Impact and Association of Diabetes-related Distress and Depression among – Children with Type 1 Diabetes and Their Caretakers

Background: Type 1 diabetes (T1D), a lifelong chronic disease, demands unrelenting effort from both the affected individual and the caregiver. This perpetual responsibility can indeed become a persistent stress factor for those involved. Aim: This thesis investigates the intricate relationship between the emotional well-being of children with T1D and their caretakers, particularly focusing on diabetes-related distress and depression. Objectives: Primary: To assess the proportion of cases of diabetes-related distress and depression among the T1D cohort and their caretakers. To find whether there is an association between diabetes distress and depression among T1D and their caretakers. Secondary: To find whether there is an association between distress and depression levels with: (a) Number of hospitalizations due to diabetic ketoacidosis (DKA) or hypoglycemia, (b) The level of education among the T1D mellitus cohort and their caretakers, (c) The level of socioeconomic status among their caretakers, (d) The number of children in the family, (e) The level of use of diabetes-related technology, (f) The duration of diabetes, Cohorts: Children with T1D aged 8–12 years and their primary caretaker. Methods: Clinical data were recorded. Diabetes-related distress was assessed by Problem Areas in Diabetes-Child Version (PAID-C), Problem Areas in Diabetes-Parents of Children; Depression in children was assessed using the Center for Epidemiological Studies Depression Scale for Children, and Patient Health Questionnaire-9 administered to children and their parents respectively. Results: The study examined distress and depression levels among both children with T1D and their parents, highlighting significant correlations with various demographic and clinical factors. Among the 42 children with T1D, a significant proportion of children experienced distress (25.4%), with 33.68% exhibiting symptoms of depression. Distress levels were positively correlated with glycated hemoglobin levels and episodes of hypoglycemia. In addition, factors such as gender, socioeconomic status, and glucose monitoring methods influenced distress levels, while depression levels varied based on socioeconomic status and the number of hospitalizations due to episodes of DKA or hypoglycemia. Interestingly, it was observed that the level of distress and depression was relatively higher among the parents than the children with T1D. About 53.5% of parents of children with T1D were in distress. Furthermore, 62.3% of parents of children with T1D were found to be affected by depression. The study found significant linear relationships between children’s distress level and depression, with a correlation coefficient of 0.345. Parent’s distress level and depression also showed a significant relationship with distress level and depression, with correlation coefficients of 0.476 and 0.517, respectively. The study also found a significant linear relationship between children’s distress level and depression, with a correlation coefficient of 0.411 and 0.374, and between parents’ distress level and depression, with a correlation coefficient of 0.679. Conclusions: Dysthymic disorder (DD) and depression among the subjects with T1D as well as their caretakers are significantly high among the particular population considered. The study sheds light on the relation between DD and depression with various demographic and clinical variables. They adversely affect the glycemic control as well as overall quality of life. Hence, early identification and timely interventions through DSME and support programs should be part and parcel of routine follow-up, for reducing the risk of development or worsening of psychosocial issues.