Mental health outcomes in adolescents and emerging adults with diabetes
Bibliographic record
Abstract
Background: The prevalence of type 1 diabetes (T1D) is increasing, thereby leading to an increasing number of adolescents with T1D transferring from paediatric to adult care. During this crucial transition period, the adolescent with T1D faces emotional, occupational, social, and financial changes which may increase his/her risk of mental health disorders. First, we aimed to study the risk of mental health outcomes in adolescents and emerging adults with diabetes in comparison to that of their peers without diabetes. Second, we aimed to explore if delays in establishing adult diabetes care following transition from paediatric care among adolescents and emerging adults with diabetes confer an increased risk of mental health outcomes. Methods: We conducted a retrospective cohort study of adolescents and emerging adults with and without diabetes living in Québec, Canada using data between April 1, 1997, and March 31, 2015, from the Québec Integrated Chronic Disease Surveillance System (QICDSS) maintained at the Institut National de Santé Publique du Québec (INSPQ). To address the first aim, all individuals with diabetes ages 1 to 15 years between April 1, 1997, and December 31, 2013, were identified and formed the exposed group. All individuals in the same age range (1-15 years) who did not have diabetes during the study period (1997-2015) were identified and formed the unexposed group. Exposed and unexposed individuals were enrolled at age 15 years and were followed up until age 25 years, March 31, 2015, death, or migration from the province, whichever came first. Multivariate Cox proportional hazard models were used to compare time to mental health outcomes among individuals with diabetes compared to those without.To address the second aim, individuals with diabetes, 15 to 25 years old, who had an adult visit for diabetes following their last paediatric diabetes-related visit were retained. Those who had a gap in establishing adult care greater than 180 days formed the exposed group and those who did not have such a gap formed the unexposed group. Exposed and unexposed individuals were followed from the transition date (180th day following the last paediatric visit for diabetes) until age 25 years, March 31, 2015, death, or migration from the province, whichever came first. Multivariate Cox proportional hazard models were used to compare time to mental health outcomes among individuals with versus without a gap in establishing adult care. Results: For the first aim, we identified 3,544 individuals with diabetes diagnosed between ages 1 to 15 years and 1,388,397 individuals without diabetes. After adjusting for material deprivation, social deprivation, sex, rural residency and year of birth, adolescents and emerging adults with diabetes were 33% more likely to experience a severe mood disorder (adjusted hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.19-1.50), 325% more likely to be hospitalized for a suicide attempt (HR 3.25, 95% CI 1.79-5.88), 82% more likely to visit a psychiatrist at least once (HR 1.82, 95% CI 1.67-1.98) and 29% more likely to have any psychiatric disorder (HR 1.29, 95% CI 1.21-1.37), compared to their peers without diabetes. For the second aim, we identified 741/1,772 (41.8%) adolescents with diabetes who had a gap in establishing adult care and 1,031/1,772 (58.2%) adolescents who did not have such a gap. In multivariate Cox regression models, a gap in establishing adult diabetes care was not associated with any of the mental health outcomes. Conclusions: We found an increased risk of mental health outcomes in adolescents and emerging adults with diabetes compared to their peers without diabetes. This increase risk may arise from the developmental challenges faced by the emerging adult with a chronic disease, rather than the continuity of care received during the transfer to adult care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".