When Kids Get Sick

Dr. Steven Cuffe guides 11-year-old Jessica Land through the software program that evaluates children for depression. Jessica was one of a number of children without diabetes used to test run the program.

When a diagnosis of diabetes enters a young person’s life, many kids adjust well to the lifestyle modifications dictated by the chronic illness and go on about the activities they enjoy. Yet others find themselves struggling with depression. Why do some children with diabetes get depressed? What factors contribute to this? A four-year study that began in 2002 will be addressing these questions and probing the complex relationship between the two illnesses.

A cooperative research effort between the University of South Carolina Arnold School of Public Health and the School of Medicine, “Exploring Diabetes and Depression in Youth” is also being conducted at the University of Colorado Health Sciences Center in Denver, Colorado. The research is serving as an ancillary study to “SEARCH for Diabetes in Youth,” an ongoing multi-site project to determine and classify cases of diabetes in children. Through the work of the University of South Carolina Arnold School of Public Health, approximately 536 children with diabetes have already been identified through the SEARCH effort in South Carolina.

Grant funding has been provided by the National Institute of Mental Health and the National Institute of Diabetes and Digestive and Kidney Diseases for the depression study, which will evaluate three ethnic groups: African American, Hispanic, and non-Hispanic whites. Youth with diabetes and a control group without diabetes between the ages of 10 and 19 will be assessed for depression, anxiety disorders, and other psychiatric problems. Few studies have been done to date with diabetes and psychiatric disorders in the pediatric population. “It’s only been relatively recently that we have begun to pay serious attention to mental health issues in children,” said Robert McKeown, Ph.D., acting chair, U.S.C. Department of Epidemiology and Biostatistics, and principal investigator of the grant.

The study will look at the numerous factors that can contribute to depression in a child with diabetes. “The stress of the illness, lifestyle changes, medical complications – all these can have an impact on the family, increasing the stress level and the risk of a mental health problem with that child,” explained Dr. Steven Cuffe, associate professor in the Department of Neuropsychiatry and Behavioral Science and co-principal investigator.

The study will be the first to examine depression in children with both type 1 and type 2 diabetes. “We used to think diabetes in children was all one type. Now we are realizing that even children can have type 2 diabetes, or hybrid or other types,” said Dr. McKeown. Dr. Cuffe addressed the additional emotional factors that can accompany type 2 diabetes. “These children tend to be overweight and there is a body image issue. A potential pre-existing depression may be in part the cause of the obesity and secondarily the diabetes. That’s part of the question: Which comes first the depression or the diabetes?” he said. Though the study will not be able to address this issue directly, it will shed light on the complex associations involved through the use of the control group without diabetes and
children with both pre-existing and newly diagnosed diabetes.

The research will delve into how depression affects children's diabetes management and glucose control, medical complications and overall quality of life. "We are going to be looking at some measures of coping, to see how diabetes affects these children and how they cope with it," said Dr. McKeown. Family and parenting issues will be explored as well. "Parents have to walk that line between helping their child manage their illness and appropriately parenting the child. A parent who is overly controlling and doesn't allow the child to develop autonomy and independence as he or she moves through childhood and adolescence may produce non-compliance by the child and a lot of increased stress," said Dr. Cuffe.

The first two years of the grant are involving data collection and diagnostic assessment of youth. The assessment began in 2003 with a computer-administered survey that guides the children and adolescents through an interview process. As the study proceeds, Dr. Cuffe and Dr. McKeown hope to gain a better understanding of the risk factors that contribute to depression in young people with diabetes and the best interventions to reduce the prevalence of depression in this group. "We are dealing with a growing problem with particular relevance in South Carolina, one that hits minority groups pretty hard. If we can get a better handle on it, we may be able to make some headway in reducing the disparities that are all too evident in South Carolina with black and white populations," said Dr. McKeown.

Dr. Cuffe is encouraged by the possibilities the results can provide for children with diabetes and their families. "Once we understand the association between diabetes and depression, we can get the children with depression into treatment. And if we can use the findings to prevent depression in the first place, that would be ideal," he said.

Reprinted from Connections newsletter, September 2003

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