Developing digital mental health tools for youth with diabetes: an agenda for future research

Youth living with diabetes face a concurrent challenge: managing a chronic health condition and managing the psychosocial and developmental changes that are characteristic of adolescence and young adulthood. Despite these unique challenges, psychological support is often difficult for youth with diabetes to access due to a lack of trained mental health professionals and other resource constraints. Digital wellbeing tools offer the potential to improve access to psychological support for this population. However, very few digital wellbeing tools exist for youth with diabetes. Of those that do exist, very few are evidence-based therapies, undermining their contribution to the field. Given the increasing global prevalence of diabetes in young people, the support necessitated by the challenges experienced by this population is not always accessible in a face-to-face setting and cannot be effectively scaled to meet demand. To support the health and wellbeing of youth with diabetes, there is a clear need to develop digital interventions that are widely accessible to users, but, more saliently, grounded in empirical evidence that supports their efficacy. Thus, the purpose of this paper is to offer an agenda for future research, including insights into which psychological techniques and behavioral change theories may be a good conceptual fit for digital mental health interventions, and how these tools may be best developed and utilized by the individuals that need them. Scalable, evidence-based wellbeing tools for this population are urgently required to improve psychological outcomes, and potentially, improve the equity of service access

Does high optimism protect against the inter-generational transmission of high BMI? The Cardiovascular Risk in Young Finns Study

Objective: The transmission of overweight from one generation to the next is well established, however little is known about what psychosocial factors may protect against this familial risk. The aim of this study was to examine whether optimism plays a role in the intergenerational transmission of obesity. Methods: Our sample included 1043 participants from the prospective Cardiovascular Risk in Young FINNS Study. Optimism was measured in early adulthood (2001) when the cohort was aged 24-39 years. BMI was measured in 2001 (baseline) and 2012 when they were aged 35-50 years. Parental BMI was measured in 1980. Hierarchical linear regression and logistic regression were used to examine the association between optimism and future BMI/obesity, and whether an interaction existed between optimism and parental BMI when predicting BMI/obesity 11 years later. Results: High optimism in young adulthood demonstrated a negative relationship with high BMI in mid-adulthood, but only in women (beta = - 0.127, p = 0.001). The optimism x maternal BMI interaction term was a significant predictor of future BMI in women (beta = 0.588, p = 0.036). The logistic regression results confirmed that high optimism predicted reduced obesity in women (OR = 0.68, 95% CI, 0.55-0.86), however the optimism x maternal obesity interaction term was not a significant predictor (OR = 0.50, 95% CI, 0.10-2.48). Conclusions: Our findings supported our hypothesis that high optimism mitigated the intergenerational transmission of high BMI, but only in women. These findings also provided evidence that positive psychosocial factors such as optimism are associated with long-term protective effects on BMI in women.Peer reviewe

Work participation and physicality of work in young adulthood and the development of unhealthy lifestyle habits and obesity later in life : a prospective cohort study

Objective To determine the effects of early entry into the labour market and physicality of work in young adulthood on the development of obesity and unhealthy lifestyle habits later in life. Methods This study is a part of the Young Finns Study. Entry into the labour market and physicality of work were measured at baseline, when participants were aged 18, 21, or 24 years in 1986 or 18 years in 1989. Follow-up of lifestyle habits were conducted in 2001, 2007 and 2011. The outcomes were obesity (n=5558 observations), abdominal obesity (n=4060 observations), daily smoking (n=5628) and leisure time physical activity (n=5946) and analysed with generalised estimating equation. Results Compared with sedentary work, physicality of work in young adulthood increased the odds of future obesity (adjusted OR=1.32, 95% CI 1.01 to 1.74 for light/moderate work and OR=1.44, 95% CI 0.99 to 2.08 for heavy manual work (particularly in women OR=2.03, 95% CI 1.07 to 3.84)) and future smoking (OR=1.79, 95% CI 1.39 to 2.30 for light/moderate work and OR=2.01, 95% CI 1.47 to 2.76 for heavy manual work (particularly in women OR=2.81, 95% CI 1.60 to 4.91)). For those who entered the labour market at ages 18-21 or younger, the odds of smoking was 1.85 times (95% CI 1.26 to 2.73) and that of obesity 1.45 times (95% CI 1.01 to 2.10) higher, and the rate of leisure time physical activity was 0.73 times (95% CI 0.58 to 0.93) lower compared with those who entered the labour market at ages 22-24 years. Conclusion Early entry into the labour market and physicality of work in young adulthood shape the development of obesity and unhealthy behaviours in later adulthood.Peer reviewe

The Association Between Social Support, Body Mass Index and Increased Risk of Prediabetes : the Cardiovascular Risk in Young Finns Study

The psychosocial determinants of prediabetes are poorly understood. The aims of our study were (1) to analyse the association between perceived social support in young adulthood and fasting glucose levels and prediabetes in mid-adulthood in a cohort of healthy Finns, (2) to explore whether body mass index (BMI), inflammation or depression mediate this relationship, (3) and to examine the association between social support trajectory groups and fasting glucose. A prospective design was used with an analytic sample of 1250 participants aged 3-18 years at baseline (1980) and aged 12-39 years when social support was measured. Fasting glucose and prediabetes were assessed 32 years after baseline. Linear and logistic regression was used to examine the association between social support and the outcome measures. A bootstrapping technique was used to examine mediation effects. Social support was associated with future glucose levels in women after adjusting for childhood socioeconomic status (SES) and youth depression (beta = -0.136, p = 0.001) and also predicted prediabetes in women after adjusting for childhood SES (beta = 1.31, 95 % CI 1.02 to 1.69, p = 0.031). Both associations were attenuated after adjusting for BMI in mid-adulthood. BMI was found to mediate the relationship between social support and prediabetes in women (beta for indirect effect beta = 0.09, SE = 0.03, CI = 0.03 to 0.16). Low perceived social support in young adulthood is associated with high fasting glucose and prediabetes in mid-adulthood in women but not men. The association between social support and prediabetes in women can be partly explained by BMI.Peer reviewe

Positive Psychosocial Factors in Childhood Predicting Lower Risk for Adult Type 2 Diabetes : The Cardiovascular Risk in Young Finns Study, 1980-2012

Introduction: Type 2 diabetes is a public health concern, but psychosocial factors that may protect against the disease are unknown. This study examines whether a positive psychosocial environment in childhood is associated with lower risk for Type 2 diabetes in adulthood or healthier glucose trajectories over the life course, and whether BMI mediates the associations. Methods: A cohort of 3,596 Finnish children was followed into adulthood over 32 years. An overall positive psychosocial score, consisting of six subdomains, was measured at study baseline (1980). Relative risk ratios and multilevel growth curve modeling were used to examine associations of the psychosocial score with Type 2 diabetes (2012) and glucose trajectories (1986-2012). The mediating effect by BMI was examined using mediation analysis. The analyses were conducted between June 2015 and January 2016. Results: There was a 21% decrease in the rate of Type 2 diabetes (relative risk ratio, 0.79; 95% CI = 0.66, 0.94) for each 1-SD increase in the positive psychosocial score after adjustment for childhood cardiovascular risk factors and dietary behaviors. Adult BMI mediated 52% and weight gain mediated 25% of the association. The growth curve model showed healthier glucose trajectories (age X psychosocial score interaction, b = -0.01; p = 0.010) for participants with higher versus lower positive psychosocial score in childhood. Conclusions: Positive psychosocial environment in childhood seems to have beneficial influences on the risk for Type 2 diabetes over the life span. RCTs will be required to see if interventions directed at early-life circumstances are warranted. (C) 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.Peer reviewe

The best of coping: a randomised trial to improve glycaemic control and psychosocial wellbeing in adolescents with Type 1 diabetes

© 2011 Dr. Anna Sofia SerlachiusType 1 diabetes mellitus (T1DM) is a challenging and complex chronic illness that is associated with serious long-term health complications. T1DM requires intensive self-management in order to regulate blood glucose levels and minimise the risk for biomedical complications. Adolescents with T1DM are considered a vulnerable group, as they are at increased risk for deterioration in glycaemic control (control of blood glucose levels) as well as at increased risk for psychiatric disorders. Psychosocial interventions have tried to reduce these risk factors, and despite moderate improvements it remains unclear which therapeutic approaches and intervention components are the most successful in improving glycaemic control and psychological wellbeing. In order to clarify these issues the following studies were undertaken: (1) a qualitative study was used to modify a generic coping skills program to suit adolescents with T1DM, and (2) a randomised controlled trial (RCT) was conducted to evaluate the modified program and its impact on improving glycaemic control and psychosocial outcomes. The RCT also sought to evaluate the efficacy of cognitive behavioural theory as an underlying framework for interventions for youth with T1DM. Thirteen adolescents with T1DM participated in the qualitative study, and 156 adolescents with T1DM participated in the RCT. The RCT was evaluated at three months after baseline, with per-protocol analyses demonstrating statistically significant improvements in productive coping skills (p=0.022), diabetes-specific self-efficacy (p=0.046), diabetes-related stress (p=0.047), and quality of life (p=0.030) in the treatment group compared to the control group. Although glycaemic control improved in the treatment group compared to the control group (effect size of 0.28), the difference was not statistically significant (p=0.227). The significant improvements seen in psychosocial outcomes testify to the success of the modified coping skills program and the importance of targeting cognitions as part of psychosocial interventions for adolescents with T1DM. If offered as part of standard care, the program is expected to reduce mental health morbidity and improve quality of life in adolescents with T1DM

Migration and autism spectrum disorder: population-based study.

BACKGROUND: Migration has been implicated as a risk factor for autism, but evidence is limited and inconsistent. AIMS: To investigate the relationship between parental migration status and risk of autism spectrum disorder, taking into consideration the importance of region of origin, timing of migration and possible discrepancies in associations between autism subtypes. METHOD: Record-linkage study within the total child population of Stockholm County between 2001 and 2007. Individuals with high- and low-functioning autism were defined as having autism spectrum disorder with and without comorbid intellectual disability, and ascertained via health and habilitation service registers. RESULTS: In total, 4952 individuals with autism spectrum disorder were identified, comprising 2855 children with high-functioning autism and 2097 children with low-functioning autism. Children of migrant parents were at increased risk of low-functioning autism (odds ratio (OR) = 1.5, 95% CI 1.3-1.7); this risk was highest when parents migrated from regions with a low human development index, and peaked when migration occurred around pregnancy (OR = 2.3, 95% CI 1.7-3.0). A decreased risk of high-functioning autism was observed in children of migrant parents, regardless of area of origin or timing of migration. Parental age, income or obstetric complications did not fully explain any of these associations. CONCLUSIONS: Environmental factors associated with migration may contribute to the development of autism presenting with comorbid intellectual disability, especially when acting in utero. High- and low-functioning autism may have partly different aetiologies, and should be studied separately

“What say ye gout experts?” a content analysis of questions about gout posted on the social news website Reddit

Abstract Background Social media is increasingly used by patients to source information for managing chronic disease. The aim of this study was to understand patient information needs about gout by a content analysis of questions posted on the social news website Reddit. Methods We analysed questions posted onto the ‘Gout sufferers unite’ subreddit site. Two reviewers coded questions into categories (inter-reviewer kappa 0.70), with discordant coding resolved by a third reviewer. Data were analysed by calculating the frequency of questions within the categories. Where relevant, categories were further separated into sub-categories to allow organisation and interpretation of the data. Results We analysed 359 questions in 287 posts by 213 individuals. A wide range of questions arose. The single most common category related to uncertainty of diagnosis (22.3% questions), with questions about disease management common. Information-seeking about medications was generally cautious, with questions about side-effects, risk of flares after starting urate-lowering therapy, and decision to start urate-lowering therapy. Community users experiencing flares posted questions about flare management, including medications, sometimes in real-time. Dietary management questions included the effectiveness of dietary changes as a management strategy, choice of alcoholic beverage, and weight loss strategies. Questions about serum urate levels were rare (2.8% questions). Conclusions Questions about gout posted on the subreddit site most often related to uncertainty about symptoms and disease management strategies, with infrequent questions about serum urate testing, results or targets. These findings may inform development of strategies to address the information needs of people with gout

Improving the Well-being of Adolescents With Type 1 Diabetes During the COVID-19 Pandemic: Qualitative Study Exploring Acceptability and Clinical Usability of a Self-compassion Chatbot

BackgroundBefore the COVID-19 pandemic, adolescents with type 1 diabetes (T1D) had already experienced far greater rates of psychological distress than their peers. With the pandemic further challenging mental health and increasing the barriers to maintaining optimal diabetes self-management, it is vital that this population has access to remotely deliverable, evidence-based interventions to improve psychological and diabetes outcomes. Chatbots, defined as digital conversational agents, offer these unique advantages, as well as the ability to engage in empathetic and personalized conversations 24-7. Building on previous work developing a self-compassion program for adolescents with T1D, a self-compassion chatbot (COMPASS) was developed for adolescents with T1D to address these concerns. However, the acceptability and potential clinical usability of a chatbot to deliver self-compassion coping tools to adolescents with T1D remained unknown. ObjectiveThis qualitative study was designed to evaluate the acceptability and potential clinical utility of COMPASS among adolescents aged 12 to 16 years with T1D and diabetes health care professionals. MethodsPotential adolescent participants were recruited from previous participant lists, and on the web and in-clinic study flyers, whereas health care professionals were recruited via clinic emails and from diabetes research special interest groups. Qualitative Zoom (Zoom Video Communications, Inc) interviews exploring views on COMPASS were conducted with 19 adolescents (in 4 focus groups) and 11 diabetes health care professionals (in 2 focus groups and 6 individual interviews) from March 2022 to April 2022. Transcripts were analyzed using directed content analysis to examine the features and content of greatest importance to both groups. ResultsAdolescents were broadly representative of the youth population living with T1D in Aotearoa (11/19, 58% female; 13/19, 68% Aotearoa New Zealand European; and 2/19, 11% Māori). Health care professionals represented a range of disciplines, including diabetes nurse specialists (3/11, 27%), health psychologists (3/11, 27%), dieticians (3/11, 27%), and endocrinologists (2/11, 18%). The findings offer insight into what adolescents with T1D and their health care professionals see as the shared advantages of COMPASS and desired future additions, such as personalization (mentioned by all 19 adolescents), self-management support (mentioned by 13/19, 68% of adolescents), clinical utility (mentioned by all 11 health care professionals), and breadth and flexibility of tools (mentioned by 10/11, 91% of health care professionals). ConclusionsEarly data suggest that COMPASS is acceptable, is relevant to common difficulties, and has clinical utility during the COVID-19 pandemic. However, shared desired features among both groups, including problem-solving and integration with diabetes technology to support self-management; creating a safe peer-to-peer sense of community; and broadening the representation of cultures, lived experience stories, and diabetes challenges, could further improve the potential of the chatbot. On the basis of these findings, COMPASS is currently being improved to be tested in a feasibility study