Paola M. Rivera-Arroyo, HSDG, Sebastián A. Quintana-Rodríguez, HSDG,

& Eduardo Cumba-Avilés, PhD

Institute for Psychological Research, College of Social Sciences, University of Puerto Rico, Río Piedras Campus, San Juan, Puerto Rico

INTRODUCTION: Adolescents with type 1 diabetes (T1D) have higher depression rates than their non-T1D peers. Among depressed youth with T1D, those with comorbid psychiatric diagnoses may be at higher risk for psychosocial and diabetes-related difficulties. However, no study has examined this issue in a sample from Puerto Rico. We examined the psychosocial and diabetes-related outcomes of depressed T1D adolescents with (n=25) and without (n=26) psychiatric comorbidity.

METHODS: Participants were 51 youth (aged 12-17) enrolled in a depression treatment study. They completed the Major Depression module of the Diagnostic Interview Schedule for Children-IV, the MINI International Neuropsychiatric Interview-Kid version 6.0, and several questionnaires during their baseline assessment. Their caregivers completed questionnaires about youths’ health, family functioning, and other areas. We used t-tests, MANOVA, ANOVAs, and Chi-square tests to examine group differences (p≤.05) in sociodemographic and continuous and categorical outcome variables.

RESULTS: As expected, adolescents with psychiatric comorbidity (G1) were significantly older. However, both groups were similar in age of onset of depression and T1D. Following a significant MANOVA, individual ANOVAs showed that youth in G1 obtained higher scores in self-reported depression, suicidal ideation, depression-related cognitive alterations, self-esteem/guilt problems, and worries about T1D than those from G2. Their caregivers reported higher scores for their offspring in somatic complaints, rule-breaking behavior, and anhedonia but lower scores in diabetes-related family guidance. Clinical evaluators reported lower global functioning scores for G1. When examining categorical variables, G1 members had a significantly higher rate of lifetime suicide attempts, alcohol or other substance use, and enrollment in psychotherapy/counseling services, but a lower rate of glycemic control.

CONCLUSION: Our findings support the claim that adolescents with T1D and depression who present psychiatric comorbidity have significantly greater psychosocial and diabetes-related challenges than similar youths with no comorbidity. Psychotherapies for depressed T1D adolescents must consider psychiatric comorbidity to optimize clinical outcomes.

IRB APPROVAL NUMBER: 1112-005 (UPR Río Piedras)

ACKNOWLEDGEMENTS: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (under Award Number R03DK092547).

KEYWORDS: adolescents, depression, Hispanics, psychiatric comorbidity, type 1 diabetes