Angst und Depression bei Typ-1-Diabetes – Erste Ergebnisse des Screenings auf psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen im Rahmen des COACH-Konsortiums

Zusammenfassung

Die interdisziplinäre Forschungskooperation COACH-Konsortium (Chronic Conditions in Adolescents – Implementation and Evaluation of Patient-centered Collaborative Healthcare) untersucht die psychosoziale Situation von Jugendlichen und jungen Erwachsenen mit chronischen körperlichen Erkrankungen. Zur Untersuchung der psychischen Komorbidität wurden bisher 1.023 Patienten mit Diabetes mellitus Typ 1 im Alter von 12–21 Jahren bei Routinevorstellungen in der Klinik bzw. Ambulanz mittels der Screening-Fragebogen Patient Health Questionnaire (PHQ-9) und Generalized Anxiety Disorder Scale-7 (GAD-7) zu Angst- und Depressionssymptomen befragt. 29,8 % der Jugendlichen und jungen Erwachsenen zeigten ein auffälliges Screening-Ergebnis. Dabei wurden 17,8 % der Fragebogen zu Angstsymptomen und 25,6 % der Fragebogen zu Depressionssymptomen auffällig mit Gesamtscore-Werten ≥ 7 in GAD-7 bzw. PHQ-9 beantwortet. Patienten mit erhöhten Depressions- und Angstwerten wiesen im Mittel einen deutlich höheren medianen HbA_1c-Wert als Zeichen einer schlechteren Stoffwechseleinstellung auf (8,33 [8,09; 8,56]) als Patienten mit unauffälligem Screening (7,58 [7,48; 7,68]; p < 0,0001). Angesichts der hohen Prävalenz auffälliger Depressions- und Angstwerte und der Assoziation mit höheren HbA_1c-Werten sollte bei allen Jugendlichen mit Diabetes mellitus Typ 1 regelmäßig das Vorliegen psychischer Belastungen abgeklärt werden. Dies könnte eine frühzeitige Diagnose einer psychischen Komorbidität und Intervention ermöglichen. Auf der Basis der Studien im COACH-Projekt können nun evidenzbasierte Empfehlungen für die interdisziplinäre Gesundheitsversorgung von Jugendlichen mit chronischen körperlichen Erkrankungen erstellt werden, die die psychischen Komorbiditäten systematisch berücksichtigen.

Abstract

The multi-center collaborative COACH consortium (Chronic Conditions in Adolescents – Implementation and Evaluation of Patient-centered Collaborative Healthcare) aims to examine mental health comorbidities in adolescents and young adults with chronic diseases. 1023 patients with type 1 diabetes at the age of 12 to 21 years were screened for symptoms of anxiety using the Generalized Anxiety Disorder Scale (GAD-7) and depression using the Patient Health Questionnaire (PHQ-9) during routine visits. Almost every third patient showed a positive screening test result. 17.8 % of screenings for anxiety and 25.6 % of screenings for depression were pathological with screening results ≥ 7, respectively. In these patients with positive screenings, glycated hemoglobin (HbA_1c), reflecting the adjustment and control of blood glucose, was higher than in those with negative screenings (p < 0.0001). As early diagnosis and intervention have relevant impact for treatment of the somatic disease all adolescents with type 1 diabetes should be regularly screened for mental comorbidities. Based on the COACH study results evidence-based recommendations for treatments of adolescents and young adults with chronic diseases will be developed so that mental health problems will be better taken into account in the future.

Schlüsselwörter

Angst - Depression - Screening - Jugendliche - Diabetes mellitus Typ 1 - psychische Komorbidität

Key words

anxiety - depression - mental health comorbidities - screening - adolescents - type 1 diabetes

Publication History

Received: 27 May 2021

Accepted: 16 August 2021

Article published online:
06 October 2021

• Literatur

• 1 Geirhos A, Domhardt M, Galler A. et al. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. Diabetologie und Stoffwechsel 2020; 15 DOI: 10.1055/a-1264-6590.
• 2 Pinquart M, Shen Y. Anxiety in children and adolescents with chronic physical illnesses: a meta-analysis. Acta Paediatr 2011; 100: 1069-1076 DOI: 10.1111/j.1651-2227.2011.02223.x.
• 3 Sengler C, Niewerth M, Holl RW. et al. Psychische Komorbidität bei der juvenilen idiopathischen Arthritis. Arthritis und Rheuma 2019; 39: 46-53 DOI: 10.1055/a-0838-4301.
• 4 Northam EA, Matthews LK, Anderson PJ. et al. Psychiatric morbidity and health outcome in Type 1 diabetes--perspectives from a prospective longitudinal study. Diabet Med 2005; 22: 152-157 DOI: 10.1111/j.1464-5491.2004.01370.x.
• 5 ADA. Standards of Medical Care in Diabetes-2020 Abridged for Primary Care Providers. Clin Diabetes 2020; 38: 10-38 DOI: 10.2337/cd20-as01.
• 6 Scheuing N, Bartus B, Berger G. et al. Clinical characteristics and outcome of 467 patients with a clinically recognized eating disorder identified among 52,215 patients with type 1 diabetes: a multicenter german/austrian study. Diabetes Care 2014; 37: 1581-1589 DOI: 10.2337/dc13-2156.
• 7 Warschburger P. Chronisch kranke Kinder und Jugendliche. Psychosoziale Belastungen und Bewältigungsanforderungen. 1. Aufl.. Göttingen: Hogrefe Verlag; 2000
• 8 Galler A, Tittel SR, Baumeister H. et al. Worse glycemic control, higher rates of diabetic ketoacidosis, and more hospitalizations in children, adolescents, and young adults with type 1 diabetes and anxiety disorders. Pediatr Diabetes 2021; 22: 519-528 DOI: 10.1111/pedi.13177.
• 9 Plener PL, Molz E, Berger G. et al. Depression, metabolic control, and antidepressant medication in young patients with type 1 diabetes. Pediatr Diabetes 2015; 16: 58-66 DOI: 10.1111/pedi.12130.
• 10 Delamater AM, de Wit M, McDarby V. et al. ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 (Suppl. 27) 237-249 DOI: 10.1111/pedi.12736.
• 11 Otto C, Petermann F, Barkmann C. et al. Risiko- und Schutzfaktoren generalisierter Ängstlichkeit im Kindes- und Jugendalter. Kindheit und Entwicklung 2016; 25: 21-30 DOI: 10.1026/0942-5403/a000185.
• 12 Stahl-Pehe A, Glaubitz L, Bächle C. et al. Diabetes distress in young adults with early-onset Type 1 diabetes and its prospective relationship with HbA(1c) and health status. Diabet Med 2019; 36: 836-846 DOI: 10.1111/dme.13931.
• 13 Ravens-Sieberer U, Wille N, Erhart M. et al. Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey. Eur Child Adolesc Psychiatry 2008; 17 (Suppl. 01) 22-33 DOI: 10.1007/s00787-008-1003-2.
• 14 Buchberger B, Huppertz H, Krabbe L. et al. Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology 2016; 70: 70-84 DOI: 10.1016/j.psyneuen.2016.04.019.
• 15 Hapke U, Cohrdes C, Nübel J. Depressive Symptomatik im europäischen Vergleich – Ergebnisse des European Health Interview Survey (EHIS) 2. 2019. DOI: 10.25646/6221
• 16 Klasen F, Otto C, Kriston L. et al. Risk and protective factors for the development of depressive symptoms in children and adolescents: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 2015; 24: 695-703 DOI: 10.1007/s00787-014-0637-5.
• 17 Plener PL, Munz LM, Allroggen M. et al. Immigration as risk factor for non-suicidal self-injury and suicide attempts in adolescents in Germany. Child Adolesc Psychiatry Ment Health 2015; 9: 34 DOI: 10.1186/s13034-015-0065-4.
• 18 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613 DOI: 10.1046/j.1525-1497.2001.016009606.x.
• 19 Spitzer RL, Kroenke K, Williams JB. et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092-1097 DOI: 10.1001/archinte.166.10.1092.
• 20 IDF AEI. Consensus statement on the worldwide standardisation of the HbA_1c measurement. Diabetologia 2007; 50: 2042-2043 DOI: 10.1007/s00125-007-0789-7.
• 21 Rosenbauer J, Dost A, Karges B. et al. Improved metabolic control in children and adolescents with type 1 diabetes: a trend analysis using prospective multicenter data from Germany and Austria. Diabetes Care 2012; 35: 80-86 DOI: 10.2337/dc11-0993.
• 22 Plummer F, Manea L, Trepel D. et al. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry 2016; 39: 24-31 DOI: 10.1016/j.genhosppsych.2015.11.005.
• 23 Richardson LP, McCauley E, Grossman DC. et al. Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics 2010; 126: 1117-1123 DOI: 10.1542/peds.2010-0852.
• 24 Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. Cmaj 2012; 184: E191-E196 DOI: 10.1503/cmaj.110829.
• 25 Tschorn M, Rieckmann N, Arolt V. et al. Erkennungsgüte dreier deutschsprachiger Screeninginstrumente für Depression bei hospitalisierten Patienten mit koronarer Herzerkrankung. Psychiatr Prax 2019; 46: 41-48 DOI: 10.1055/s-0042-123434.
• 26 Lunkenheimer F, Domhardt M, Geirhos A. et al. Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACH(CD)): study protocol for a multicentre randomized controlled trial. Trials 2020; 21: 253-253 DOI: 10.1186/s13063-019-4041-9.
• 27 Haak T, Gölz S, Fritsche A. et al. Therapie des Typ-1-Diabetes. Der Diabetologe 2019; 15: 135-145 DOI: 10.1007/s11428-019-0458-8.
• 28 Thapar A, Collishaw S, Pine DS. et al. Depression in adolescence. Lancet 2012; 379: 1056-1067 DOI: 10.1016/s0140-6736(11)60871-4.
• 29 Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull 2017; 143: 783-822 DOI: 10.1037/bul0000102.
• 30 Parekh A, Phillips M. Preventing Suicide: A Global Imperative. 2014
• 31 Oliffe JL, Rossnagel E, Seidler ZE. et al. Men’s Depression and Suicide. Curr Psychiatry Rep 2019; 21: 103 DOI: 10.1007/s11920-019-1088-y.
• 32 Butwicka A, Frisén L, Almqvist C. et al. Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: a population-based cohort study. Diabetes Care 2015; 38: 453-459 DOI: 10.2337/dc14-0262.
• 33 O’Brien K, White E, Aguinaldo L. et al. Suicide Risk in Adolescents with Diabetes: A Case Report. Emergency Medicine: Open Access 2015; 05 DOI: 10.4172/2165-7548.1000281.
• 34 Pompili M, Forte A, Lester D. et al. Suicide risk in type 1 diabetes mellitus: A systematic review. J Psychosom Res 2014; 76: 352-360 DOI: 10.1016/j.jpsychores.2014.02.009.
• 35 Matlock KA, Yayah Jones NH, Corathers SD. et al. Clinical and Psychosocial Factors Associated With Suicidal Ideation in Adolescents With Type 1 Diabetes. J Adolesc Health 2017; 61: 471-477 DOI: 10.1016/j.jadohealth.2017.05.004.
• 36 Forkmann T, Teismann T, Glaesmer H. Diagnostik von Suizidalität. 1. Aufl.. Göttingen: Hogrefe; 2016
• 37 Davis M, Rio V, Farley AM. et al. Identifying Adolescent Suicide Risk via Depression Screening in Pediatric Primary Care: An Electronic Health Record Review. Psychiatric Services 2021; 72: 163-168 DOI: 10.1176/appi.ps.202000207.
• 38 Etter DJ, McCord A, Ouyang F. et al. Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents. J Adolesc Health 2018; 62: 191-197 DOI: 10.1016/j.jadohealth.2017.08.026.
• 39 Inman DD, Matthews J, Butcher L. et al. Identifying the risk of suicide among adolescents admitted to a children’s hospital using the Ask Suicide-Screening Questions. J Child Adolesc Psychiatr Nurs 2019; 32: 68-72 DOI: 10.1111/jcap.12235.
• 40 Patel A, Watts C, Shiddell S. et al. Universal Adolescent Suicide Screening in a Pediatric Urgent Care Center. Archives of Suicide Research 2017; 22 DOI: 10.1080/13811118.2017.1304303.
• 41 Reinauer C, Viermann R, Förtsch K. et al. Motivational Interviewing as a tool to enhance access to mental health treatment in adolescents with chronic medical conditions and need for psychological support (COACH-MI): study protocol for a clusterrandomised controlled trial. Trials 2018; 19: 629 DOI: 10.1186/s13063-018-2997-5.
• 42 Härter M, Baumeister H, Reuter K. et al. Increased 12-month prevalence rates of mental disorders in patients with chronic somatic diseases. Psychother Psychosom 2007; 76: 354-360 DOI: 10.1159/000107563.
• 43 Rechenberg K, Whittemore R, Grey M. Anxiety in Youth With Type 1 Diabetes. J Pediatr Nurs 2017; 32: 64-71 DOI: 10.1016/j.pedn.2016.08.007.
• 44 Sildorf SM, Breinegaard N, Lindkvist EB. et al. Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity. Diabetes Care 2018; 41: 2289-2296 DOI: 10.2337/dc18-0609.
• 45 Starkman H, Fisher K, Pilek NL. et al. Listening to adolescents with uncontrolled diabetes, their parents and medical team. Fam Syst Health 2019; 37: 30-37 DOI: 10.1037/fsh0000396.
• 46 Bendig E, Bauereiß N, Ebert DD. et al. Internet-Based Interventions in Chronic Somatic Disease. Dtsch Arztebl Int 2018; 115: 659-665 DOI: 10.3238/arztebl.2018.0659.
• 47 Domhardt M, Steubl L, Baumeister H. Internet- and Mobile-Based Interventions for Mental and Somatic Conditions in Children and Adolescents. Z Kinder Jugendpsychiatr Psychother 2020; 48: 33-46 DOI: 10.1024/1422-4917/a000625.
• 48 Geirhos A, Klein JP, Ebert DD. et al. Onlinetherapie verringert bestehende Lücken in der Versorgung. InFo Neurologie & Psychiatrie 2019; 21: 36-45 DOI: 10.1007/s15005-019-0170-7.
• 49 Kohlmann CW, Salewski C, Wirtz MA. Psychologie in der Gesundheitsförderung. 1. Aufl.. Göttingen: Hogrefe; 2018
• 50 Möller-Leimkühler AM, Mühleck J. [Development and Preliminary Validation of a Gender-Sensitive Depression Screening (GSDS)]. Psychiatr Prax 2020; 47: 79-86 DOI: 10.1055/a-1067-0241.
• 51 Rice SM, Fallon BJ, Aucote HM. et al. Development and preliminary validation of the male depression risk scale: furthering the assessment of depression in men. J Affect Disord 2013; 151: 950-958 DOI: 10.1016/j.jad.2013.08.013.
• 52 Zülke AE, Kersting A, Dietrich S. et al. [Screening Instruments for the Detection of Male-Specific Symptoms of Unipolar Depression – A Critical Overview]. Psychiatr Prax 2018; 45: 178-187 DOI: 10.1055/s-0043-120289.
• 53 Hanlan ME, Griffith J, Patel N. et al. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Curr Diab Rep 2013; DOI: 10.1007/s11892-013-0418-4.
• 54 Löwe B. Gesundheitsfragebogen für Patienten (GAD-7). In: Hamburg-Eppendorf U ed 2015:
• 55 Löwe B. Gesundheitsfragebogen für Patienten (PHQ-9). In: Hamburg-Eppendorf U ed 2015: