title: Trajectories of depression in adults with newly diagnosed type 1 diabetes: results from the German Multicenter Diabetes Cohort Study.
abstract: There is a paucity of longitudinal data on type 1 diabetes and depression, especially in adults. The present study prospectively analysed trajectories of depressive symptoms in adults during the first 5 years of living with type 1 diabetes. We aimed to identify distinct trajectories of depressive symptoms and to examine how they affect diabetes outcome.
  
  
  
  We reanalysed data from a prospective multicentre observational cohort study including 313 adults with newly diagnosed type 1 diabetes. At baseline and in annual postal surveys over 5 consecutive years, we gathered patient characteristics and behavioural and psychosocial data (e.g. Symptom Checklist-90-R [SCL-90-R]). Medical data (e.g. HbA1clevels) was obtained from the treating physicians. We applied growth mixture modelling (GMM) to identify distinct trajectories of depression over time.
  
  
  
  Five years after diagnosis, 7.8% (n = 20) of patients were moderately depressed and 10.2% (n = 26) were severely depressed. GMM statistics identified three possible models of trajectories (class 1, 'no depressive symptoms'; class 2, 'worsening depressive symptoms that improve after 2 years'; class 3, 'worsening depressive symptoms'). Severity of depression symptoms at baseline (subscale of the SCL-90-R questionnaire) significantly predicted membership of classes 2 and 3 vs class 1. After 5 years, higher HbA1cvalues were detected in class 3 patients (mean = 8.2%, 66 mmol/mol) compared with class 1 and class 2 (both: mean = 7.2%, 55 mmol/mol).
  
  
  
  We identified distinct trajectories of depressive symptoms that are also relevant for diabetes outcome. Patients with worsening depressive symptoms over time exhibited poor glycaemic control after the first 5 years of living with diabetes. They also exhibited a reduced quality of life and increased diabetes-related distress.
authors: Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany. hanna.kampling@uniklinik-freiburg.de.
authors: Hanna
authors: H
authors: Kampling
authors: Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Bochum, Germany.|Center for Psychotherapy Wiesbaden, Wiesbaden, Germany.
authors: Frank
authors: F
authors: Petrak
authors: Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany.
authors: Erik
authors: E
authors: Farin
authors: Diabetes Center Mergentheim, Germany; Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany.|Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
authors: Bernd
authors: B
authors: Kulzer
authors: Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum - Ruhr-University Bochum, Bochum, Germany.
authors: Stephan
authors: S
authors: Herpertz
authors: Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 49, 79106, Freiburg, Germany.
authors: Oskar
authors: O
authors: Mittag
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin
keywords: Adults; Depression; Growth mixture modelling; Longitudinal data; Onset cohort; Psychological outcomes; Type 1 diabetes