Journal Article

Comprehensive psychosocial screening in a pediatric diabetes clinic

Sanchez, Janine, Delamater, Alan M., Davis, Eileen M., Lynn, Courtney, Starr‐Glass, Lolly, Brodar, Kaitlyn E., Lui, Joyce H. L.

2021

Overview

Objective The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center. Research Design and Methods Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non‐adherence and glycemic control (measured by A1c). Results Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non‐adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non‐adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non‐adherence. Eighty‐three percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented. Conclusions Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.

• Publisher: John Wiley & Sons A/S,John Wiley & Sons, Inc
• Subject: adherence / Adolescent / Adolescent Health Services / Adolescents / Ambulatory Care Facilities / Blood Glucose / Diabetes / Diabetes mellitus (insulin dependent) / Diabetes Mellitus, Type 1 - blood / Diabetes Mellitus, Type 1 - psychology / Diabetes Mellitus, Type 1 - therapy / Female / Glucose monitoring / glycemic control / Humans / Hypoglycemic Agents - therapeutic use / Insulin / Insulin - therapeutic use / Male / Mass Screening / Medication Adherence / Mental Disorders - diagnosis / Mental Disorders - epidemiology / Mental Disorders - psychology / Motivation / Pediatrics / psychosocial / Suicide / Teenagers / type 1 diabetes