Psychosocial Aspects


Linh A. Nguyen, Frans Pouwer, Paul Lodder, Esther Hartman, Per Winterdijk, Henk-Jan Aanstoot, Giesje Nefs

Depression and anxiety in adolescents with type 1 diabetes and their parents. Pediatr Res . 2022 Jan;91(1):188-196.

About one in five adolescents experiences depression and anxiety, and even more adolescents with type 1 diabetes. This negatively affects glycemic control due to less optimal self-care behaviors. Parents of adolescents with type 1 diabetes also experience more emotional problems compared with other parents. Earlier research suggests that in the general population, children of depressed parents are at increased risk of developing depression and anxiety themselves. Not much is known about this association between adolescents with type 1 diabetes and their parents. Maternal depression has been linked to HbA1c and it has been suggested that the quantity and quality of parental involvement could be involved. Many studies were limited by their cross-sectional design, however.


As part of the ‘Longitudinal study of Emotional problems in Adolescents with type 1 diabetes and their Parents/caregivers’ (Diabetes LEAP) study it was hypothesized that:

  • An association exists between parental emotional distress at baseline and symptoms of anxiety and depression in adolescents 1 year later
  • An association exists between parental emotional distress at baseline and HbA1c 1 year later
  • The putative association between emotional distress and HbA1c is mediated by:
    • The division of diabetes management responsibilities
    • The level of following treatment recommendations

Key finding:

  • None of the hypothesized associations were observed

Although this study has a number of strengths (prospective design, focus on adolescent mental health and diabetes outcomes, validated questionnaires) the authors describe a number of limitations which may (partly) explain the findings:

  • Selection bias during recruitment: mental health data were not collected
  • Low rates of parental depression and mood/anxiety disorders
  • This study focused only on the most involved parent: significant others in the social networks may also play an important role
  • Attrition bias: not all participants were retained during follow-up
  • Different associations may exist between early and late adolescents, as many developmental changes take place very fast during puberty


Concluding, the authors state

"“…it might be premature to discard the notion of parental emotional distress affecting adolescent outcomes, given the limitations of the present study. Previous studies focusing on diagnoses did suggest transgenerational links of emotional distress, thus future research should focus specifically on the group with psychopathology. " -

Please click here for this publication in PubMed.

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