Dr Naomi Hackwortha, Professor Susan Moorea, Associate Professor Fergus Cameronb, Associate Professor Elisabeth Northamc
a Faculty of Life & Social Sciences, Swinburne University of Technology
b Department of Endocrinology & Diabetes, The Royal Children’s Hospital
c Department of Psychology, The Royal Children’s Hospital
Beyond Blue Victorian Centre of Excellence
Project completion year
There is growing evidence to support strong links between Type 1 diabetes and poor psychological health, such as depression and anxiety. Preliminary evidence suggested that regional youth with Type 1 diabetes potentially face poorer mental health outcomes than their urban counterparts.
The study examined the relationship between disease concerns and depression, anxiety, quality of life and the availability of social support. Comparisons were made between levels reported among participants living in rural and urban areas.
Data collection comprised interviews, online focus groups and questionnaires to ascertain self-reported concerns from participants about their disease, their levels of depression and anxiety related to the disease, their quality of life and their levels of social support.
The study attracted 123 volunteer adolescents and young adults with Type 1 diabetes (50 males and 73 females aged 13 to 25). Of the participants, 73 lived in rural or regional Victoria and 50 in urban settings. Parents of participants who were under the age of 18 were also invited to participate, and 76 did so.
Findings were to be used to develop a website to educate and support adolescents with diabetes living in rural areas.
The study found that rural and urban participants did not differ on general health rating, community engagement, diabetes self-efficacy, risk behaviour, risk perception, negative mood, quality of life judgments, perceived support or diabetes self-care. Parents were more likely than adolescents to perceive living in rural locations as a disadvantage with both groups citing isolation from specialist services and peers, emergency care and information as concerns.
Adolescents reported a lack of understanding from their peers and frustration at ongoing disease management, and worry about life-threatening health complications. A quantitative analysis indicated that adolescents with diabetes had an increased risk of developing depression or anxiety, regardless of where they lived. However, self-management of diabetes was higher among participants with lower levels of negative effect, higher community engagement and lower levels of risk engagement.
The study found behavioural differences between males and females, with males showing higher self-efficacy and less worry, but also higher levels of risk-taking behaviour than females.
Parents of adolescent patients with improved metabolic control rated their children’s psychological and physical well-being, and quality of life higher than parents of adolescent patients without improved diabetes management.
Implications for policy, practice and further research
Health professionals treating adolescents with diabetes should be aware of the likely presence of depression or other mental health issues and monitor for signs. There is an urgent need for a preventative treatment or tool to target depression, anxiety, risk-taking and avoiding social contact, which will reduce the likelihood of psychological problems and in turn increase the likelihood of adequate disease management. However, any such intervention must be suitably engaging for young people, and an online method seems suitable – especially when attempting to reach young people in geographically remote areas.