Depression and distress in pediatric type 1 diabetes: a Latin American multicenter study

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OBJECTIVE: To determine (1) the prevalence of depressive symptoms and diabetes-related distress and (2) the association between their combined presence and metabolic outcomes in Latin American children with type 1 diabetes mellitus (T1DM). METHODS: This cross-sectional study included children with T1DM of> 1 year's duration from 10 diabetes centers in Argentina and Chile. Age, sex, socioeconomic status (SES), and HbA1c were evaluated. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; range 0-60; depression ≥16) and diabetes distress using the Problem Areas in Diabetes (PAID; range 0-80; distress ≥40). Spearman correlation, Phi coefficient, and multivariable logistic regression were used for statistical analysis. RESULTS: Among 244 children (50% female), median age was 13.4 years (IQR 11.3-15.0), and median HbA1c was 8.3% (IQR 7.2-9.5). Depressive symptoms were present in 52% of participants and diabetes-distress in 26.6%. The agreement between CES-D and PAID categorical thresholds was fair (Phi = 0.39). The Both-1 group (n = 55; 22.5%) (high CES-D and PAID ) showed an inverse Spearman correlation with SES (r = -0.32, p < 0.01) and a positive correlation with HbA1c (r = 0.30, p < 0.01). In multivariable logistic regression, higher HbA1c (OR 1.34; 95% CI 1.1-1.6) and lower SES (OR 0.36; 95% CI 0.2-0.6) were independently associated with the Both-1 group (high CES-D and PAID), adjusted for age, sex, and BMI. CONCLUSION: In Latin American children with T1DM, the combined presence of depressive symptoms and diabetes-related distress was associated with poorer metabolic control and lower SES.

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