Depression and diabetes in children and adolescents.
OBJECTIVE
Diabetes and depression are each public health concerns. They frequently co-occur, compounding complications of each disease. This review provides recent information regarding the mechanisms of association between the disorders and the availability and effectiveness of interventions for youth with diabetes who are depressed. Implications for primary care physicians are considered, particularly in relation to recognition of depression, and also to preventive strategies that increase the patient's self-efficacy (evidence-based confidence in his/her ability to manage diabetes) and serve as protective factors in the development of depression.


RESULTS
Depressive symptoms are strongly associated with diabetes complications. To date, no studies have tested effectiveness of interventions with depressed youth with diabetes. Clinical trials with adults have shown the effectiveness of pharmacotherapy, but those with more complications show the least improvement, and health gains do not persist. In the absence of other data, these findings suggest that it would be prudent to identify and treat comorbid depression in children with diabetes early in the course of their illness, before medical complications develop.


CONCLUSIONS
Primary care physicians are in an important position to recognize early signs of depression in youth with diabetes and refer them for treatment. Furthermore, the literature provides numerous strategies that can be employed by primary care doctors that may enhance diabetes management as well as protect against depression.
Stewart
Sunita M
SM
Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390, USA. sunita.stewart@utsouthwestern.edu
Rao
Uma
U
White
Perrin
P
D000293:Adolescent; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000523:psychology*; D006801:Humans; D011320:Primary Health Care