Psychosocial Burden During the COVID-19 Pandemic in Adolescents With Type 1 Diabetes in Germany and Its Association With Metabolic Control

Clemens Kamrath; Sascha R Tittel; Gebhard Buchal; Susanne Brämswig; Eva Preiss; Julia M Göldel; Susanna Wiegand; Kirsten Minden; Petra Warschburger; Anna Stahl-Pehe; Reinhard W Holl; Stefanie Lanzinger

doi:10.1016/j.jadohealth.2023.12.004

Psychosocial Burden During the COVID-19 Pandemic in Adolescents With Type 1 Diabetes in Germany and Its Association With Metabolic Control

J Adolesc Health. 2024 May;74(5):900-907. doi: 10.1016/j.jadohealth.2023.12.004. Epub 2024 Feb 5.

Authors

Affiliations

¹ Department of General Pediatrics and Neonatology, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany. Electronic address: clemens.kamrath@paediat.med.uni-giessen.de.
² German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany.
³ DRK Children's Hospital Siegen, Siegen, Germany.
⁴ RoMed Children's Hospital Rosenheim, Rosenheim, Germany.
⁵ Divison of Pediatric Diabetology, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany.
⁶ Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany.
⁷ Department of Pediatric Endocrinology and Diabetology, Center for Social-Pediatric Care, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt- Universität zu Berlin, Berlin, Germany.
⁸ German Rheumatism Research Center (DRFZ), Program Area Epidemiology, Berlin, Germany; Department of Pediatric Respiratory Medicine, German Charité University Medicine Berlin, corporate member of Freie Universität Berlin und Humboldt- Universität zu Berlin, Immunology and Critical Care Medicine at Charité University Hospital Berlin, Berlin, Germany.
⁹ German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

PMID: 38323968
DOI: 10.1016/j.jadohealth.2023.12.004

Abstract

Purpose: To investigate the psychosocial burden during the COVID-19 pandemic in adolescents with type 1 diabetes and its association with metabolic control.

Methods: Prospective multicenter observational cohort study based on data from the German Diabetes Prospective Follow-up Registry. Adolescents aged 12-20 years with type 1 diabetes were asked during routine follow-up visits to complete a questionnaire on psychosocial distress and daily use of electronic media during the COVID-19 pandemic from June 2021 to November 2022. Well-being, anxiety, and depression symptoms were assessed using World Health Organization Five Well-Being Index (WHO-5), General Anxiety Disorder scale 7 (GAD-7), and Patient Health Questionnaire-9 questionnaires. The impact of mental health symptoms on metabolic control was analyzed by using multivariable linear regression models adjusted for sex, diabetes duration, treatment, socioeconomic deprivation, and immigrant background.

Results: Six hundred eighty eight adolescents (45.6% females) from 20 diabetes centers participated. Compared with a prepandemic cohort, WHO-5 scores were lower during the COVID-19 pandemic (estimated mean difference -9.6 [95% confidence interval -11.6; -7.6], p < .001), but GAD-7 scores were not different (estimated mean difference 0.6 [95% confidence interval -0.2; 1.5], p = .14). HbA_1c was significantly positively associated with GAD-7 and Patient Health Questionnaire-9 and negatively associated with WHO-5 scores (all p < .001). Daily electronic media use was positively associated with adjusted mental health symptoms (all p < .01).

Discussion: Although the overall well-being of adolescents with type 1 diabetes was reduced during the later phase of the COVID-19 pandemic, the additional psychological burden was relatively low. However, mental health symptoms were associated with poorer metabolic control and higher use of electronic media.

Keywords: Anxiety; Chronic disease; Depression; Mental health; Pandemic; Type 1 diabetes; Well-being.

Publication types

Observational Study
Multicenter Study

MeSH terms

Adolescent
Anxiety / epidemiology
Anxiety Disorders*
COVID-19*
Depression / epidemiology
Diabetes Mellitus, Type 1*
Female
Germany / epidemiology
Humans
Male
Pandemics
Prospective Studies

Supplementary concepts

general anxiety disorder