title: Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up.
abstract: OBJECTIVE
  To determine the incidence of and risk factors for psychiatric disorders in early adulthood in patients with childhood onset type 1 diabetes (T1D).
  
  
  METHODS
  In this retrospective-cohort study, we identified a population-based childhood onset T1D cohort and an age and sex matched (5:1) non-diabetic comparison cohort. Data linkage was used to access inpatient hospitalization data, mental health support service data, and mortality data to follow-up both cohorts into early adulthood.
  
  
  RESULTS
  The mean age of T1D diagnosis was 9.5 years (SD 4.1), with a mean age at end of follow-up of 26.4 years (SD 5.2, max 37.7). The diagnosis of any psychiatric disorder was observed for 187 of 1302 (14.3%) in the T1D cohort and 400 of 6422 (6.2%) in the comparison cohort [adjusted hazard ratio (HR) 2.3; 95% CI 1.9, 2.7]. Anxiety, eating, mood, and personality and behaviour disorders were observed at higher rates within the T1D cohort. Comorbid psychiatric disorders were more frequent, at the cohort level, within the T1D cohort (2-3 disorders 3.76% vs 1.56%) and service utilization was higher (15+ contacts 6.8% vs 2.8%); though these differences did not remain when restricted to only those individuals diagnosed during follow-up. A history of poor glycaemic control was associated with an increased risk of anxiety, mood, and 'any' disorder (HR ranging from 1.35 to 1.42 for each 1% increase in mean paediatric HbA1c).
  
  
  CONCLUSIONS
  Our findings highlight the need for access to mental health support services as part of routine patient care for young adults with T1D, and for better predictive tools to facilitate targeting at-risk patients with early intervention programs.
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia.
authors.forename: M N
authors.initials: MN
authors.lastname: Cooper
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Lin
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Alvares
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia.|The School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.
authors.forename: N H
authors.initials: NH
authors.lastname: de Klerk
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia.|The School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.|Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.
authors.forename: T W
authors.initials: TW
authors.lastname: Jones
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia.|The School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.|Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia.
authors.forename: E A
authors.initials: EA
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology / Q000401:mortality / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology / Q000628:therapy; D057286:Electronic Health Records; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000401:mortality / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D019964:Mood Disorders / Q000453:epidemiology / Q000401:mortality / Q000523:psychology; D009026:Mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014904:Western Australia / Q000453:epidemiology
keywords: mental health; morbidity; psychiatric disorders; risk factors; type 1 diabetes