Terrah Foster Akard

Background. Depression is a common comorbidity in adolescents with type 1 diabetes (T1D). It is unclear if patterns of responses from questionnaires used to screen for depressive symptoms are influenced by the burden of living with T1D and/or the consequences of hyperglycemia. Based on this gap in the adolescent research, we sought to identify potential differences in depression screening response patterns between adolescents with and without T1D and relate response patterns with glycemic outcomes. Methods. Using a retrospective case–control design, we analyzed electronic health records for age, sex, and race-matched adolescents 13–18 years of age from a pediatric diabetes clinic (n = 477) and a pediatric primary care clinic (n = 477) in the United States. Adolescents in both settings were screened for depressive symptoms during the same time period using the Patient Health Questionnaire-9 (PHQ-9). Results. Participant demographics for matched characteristics were: 53.5% male, 71.7% White, median age 13.0 (interquartile range = 13.0, 14.0). After controlling for type of insurance, adolescents with T1D were more likely to have higher total PHQ-9 scores (odds ratio (OR) = 1.51, 95% CI = 1.17, 1.98, p = 0.002 ) and higher somatic subscores (OR = 1.57, 95% CI = 1.20, 2.05, p = 0.001 ) compared to the primary care sample. The pattern of item endorsement greater than “not at all” indicated that adolescents with T1D were more likely to have higher values for somatic items such as “trouble falling asleep” and “feeling tired” than those in the primary care sample. Item-total correlations and Cronbach’s α indicated that all items were contributing to the overall score in the same manner in each group. Conclusions. Symptom endorsement for sleep and fatigue were higher for adolescents with T1D and without T1D. Study results support the need for further examination of the origins of somatic symptoms in T1D and for an additional examination of the specificity of depression screening instruments used in routine pediatric diabetes care.

Background: Family factors, such as household income and parental psychosocial distress, have been associated with quality of life in children with cancer. However, relationships between parent anxiety and child health-related quality of life (HRQoL) have not been evaluated in children with advanced cancer. Objective: To examine relationships between parent anxiety and both parent-reported and child self-reported HRQoL for children with advanced cancer. Method: Children (aged 5–17 years) with relapsed or refractory cancer and their parents participated in this single-institution cross-sectional study. Parents completed measures of their own baseline anxiety (State-Trait Anxiety Inventory–Trait [STAI-T] form) and their ill child's HRQoL (PedsQL Generic and PedsQL Cancer, parent report). Children completed age-specific PedsQL Generic and PedsQL Cancer, child report. Spearman's rho coefficients assessed correlations between total parent STAI-T score and both parent-reported and child-reported HRQoL scales. Results: Twenty children ( M age = 9.5 years, 50% female) and their 20 parents (90% mothers) participated. The strongest and statistically significant ( p < .05) correlations were inverse associations between parental trait anxiety and parent-reported child psychosocial HRQoL ( r s = −.54), emotional functioning ( r s = −.49), school functioning ( r s = −.45), and child pain and hurt ( r s = −.45). Correlations of parental anxiety with all dimensions of child-reported HRQoL were generally smaller ( r s < .40), positive, and not statistically significant ( p > .05). Discussion: Given the inverse correlations between parental anxiety and child psychosocial HRQoL, assessment of parent mental health needs and access to interventions should be provided routinely for parents of children with advanced cancer.