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Depression and adherence to treatment in diabetic children and adolescents: a systematic review and meta-analysis of observational studies

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Abstract

Depression compromises diabetes treatment in juveniles, and this study aimed to identify influential targets most likely to improve adherence to treatment and glycemic control. Prospective observational studies investigating associations between depression and treatment adherence in juveniles with type 1 diabetes were extracted from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central. Nineteen studies comprising 2,935 juveniles met our criteria. Median effect sizes between depression and treatment adherence were 0.22 (interquartile range (IQR), 0.16–0.35) by patient and 0.13 (IQR, 0.12–0.24) caregiver report. Corresponding values for depression/glycemic control were 0.16 (IQR, 0.09–0.23) and 0.08 (IQR, 0.04–0.14), respectively. Effect sizes varied with study design, publication year and assessment tools: CES-D yielded a higher effect size than other assessment tools for depression, where associations for depression and either adherence or glycemic control was investigated. Several behaviours influenced adherence and glycemic control. Conclusion: This study showed moderate associations between depression and poor treatment adherence. Targeting behaviour and social environments, however, may ultimately provide more cost-effective health gains than targeting depressive symptoms.

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Abbreviations

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

EMBASE:

Excerpta Medica Database

CINAHL:

Cumulative Index to Nursing and Allied Health Literature

HbA1c:

Haemoglobin A1c

CDI:

Children's Depression Inventory

CES-D:

Centre for Epidemiological Studies Scale for Depression

BASC:

Behaviour Assessment System for Children

CDI-S:

Children's Depression Inventory-Short Form

SCI:

Self-Care Inventory

BGMF:

Blood glucose monitoring frequency

DSMP:

Diabetes Self-Management Profile

DMS:

Diabetes Self-Management Scale

SCQ:

Self-Care Questionnaire

IQR:

Interquartile range

CI:

Confidence interval

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Acknowledgments

We would like to thank Thepsirin Chuatong for her help in data acquisition. This review was supported by Naresuan University, Thailand.

Conflict of interest

CK, KJ, CC and NS have no conflicts of interest that are directly relevant to the content of this study. CK contributed to develop conception and planning of this work. CK and KJ involved in analysis of data. CK, KJ and NS interpreted the data. All authors have approved the submission of the manuscript in the present form.

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Authors and Affiliations

  1. Faculty of Pharmaceutical Sciences, Naresuan University, 99 Mu 9, NakhonSawan Road, Phitsanulok, 65000, Thailand

    Chuenjid Kongkaew & C. Norman Scholfield

  2. Faculty of Sciences, Naresuan University, Phitsanulok, Thailand

    Katechan Jampachaisri

  3. Child Development & Neuropsychiatric Unit, Bangkok Medical Center, Bangkok, Thailand

    Chollapat A. Chaturongkul

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  1. Chuenjid Kongkaew
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  2. Katechan Jampachaisri
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  3. Chollapat A. Chaturongkul
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  4. C. Norman Scholfield
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Correspondence to Chuenjid Kongkaew.

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Kongkaew, C., Jampachaisri, K., Chaturongkul, C.A. et al. Depression and adherence to treatment in diabetic children and adolescents: a systematic review and meta-analysis of observational studies. Eur J Pediatr 173, 203–212 (2014). https://doi.org/10.1007/s00431-013-2128-y

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