title: Prevalence and associations of psychological distress in young adults with Type 1 diabetes.
abstract: OBJECTIVE
  To determine the prevalence of psychological distress in young adults with Type 1 diabetes and to explore associated factors.
  
  
  METHODS
  Ninety-two participants with Type 1 diabetes (46 male, 46 female) attending a young adult clinic completed two psychological self-report assessments; the Centre for Epidemiological Studies-Depression Scale (CES-D) and Adult Self-Report Scale (ASR). The mean age was 21.6 +/- 2.8 years (sd) and mean duration of diabetes was 9.3 +/- 5.4 years. A questionnaire identified the method of insulin delivery, the frequency of blood glucose monitoring and hypoglycaemia requiring third-party assistance. HbA(1c) was measured.
  
  
  RESULTS
  Of the participants, 35.2% reported depressive symptoms (CES-D > or = 16), 23.1% indicating severe depressive symptoms (CES-D > or = 24), and 32.2, 40.4 and 35.5% of participants reported significant distress (ASR > or = 60) on the ASR total problem scales, ASR internalizing and ASR externalizing scores, respectively. Mean HbA(1c) levels were higher in participants with depressive symptoms compared with those with normal scores (CES-D > or = 16, HbA(1c)= 9.4% vs. CES-D < 16, HbA(1c)= 8.4%, P = 0.01). Factors associated with psychological distress included use of continuous subcutaneous insulin infusion (CSII) (P = 0.02) and increased frequency of hypoglycaemic episodes (P = 0.03). CSII users had higher CES-D (21.3 vs. 11.9, P = 0.001) and ASR-Total (59.7 vs. 53.0, P = 0.02) scores than non-CSII users.
  
  
  CONCLUSIONS
  Approximately one-third of young adults with Type 1 diabetes experience psychological distress, which is associated with poorer glycaemic control. Psychological distress was related to frequency of hypoglycaemic episodes and method of insulin administration, with significantly greater distress being observed in those using CSII. These findings support inclusion of a psychologist in the diabetes team.
authors.affiliation: Diabetes Education Unit, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: A L
authors.initials: AL
authors.lastname: Hislop
authors.forename: P G
authors.initials: PG
authors.lastname: Fegan
authors.forename: M J
authors.initials: MJ
authors.lastname: Schlaeppi
authors.forename: M
authors.initials: M
authors.lastname: Duck
authors.forename: B B
authors.initials: BB
authors.lastname: Yeap
mesh_terms: D000328:Adult; D003863:Depression / Q000209:etiology; D003866:Depressive Disorder / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems; D008297:Male; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin