Psychological screening in adolescents with Type 1 diabetes

Abstract

Type 1 diabetes is one of the more prevalent chronic illnesses in the paediatric population, with child and adolescent prevalence in New Zealand being recently estimated at 227 per 100,000. Along with the developmental tasks and challenges of adolescence, the added complication of Type 1 diabetes can place further stress on these young people. Associations with psychological problems such as depression, anxiety and eating disorders have been reported in the literature. The current study was developed through consultation with staff of the Starship Paediatric Diabetes Service, Auckland District Health Board, who were interested in developing a psychological screening tool for use with their adolescent clients and their parents. Ultimately, they hoped to be further equipped to identify those adolescents who may benefit from a referral for a full mental health assessment, particularly in the areas of internalising disorders and eating difficulties. In addition, the service was interested in gaining an understanding of the psychological status of their population, for future planning and service development. One hundred and twelve young people between the ages of 11 and 17 years and 107 of their parents completed a battery comprising of demographic and health information, The Strengths and Difficulties Questionnaire, The Brief Illness Perception Questionnaire, The Paediatric Quality of Life Inventory (Type 1 Diabetes Module), The Eating Attitudes Test-26 and two open-ended questions measuring the areas and degree of worry and help in the adolescents’ lives. Analysis revealed that approximately one in 25 adolescents met the clinical criteria on a measure of overall psychological difficulty and these numbers were seen to double on parent report. There were a number of specific areas of concern identified in adolescents of different demographic groups, particularly in females, older adolescents and adolescents of ethnic minorities. Key differences were also observed in the responses of adolescents and their parents. Following reliability and validity analysis, a screening tool was proposed that comprised the Strengths and Difficulties Questionnaire and an adapted Eating Attitudes Test-26 more suitable for use with adolescents with Type 1 diabetes. The proposed screening tool was found to identify a further seven adolescents on self-report and eight adolescents on parent-report that would not have been identified by previous staff consultation methods. Relevant considerations are discussed, including the usefulness of different versions of the proposed screening tool and practical guidelines. The role of additional measures and methods in psychological screening are outlined and recommendations for the implementation of the proposed screening tool are made. Methodological limitations are outlined and areas for future research are proposed. The study used an action research model, in that all areas of the process were strongly driven by the needs of the service.