Improving Psychosocial Care of Adolescent Youth with Type 1 Diabetes: A Quality Improvement Project

Abstract

Abstract Purpose: This quality improvement (QI) project aimed to identify adolescents with type 1 diabetes (T1D) at risk for mental health comorbidities and promote psychosocial referrals. Background: Adolescents with T1D are twice as likely to experience depression as their peers without diabetes, and one in three report significant diabetes-related distress. Untreated depression and diabetes distress can worsen diabetes self-management, leading to higher A1C levels, reduced quality of life, suicide ideations, and chronic complications. Validated screening measures can improve access to psychosocial services. Sample/Setting: Adolescent T1D patients (ages 12-18) receiving pediatric diabetic specialty care in two outreach endocrine clinics in the Pacific Northwest. Methods: To identify youth at risk for depression or diabetes distress, the Patient Health Questionnaire-9 (PHQ-9) and Problem Areas in Diabetes Survey Teen (PAID-T) were administered during routine endocrine visits. Project developed clinical care algorithm guided social work and psychology care escalation for those who scored at risk (PAID-T ≥ 44 and PHQ-9 ≥ 5). Results: Over eight weeks, 67 eligible patients were screened. In total, 37 (55.2%) were screened using the PAID-T, and 28 (41.8%) with the PHQ-9. Six patients (16.2%) scored 44 or higher on the PAID-T, indicating diabetes distress, and 14 patients (50%) scored 5 or higher on the PHQ-9, indicating depression risk. There was a strong relationship between PHQ-9 scores and PAID-T scores (r(26) = 0.70, p < 0.001). No patients screened positive for diabetes distress without screening positive for depression. Fourteen patients (37.8%) met referral criteria for care escalation; 85% of patients who received referrals were contacted within 24 hours. The PHQ-9 identified three (10.7%) youth with suicide ideation. According to the PAID-T screening tool, sadness, overwhelm, anger, and social support challenges were identified as the most prevalent themes of diabetes-distress. Conclusion: The PHQ-9 and PAID-T are both effective methods for identifying adolescents with T1D who may be at risk for depression and diabetes-related distress. PHQ-9 scores of 5 or higher also identified youth with diabetes distress, suggesting that the PHQ-9 can be used as a stand-alone screening tool for both depression and diabetes distress. Assessing suicidality is essential for this vulnerable population. Prompt psychosocial referrals in outpatient endocrine clinics are likely to enhance long-term diabetic outcomes for adolescents diagnosed with T1D. Keywords: type 1 diabetes, adolescents, depression, diabetes distress, psychosocial comorbiditie