title: Mental health problems among adolescents with early-onset and long-duration type 1 diabetes and their association with quality of life: a population-based survey.
abstract: OBJECTIVE
  To evaluate mental health problems and associations between mental health problems and health-related quality of life in adolescents with type 1 diabetes in comparison with the general population.
  
  
  METHODS
  A total of 629 11- to 17-year-olds with early-onset and long-lasting type 1 diabetes and their parents completed comprehensive questionnaires. Mental health was assessed using the parent- and self-report versions of the Strengths and Difficulties Questionnaire (SDQ). The Revised Children's Quality of Life Questionnaire (KINDL-R) was used to measure quality of life. The comparison group (n = 6,813) was a representative sample from the German KiGGS study.
  
  
  RESULTS
  The proportion of youths with mental health problems (defined as abnormal SDQ total difficulties score) was, based on self-reports, 4.4% in the patient group and 2.9% in the general population (adjusted OR = 1.61, p = 0.044); and based on proxy reports, 7.9% in the patient group and 7.2% in the general population (OR = 1.05, p = 0.788). Youths with type 1 diabetes and self-reported mental health problems scored worse in the KINDL-R subscales of physical well-being (adjusted average difference β = -16.74, p<0.001) and family (β = -11.09, p = 0.017), and in the KINDL-R total score (β = -8.09, p<0.001), than peers with self-reported mental health problems. The quality of life of diabetic adolescents and proxy-reported mental health problems did not differ from peers with proxy-reported mental health problems adjusted for confounders.
  
  
  CONCLUSIONS
  Compared with the general population with mental health problems, the quality of life of adolescents with type 1 diabetes who report mental health problems is more severely impaired. This observation calls for early prevention and intervention as part of pediatric diabetes long-term care.
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Stahl-Pehe
authors.affiliation: Medical Psychology Unit, Hannover Medical School, Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Lange
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bächle
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Katty
authors.initials: K
authors.lastname: Castillo
authors.affiliation: Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires