. Fear of hypoglycaemia in mothers and fathers of children with type 1 diabetes is associated with poor glycaemic control and parental emotional distress: a population-based study. Diabet Med. 2010;27:72–8.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Cox DJ, Gonder-Frederick L, Polonsky W, Schlundt D, Kovatchev B, Clarke W. Blood glucose awareness training (BGAT-2): long-term benefits. Diabetes Care. 2001;24:637–42.

    CAS  PubMed  Article  Google Scholar 

  32. 32.••

    Vallis M, Jones A, Pouwer F. Managing hypoglycemia in diabetes may be more fear management than glucose management: a practical guide for diabetes care providers. Curr Diabetes Rev. 2014;10:364–70. This article provides an overview of the psychological consequences of hypoglycemia and strategies that can be implemented as treatment (i.e., exposure).

    PubMed  Article  Google Scholar 

  33. 33.

    Simmons JH, McFann KK, Brown AC, Rewers A, Follansbee D, Temple-Trujillo RE, et al. Reliability of the diabetes fear of injecting and self-testing questionnaire in pediatric patients with type 1 diabetes. Diabetes Care. 2007;30:987–8.

    PubMed  Article  Google Scholar 

  34. 34.••

    Cemeroglu AP, Can A, Davis AT, Cemeroglu O, Kleis L, Daniel MS, et al. Fear of needles in children with type 1 diabetes mellitus on multiple daily injections and continuous subcutaneous insulin infusion. Endocr Pract. 2015;21:46–53. This study used the Diabetes Fear of Injecting and Self-Testing Questionnaire to assess fear of needles in children with type 1 diabetes. Fear of testing was found in 10 % of the sample, whereas fear of injecting was found in 33 %.

    PubMed  Article  Google Scholar 

  35. 35.

    Howe CJ, Ratcliffe SJ, Tuttle A, Dougherty S, Lipman TH. Needle anxiety in children with type 1 diabetes and their mothers. MCN Am J Matern Child Nurs. 2011;36:25–31.

    PubMed  Article  Google Scholar 

  36. 36.••

    Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2013;10. This article reviews 39 trials on managing needle pain associated with venipuncture, intravenous line insertion, and immunization. There is strong evidence for the use of distraction and hypnosis for needle-related pain and distress, but more research is needed for other approaches (e.g., cognitive behavioral therapy, parent coaching and distraction).

  37. 37.••

    Markowitz JT, Harrington KR, Laffel LM. Technology to optimize pediatric diabetes management and outcomes. Curr Diab Rep. 2013;13:877–85. This article provides a review of the psychosocial factors associated with use of new diabetes technology.

    PubMed  Article  Google Scholar 

  38. 38.

    Kaufman FR, Halvorson M, Kim C, Pitukcheewanont P. Use of insulin pump therapy at nighttime only for children 7–10 years of age with type 1 diabetes. Diabetes Care. 2000;23:579–82.

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Mauras N, Beck R, Xing D, Ruedy K, Buckingham B, Tansey M, et al. A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to <10 years. Diabetes Care. 2012;35:204–10.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  40. 40.

    Cemeroglu AP, Stone R, Kleis L, Racine MS, Postellon DC, Wood MA. Use of a real-time continuous glucose monitoring system in children and young adults on insulin pump therapy: patients’ and caregivers’ perception of benefit. Pediatr Diabetes. 2010;11:182–7.

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Barnard KD, Wysocki T, Allen JM, Elleri D, Thabit H, Leelarathna L, et al. Closing the loop overnight at home setting: psychosocial impact for adolescents with type 1 diabetes and their parents. BMJ Open Diabetes Res Care. 2014;2, e000025.

    PubMed Central  PubMed  Article  Google Scholar 

  42. 42.

    Rooksby M, Elouafkaoui P, Humphris G, Clarkson J, Freeman R. Internet-assisted delivery of cognitive behavioural therapy (CBT) for childhood anxiety: systematic review and meta-analysis. J Anxiety Disord. 2015;29:83–92.

    PubMed  Article  Google Scholar 

  43. 43.

    Hackworth NJ, Matthews J, Burke K, Petrovic Z, Klein B, Northam EA, et al. Improving mental health of adolescents with type 1 diabetes: protocol for a randomized controlled trial of the Nothing Ventured Nothing Gained online adolescent and parenting support intervention. BMC Public Health. 2013;13:1185.

    PubMed Central  PubMed  Article  Google Scholar 

  44. 44.

    Spaulding R, Cain S, Sonnenschein K. Urban telepsychiatry: uncommon service for a common need. Child Adolesc Psychiatr Clin N Am. 2011;20:29–39.

    PubMed  Article  Google Scholar 

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Shideh Majidi, Kimberly A. Driscoll, and Jennifer K. Raymond declare that they have no conflict of interest.

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Correspondence to Shideh Majidi.

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This article is part of the Topical Collection on Psychosocial Aspects

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Majidi, S., Driscoll, K.A. & Raymond, J.K. Anxiety in Children and Adolescents With Type 1 Diabetes. Curr Diab Rep 15, 47 (2015). https://doi.org/10.1007/s11892-015-0619-0

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Keywords

  • Type 1 diabetes
  • Pediatrics
  • Anxiety
  • Fear of hypoglycemia
  • Needle anxiety