Skip to main content
NCBI home page
HHS Author Manuscripts logoLink to HHS Author Manuscripts
. Author manuscript; available in PMC: 2024 Apr 8.
Published in final edited form as: J Pediatr. 2022 Sep 14;253:25–32. doi: 10.1016/j.jpeds.2022.09.008

Prevalence of Mental, Behavioral, and Developmental Disorders Among Children and Adolescents with Diabetes, United States (2016–2019)

Catherine E Barrett 1, Xilin Zhou 1, Isabel Mendez 2, Joohyun Park 1, Alain K Koyama 1, Angelika H Claussen 3, Kim Newsome 3, Kai McKeever Bullard 1
PMCID: PMC11000210  NIHMSID: NIHMS1979829  PMID: 36113638

Abstract

Objective

To assess the association of diabetes and mental, behavioral, and developmental disorders in youth, we examined the magnitude of overlap between these disorders in children and adolescents.

Study design

In this cross-sectional study, we calculated prevalence estimates using the 2016–2019 National Survey of Children’s Health. Parents reported whether their child was currently diagnosed with diabetes or with any of the following mental, behavioral, or developmental disorders: attention-deficit/hyperactivity disorder, autism spectrum disorder, learning disability, intellectual disability, developmental delay, anxiety, depression, behavioral problems, Tourette syndrome, or speech/language disorder. We present crude prevalence estimates weighted to be representative of the US child population and adjusted prevalence ratios (aPRs) adjusted for age, sex, and race/ethnicity.

Results

Among children and adolescents (aged 2–17 years; n = 121 312), prevalence of mental, behavioral, and developmental disorders varied by diabetes status (diabetes: 39.9% [30.2–50.4]; no diabetes: 20.3% [19.8–20.8]). Compared with children and adolescents without diabetes, those with diabetes had a nearly 2-fold higher prevalence of mental, behavioral, and developmental disorders (aPR: 1.72 [1.31–2.27]); mental, emotional, and behavioral disorders (aPR: 1.90 [1.38–2.61]) and developmental, learning, and language disorders (aPR: 1.89 [1.35–2.66]).

Conclusions

These results suggest that approximately 2 in 5 children and adolescents with diabetes have a mental, behavioral, or developmental disorder. Understanding potential causal pathways may ultimately lead to future preventative strategies for mental, behavioral, and developmental disorders and diabetes in children and adolescents.

The prevalence of mental disorders among adults and youth with diabetes is greater than that in the general population in the US largely accounted for by higher prevalence of depression and anxiety.1–4 Diabetes has been shown to co-occur with developmental5 and learning disorders,6 including attention-deficit/hyperactivity disorder (ADHD).7 Even as the prevalence of both diabetes8,9 and mental, behavioral, and developmental disorders10,11 is on the rise among youth in the US,10 there is limited understanding of the magnitude of overlap between mental, behavioral, and developmental disorders and diabetes among youth.

The relationship between mental, behavioral, and developmental disorders and diabetes may have multiple causal pathways, including common behavioral and environmental factors.12 For example, lower socioeconomic status is known to be common among children with diabetes and mental, behavioral, or developmental disorders,11,13 which is associated with economic, social, and environmental disadvantages such as decreased access to health care, lower income, and lower parental educational attainment. Moreover, insufficient physical activity is associated with increased prevalence of diabetes and some mental, behavioral, and developmental disorders.14–16 Lastly, a pro-inflammatory profile characterized by high levels of inflammatory cytokines, cortisol, and leptin is common in both diabetes and depression.17

Much previous work has focused on mood disorders and diabetes.18 Studies consistently demonstrate associations between depressive symptoms and worse glycemic control.19,20 Depression in adolescence might influence the later development of type 2 diabetes.21 Similarly, anxiety is associated with poor self-management and glycemic control in adolescents with type 1 diabetes.22 Conversely, diabetes can trigger diabetes distress, which is observed in approximately one-third of adolescents with diabetes and characterized by subclinical negative emotions associated with inadequate self-management and poor glycemic control.18

Here, we examine prevalence of mental, behavioral, and developmental disorders among children and adolescents (2–17 years old) with and without diabetes using annual data from the 2016–2019 National Survey of Children’s Health (NSCH). We also examined perceived severity of and treatment utilization for mental, behavioral, and developmental disorders among children with and without diabetes. Although NSCH does not distinguish between diabetes sub-types, results are most likely representative of type 1 diabetes which accounts for over 80% of diabetes diagnoses among children and adolescents under 20 years of age.23

Methods

This analysis used data from the 2016–2019 NSCH, an annual, cross-sectional, nationally representative population-based survey of households with noninstitutionalized children and adolescents ≤17 years of age in the US Eligible households were randomly selected from addresses drawn from the US Census Bureau Master Address File. A parent or caregiver answered age-specific questionnaires (≤5 years, 6–11 years, 12–17 years) about one randomly selected child in their household. Survey questions covered the general health of the child, health care utilization, health insurance, family and household information, and neighborhood and community factors. NSCH is conducted by the US Census Bureau, and additional information is available online (https://mchb.hrsa.gov/data/national-surveys). This activity was reviewed by Centers for Disease Control and Prevention (CDC) and was conducted in consistent with applicable federal law and CDC policy (45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq).

The combined total sample size of respondents was 131 774 (2016: n = 50 212; 2017: n = 21 599; 2018: n = 30 530; 2019: n = 29 433). The present analytic sample excluded children ≤1 years of age (n = 9973) and those missing information on diabetes status (n = 489), yielding a final analytic sample of 121 312 children and adolescents.

Diabetes Status and Mental, Behavioral, and Developmental Disorders Outcome Measures

Parent-reported diabetes diagnosis was determined using the questions, “Has a doctor or other health care provider ever told you that (child name) has diabetes?” followed up by “If yes, does (child name) currently have the condition?” To increase specificity in identifying diabetes and as diabetes is a chronic condition, those reporting “no” to currently having diabetes were considered to not have diabetes (n = 70). The survey did not differentiate between type 1 and type 2 diabetes.

The mental, behavioral, and developmental disorders reported here fall into two categories: (1) mental, emotional, and behavioral disorders: ADHD, anxiety, depression, behavioral or conduct problems (defined here as disruptive behavior disorder), and Tourette syndrome, and (2) developmental, learning, and language disorders: autism spectrum disorder (ASD), intellectual disability, developmental delay, learning disability, and speech/language disorder.

The presence of current mental, behavioral, or developmental disorder diagnosis was a combined category based on parent report to individual questions on each mental, behavioral, or developmental disorder. Parents were asked the question, “Has a doctor or other health care provider ever told you that (child name) has (name of disorder)?” for ADHD, anxiety problems, depression, Tourette syndrome, and ASD. For disruptive behavior disorder, intellectual disability, developmental delay, learning disability, and speech/language disorder, parents were asked, “Has a doctor or other health care provider or educator ever told you that (child name) has (name of disorder)?” Examples of educators are teachers and school nurses. Current diagnoses were determined by a “yes” response to follow-up questions asking if the child currently has the disorder. Parents were told ADHD was defined as attention-deficit disorder or attention-deficit/hyperactivity disorder, ie., attention deficit disorder or ADHD; ASD was defined as autism or autism spectrum disease and included a diagnosis of Asperger disorder or pervasive developmental disorder; and intellectual disability as also known as intellectual disability. Parents were also asked to rate the severity of each mental, behavioral, or developmental disorder as 1 = mild, 2 = moderate, and 3 = severe.

Sociodemographic, Health Care, Family and Community Variables

Sociodemographic characteristics were sex, age (younger children aged 2–11 years and adolescents aged 12–17 years), race/ethnicity, parents’ highest level of education, primary language, urban/rural metropolitan designation, family poverty ratio (ratio of prior-year total family income and US Census Bureau’s family poverty threshold), and the child’s current private or public health care coverage. Additional parent-reported characteristics were adequacy of mental health or behavioral insurance coverage (if the child was insured and had mental or behavioral health needs, the parent reports that health insurance offers benefits or covers services that meet mental or behavioral needs), health care utilization in the past 12 months, family factors (fair or poor parental mental or emotional health, fair or poor parental physical health, difficulty affording food and housing on the family’s income, and lack of emotional support for the responding parent), and community factors (neighborhood without amenities, neighborhood in poor condition, lack of support in neighborhood, neighborhood perceived to lack safety). For more information, see the Appendix (available at www.jpeds.com).

Treatment Variables

Mental, behavioral, or developmental disorder treatment in the past year was based on available questions regarding receipt of behavioral treatment or developmental services or use of medication in the last 12 months. Behavioral treatment or services in the last 12 months was the parent’s report of the child receiving any treatment or counseling from a mental health professional, behavioral treatment for ASD or ADHD, current special services to meet developmental needs (such as speech, occupational, or behavioral therapy), or current special education or early intervention services. Parents reported whether the child received medication for ADHD, ASD, or difficulties with emotions, concentration, or behaviors. Parents also reported whether it was a problem getting the mental health treatment or counseling that their child needed in the last 12 months.

Statistical Analyses

All estimates are weighted to be nationally representative of the US child and adolescent population and account for complex survey design. Demographic, health care, family, and community factors are presented as percentages with 95% CI. Children and adolescents with and without current diabetes were categorized by the presence of mental, behavioral, or developmental disorders; those with mental, behavioral, or developmental disorders were further grouped by the presence of any reported mental, emotional, or behavioral disorder, and any developmental, learning, or language disorder. Chi-square statistics were used to test differences across diabetes and mental, behavioral, and developmental disorder groups. Relative standard error (RSE) was calculated as the SE divided by the estimate and multiplied by 100. RSEs above 30% were considered unreliable, and those estimates are noted but not displayed. Tourette syndrome was not analyzed separately due to small sample sizes and RSEs >30%, preventing accurate estimation. Intellectual disability and developmental delay categories were combined because the RSE of intellectual disability alone approached 30%.

Age, sex, and race/ethnicity adjusted prevalence of mental, behavioral, and developmental disorders overall and among younger children aged 2–11 years and adolescents aged 12–17 years was computed using multivariable logistic regression with predictive margins. Among children and adolescents with mental, behavioral, and developmental disorders, we further estimated prevalence of severe or moderate mental, behavioral, and developmental disorders and receipt of treatment in children and adolescents with or without diabetes. Interaction between diabetes and age, sex, and race/ethnicity was examined. Analyses were conducted using SAS 9.4 (SAS Institute Inc.) and SUDAAN 11.0.3 (RTI International).

Results

Among children and adolescents aged 2–17 years in the US, the crude weighted prevalence of diabetes was 0.43% (95% CI: 0.34%–0.54%) and of mental, behavioral, and developmental disorders was 20.38% (19.89%–20.88%). The average age of individuals with diabetes was 13.0 years (95% CI: 12.3%–13.7%); the average age with current mental, behavioral, or developmental disorder was 10.7 years (10.6–10.8). The average age for current mental, emotional, or behavioral disorder was 11.5 years (11.4–11.6), and the average age for current developmental, learning, or language disorder was 9.7 years (9.5–9.9).

Demographics

Figure 1 shows participant characteristics, by diabetes and mental, behavioral, and developmental disorder status, and pairwise comparisons highlighting the association of diabetes and mental, behavioral, and developmental disorders between study groups. Groups with diabetes had a significantly higher proportions of adolescents, reflecting the expected age distribution of prevalent diabetes. Regardless of diabetes status, those with a mental, behavioral, or developmental disorder were significantly more likely to be male.

Figure 1.

Figure 1.

Open in a new tab

Demographic, health care, family, and community factors in children and adolescents (2–17 years) with or without diabetes and mental, behavioral, or developmental disorders*. Column percentages are presented numerically and as bars. *Mental, behavioral, and developmental disorders (MBDD) include any current parent-reported diagnosis of attention-deficit/hyperactivity disorder, anxiety, depression, disruptive behavior disorders, Tourette syndrome, autism spectrum disorder, intellectual disability, developmental delay, learning disability, or speech/language disorder. †Significant mental, behavioral, and developmental disorder association between groups without diabetes, chi-square P < .05. ‡Significant diabetes association between groups without mental, behavioral, and developmental disorders, chi-square P < .05. §Significant mental, behavioral, and developmental disorder association between groups with diabetes, chi-square P < .05. ||Significant diabetes association between groups with mental, behavioral, and developmental disorders, chi-square P < .05.

Across the remaining characteristics, the most consistent and significant differences were seen when comparing mental, behavioral, and developmental disorder status in children and adolescents without diabetes. Among children without diabetes, those with mental, behavioral, and developmental disorders displayed a higher probability of non-Hispanic White race/ethnicity, English as a primary language, family poverty ratio <100%, public-only health insurance, mental/behavioral coverage needed, sufficient mental/behavioral health insurance coverage, doctor visits, unmet mental and general health care needs, family problems, and community problems. Among children and adolescents with diabetes, those with mental, behavioral, and developmental disorders also had a higher probability of having public-only insurance and of mental/behavioral health care utilization. This group also displayed greater poverty and unmet mental health needs that did not reach statistical significance.

Few differences were detected between children without mental, behavioral, or developmental disorders; however, those with diabetes were more likely to have English as a primary language and utilize general health care. Among children with a mental, behavioral, or developmental disorder, those with diabetes displayed increased probability of non-Hispanic Black race/ethnicity and more public-only insurance. Increased poverty, unmet general health care needs, and worse parental physical health did not reach statistical significance.

Prevalence of Mental, Behavioral, and Developmental Disorders by Diabetes Status

Children and adolescents between 2–17 years of age with diabetes more often had a mental, behavioral, or developmental disorder than those without diabetes (Figure 2). Those with diabetes had a nearly 2-fold higher adjusted prevalence of mental, behavioral, and developmental disorders (adjusted prevalence ratio [aPR]: 1.72 [1.31–2.27]); mental, emotional, and behavioral disorders (aPR: 1.90 [1.38–2.61]); and developmental, learning, and language disorders (aPR: 1.89 [1.35–2.66]), as well as all individual mental, behavioral, or developmental disorders. Similarly, the prevalence of diabetes was 0.33% (0.23%–0.45%) among children and adolescents without mental, behavioral, or developmental disorders and 0.84% (0.64%–1.11%) among children and adolescents with current mental, behavioral, or developmental disorders.

Figure 2.

Figure 2.

Open in a new tab

Prevalence of mental, behavioral, and developmental disorders* among children and adolescents (2–17 years) with and without diabetes, National Survey of Children’s Health, 2016–2019. *Mental, behavioral, and developmental disorders reported here include parent-reported current diagnosis of any of the following mental, emotional, and behavioral disorders: depression, anxiety, disruptive behavior disorders, ADHD, and Tourette syndrome, and the following developmental, learning, and language disorders: intellectual disability, developmental delay, speech/language disorder, and learning disability. †Crude, weighted prevalence estimates of mental, behavioral, and developmental disorders are shown by diabetes status. ‡aPRs are adjusted by age, sex, and race/ethnicity.

Children aged 2–11 years with diabetes had 2.5-fold higher prevalence of mental, behavioral, and developmental disorders (aPR: 2.45 [1.71–3.50]) and adolescents aged 12–17 years with diabetes had 1.5-fold higher prevalence of mental, behavioral, and developmental disorders (aPR: 1.50 [1.12–2.01]; Figure 3). Mental, emotional, and behavioral disorders were more prevalent among children and adolescents with diabetes within both age groups (2–11 years, aPR: 3.24 [2.14–4.90]; 12–17 years, aPR: 1.57 [1.15–2.14]), whereas developmental, learning, and language disorders were significantly more common only for adolescents with diabetes (aPR: 2.09 [1.45–3.02]). Among individual mental, emotional, or behavioral disorders (data not shown), all but ADHD were higher in younger children with diabetes. Among developmental, learning, or language disorders, only ASD prevalence was higher in younger children with diabetes. Among adolescents, all examined mental, behavioral, or developmental disorders were higher in adolescents with diabetes, with the exception of Tourette syndrome. Among younger children, significant interaction was observed between diabetes and race/ethnicity (P = .009), with the highest odds of prevalent mental, behavioral, or developmental disorders among non-Hispanic Black children with diabetes. However, stratified prevalence estimates had RSE>30%, thus are not reported.

Figure 3.

Figure 3.

Open in a new tab

Prevalence of mental, behavioral, and developmental disorders* among younger children 2–11 and adolescents 12–17 years with and without diabetes, National Survey of Children’s Health, 2016–2019. *Mental, behavioral, and developmental disorders reported here include parent-reported current diagnosis of any of the following mental, emotional, and behavioral disorders: depression, anxiety, disruptive behavior disorders, attention-deficit/hyperactivity disorder, and Tourette syndrome, and the following developmental, learning, and language disorders: autism spectrum disorder, intellectual disability, developmental delay, speech/language disorder, and learning disability. †Crude, weighted prevalence estimates of mental, behavioral, and developmental disorders are shown by diabetes status. ‡aPRs are adjusted by age, sex, and race/ethnicity.

Severity and Treatment of Mental, Behavioral, and Developmental Disorders

Among children and adolescents with a mental, behavioral, or developmental disorder, perceived parent-reported severe disruptive behavior disorder and all developmental, learning, and language disorders were more prevalent in children with diabetes than in children without diabetes (Figure 4). In age-stratified analyses (data not shown), the prevalence of severe developmental, learning, and language disorders was similarly elevated in both younger children (aPR: 1.56 [1.17–2.08]) and adolescents (aPR: 1.38 [1.09–1.75]). The prevalence of severe disruptive behavior disorder was higher among younger children with diabetes (aPR: 1.60 [1.38–1.85]), but not among adolescents. Utilization of treatment services or medication for mental, behavioral, or developmental disorders did not differ significantly by diabetes status (Figure 4).

Figure 4.

Figure 4.

Open in a new tab

Perceived* severity and treatment of mental, behavioral, and developmental disorders† in children and adolescents (2–17 years) with or without diabetes, National Survey of Children’s Health, 2016–2019. *Parents reported severity of individual mental, behavioral, or developmental disorders as mild, moderate, or severe. Both moderate and severe responses are grouped into the severe category. Only children with a given mental, behavioral, or developmental disorder are included within each analysis. †Mental, behavioral, and developmental disorders reported here include parent-reported current diagnosis of any of the following mental, emotional, and behavioral disorders: depression, anxiety, disruptive behavior disorders, ADHD, and Tourette syndrome, and the following developmental, learning, and language disorders: ASD, intellectual disability, developmental delay, speech/language disorder, and learning disability. ‡Crude, weighted prevalence estimates of mental, behavioral, and developmental disorders are shown by diabetes status. §aPRs are adjusted by age, sex, and race/ethnicity. ¶Child received any behavioral treatment, developmental services, or mental health medication in the last 12 months.

Discussion

Children and adolescents with diabetes had significantly higher prevalence of all examined mental, behavioral, or developmental disorders, which were on average approximately 2-fold higher than in children and adolescents without diabetes. These findings are consistent with previous reports of higher anxiety and depression among individuals with diabetes1–4,24 and are now extended to developmental and learning disabilities. Children and adolescents with diabetes had both greater prevalence of any and of severe developmental, learning, or language disorder as reported by parents.

Similar to prior findings,25 mental, behavioral, and developmental disorders were associated with greater reported socioeconomic risks, such as lower family income, having public-only insurance, and reporting unmet health care needs. Although mental, behavioral, and developmental disorders were also associated with family and community problems in children without diabetes, these differences were not observed among children and adolescents with diabetes. It is possible that having diabetes compounded risk such that having a mental, behavioral, or developmental disorder did not make an additional difference; however, the small sample size in the group with both diabetes and mental, behavioral, or developmental disorders limits ability to assess this hypothesis.

Mental, emotional, and behavioral disorders were significantly higher in both younger children (aPR: 3.24) and adolescents (aPR: 1.57) compared with their peers without diabetes. The higher prevalence of mental, emotional, and behavioral disorders among younger children with diabetes could be due to factors such as a new diabetes diagnosis and potentially higher diabetes severity in younger children.26,27 The highest likelihood for diagnosis of a psychiatric condition is during the first year after diabetes diagnosis, suggesting considerable stress and possible risk for mental, emotional, and behavioral disorder onset associated with diabetes diagnosis, which may be amenable to early intervention.26 In the present study, mental, emotional, and behavioral disorder prevalence was slightly lower in older than younger children with diabetes. Differences in genetic and autoimmune profiles have been shown in youth with type 1 diabetes diagnosed at younger ages compared with older ages.28,29 Earlier diagnosis (<7 years) with type 1 diabetes is associated with a more aberrant proinsulin processing and lower C-peptide levels than in children diagnosed at ≥13 years.27 Additionally, younger children have higher rates of diabetic ketoacidosis at the time of diabetes diagnosis30; cortisol hypersecretion is associated with acute onset of diabetic ketoacidosis.31 Whether a more severe endotype associated with earlier type 1 diabetes diagnosis is also associated with more severe mental health comorbidities warrants future investigation. Higher prevalence of depression has been reported among youth with type 2 diabetes than with type 1 diabetes.32,33

More than one-third of children and adolescents with diabetes were reported to have a mental, emotional, and/or behavioral disorder. Comparably, 20–30% of children and adolescents with diabetes screened for symptoms of depression or anxiety, with 20% of those reporting self-harm not having a documented referral to mental health services.34 These findings underscore the need to implement mental health screening as a part of routine care in diabetes in children and adolescents, as well as facilitating proper follow-up when children and adolescents show signs of mental disorders. Appropriate intervention may then improve outcomes such as glycemic control and quality of life.35

Higher prevalence of mental disorders is not unique to diabetes and is also observed among other chronic disorders, including coronary heart disease,36 cancer,37 and chronic obstructive pulmonary disorder.38 In the present data set, secondary analysis of mental, behavioral, or developmental disorder prevalence among children and adolescents with allergies, arthritis, asthma, and heart conditions showed similar elevated burden of mental, behavioral, and developmental disorders compared with diabetes (data not shown), suggesting other chronic conditions could benefit from similar analyses for associations with mental, behavioral, and developmental disorders. Adding to the complexity in understanding those at risk, the association of mental, emotional, and behavioral disorders and diabetes is potentially bidirectional. For example, diabetes may put youth at higher risk for developing depression and anxiety, and depression may increase risk of type 2 diabetes.19–21 In addition, our data suggest that enhanced support and intervention services are likely universally needed for youth with chronic disorders including, but not limited to, diabetes. Estimates of mental, behavioral, or developmental disorder treatment did not significantly differ by diabetes status in children and adolescents with mental, behavioral, or developmental disorders, suggesting children and adolescents with diabetes were getting similar levels of behavioral treatment, developmental services, and medications as their peers without diabetes. All groups reported high rates (>50%) of insufficient mental or behavioral health insurance coverage, supporting the need to improve access to mental health services among all children and adolescents.

This report is subject to several limitations. Estimates from NSCH rely on parent report of diagnosis by a health care provider or educator and parent estimate of mental, behavioral, or developmental disorder severity, both of which may be impacted by recall bias and misclassification error. This concern is mitigated by previous evidence of the validity of NSCH parent report in measuring ADHD and ASD.39,40 NSCH did not include an exhaustive list of mental, behavioral, and developmental disorders, some of which may be important for children and adolescents with diabetes (eg, eating disorders). Therefore, the lack of reported mental, behavioral, and developmental disorders cannot be interpreted as complete absence of diagnoses. Furthermore, NSCH cannot distinguish diabetes type, limiting ability to capture differences in mental, behavioral, and developmental disorder burden between type 1 and 2 diabetes. However, in this age range, over 80% of diagnoses would be type 1 diabetes.23 NSCH did not include questions on diabetes medication use, which would help to identify true cases of diabetes in this age group. The survey design is cross-sectional, thus preventing the ability to track individuals longitudinally and determine temporality. Finally, age-stratified individual mental, behavioral, or developmental disorder estimates were statistically unreliable due to small sample sizes and are not presented.

These results suggest a significant health burden, with approximately 2 in 5 children and adolescents with diabetes having a mental, behavioral, or developmental disorder. Future work examining the directionality of the relationship between mental, behavioral, and developmental disorders and diabetes, as well as potential causal pathways, could inform best practices for screening, comprehensive diagnoses, monitoring of children and adolescents over time and development, and integrated treatment approaches when multiple diagnoses are present. Appropriate treatment and monitoring of both diabetes and mental, behavioral, and developmental disorders with multidisciplinary, collaborative care and a support team may be needed in children and adolescents with these disorders.

Supplementary Material

Supplementary material

Acknowledgments

The authors would like to thank Benjamin Zablotsky, PhD, CDC, for critical discussion during study design, and Carla Mercado, PhD, CDC, and Meda Pavkov, MD, PhD, CDC, for contributions during study design and editing.

Glossary

ADHD

Attention-deficit/hyperactivity disorder

aPR

Adjusted prevalence ratio

ASD

Autism spectrum disorder

NSCH

National Survey of Children’s Health

RSE

Relative standard error

Footnotes

The authors declare no conflicts of interest.

Portions of this study were presented as a poster during the American Diabetes Association meeting, June 25–29, 2021, virtual.

References

  • 1.Bernstein CM, Stockwell MS, Gallagher MP, Rosenthal SL, Soren K. Mental health issues in adolescents and young adults with type 1 diabetes: prevalence and impact on glycemic control. Clinical Pediatrics 2012;52:10–5. [DOI] [PubMed] [Google Scholar]
  • 2.Butwicka A, Fendler W, Zalepa A, Szadkowska A, Zawodniak-Szalapska M, Gmitrowicz A, et al. Psychiatric disorders and health-related quality of life in children with type 1 diabetes mellitus. Psychosomatics 2016;57: 185–93. [DOI] [PubMed] [Google Scholar]
  • 3.Ducat L, Philipson LH, Anderson BJ. The mental health comorbidities of diabetes. JAMA 2014;312:691–2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Dybdal D, Tolstrup JS, Sildorf SM, Boisen KA, Svensson J, Skovgaard AM, et al. Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: a population-based cohort study. Diabetologia 2018;61:831–8. [DOI] [PubMed] [Google Scholar]
  • 5.Gaudieri PA, Chen R, Greer TF, Holmes CS. Cognitive function in children with type 1 diabetes. A Meta-Analysis 2008;31:1892–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Maine A, Brown M, Truesdale M. Diabetes and people with learning disabilities: issues for policy, practice, and education. Tizard Learning Disability Review 2020;25:26–34. [Google Scholar]
  • 7.Chen MH, Pan TL, Hsu JW, Huang KL, Su TP, Li CT, et al. Risk of type 2 diabetes in adolescents and young adults with attention-deficit/hyperactivity disorder: a nationwide longitudinal study. J Clin Psychiatry 2018;79. [DOI] [PubMed] [Google Scholar]
  • 8.Divers J, Mayer-Davis EJ, Lawrence JM, Isom S, Dabelea D, Dolan L, et al. Trends in incidence of type 1 and type 2 diabetes among youths - selected counties and Indian Reservations, United States, 2002–2015. MMWR Morb Mortal Wkly Rep 2020;69:161–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA 2014;311:1778–86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Zablotsky B, Black LI, Maenner MJ, Schieve LA, Danielson ML, Bitsko RH, et al. Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009–2017. Pediatrics 2019;144: e20190811. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Cree RA, Bitsko RH, Robinson LR, Holbrook JR, Danielson ML, Smith C, et al. Health Care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2–8 years - United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1377–83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Holt RIG, de Groot M, Golden SH. Diabetes and depression. Current Diabetes Reports 2014;14:491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Butler AM. Social determinants of health and racial/ethnic disparities in type 2 diabetes in youth. Curr Diab Rep 2017;17:60. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Rush E, Simmons D. Physical activity in children: prevention of obesity and type 2 diabetes. Med Sport Sci 2014;60:113–21. [DOI] [PubMed] [Google Scholar]
  • 15.Rommel AS, Lichtenstein P, Rydell M, Kuja-Halkola R, Asherson P, Kuntsi J, et al. Is physical activity causally associated with symptoms of attention-deficit/hyperactivity disorder? J Am Acad Child Adolesc Psychiatry 2015;54:565–70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Belair MA, Kohen DE, Kingsbury M, Colman I. Relationship between leisure time physical activity, sedentary behaviour and symptoms of depression and anxiety: evidence from a population-based sample of Canadian adolescents. BMJ Open 2018;8:e021119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Leboyer M, Berk M, Yolken RH, Tamouza R, Kupfer D, Groc L. Immuno-psychiatry: an agenda for clinical practice and innovative research. BMC Med 2016;14:173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Hagger V, Hendrieckx C, Sturt J, Skinner TC, Speight J. Diabetes Distress Among Adolescents with Type 1 Diabetes: a Systematic Review. Current Diabetes Reports 2016;16:9. [DOI] [PubMed] [Google Scholar]
  • 19.Johnson B, Eiser C, Young V, Brierley S, Heller S. Prevalence of depression among young people with Type 1 diabetes: a systematic review. Diabetic Medicine 2013;30:199–208. [DOI] [PubMed] [Google Scholar]
  • 20.Buchberger B, Huppertz H, Krabbe L, Lux B, Mattivi JT,Siafarikas A.Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology 2016;70:70–84. [DOI] [PubMed] [Google Scholar]
  • 21.Suglia SF, Demmer RT, Wahi R, Keyes KM, Koenen KC. Depressive Symptoms During Adolescence and Young Adulthood and the Development of Type 2 Diabetes Mellitus. Am J Epidemiol 2016;183:269–76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Herzer M, Hood KK. Anxiety symptoms in adolescents with type 1 diabetes: association with blood glucose monitoring and glycemic control. J Pediatr Psychol 2010;35:415–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Lawrence JM, Divers J, Isom S, Saydah S, Imperatore G, Pihoker C, et al. Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001–2017. JAMA 2021;326:717–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Canadian Diabetes Association Clinical Practice Guidelines Expert C, Robinson DJ, Luthra M, Vallis M. Diabetes and mental health. Can J Diabetes 2013;37(Suppl 1):S87–92. [DOI] [PubMed] [Google Scholar]
  • 25.Bitsko RH, Holbrook JR, Robinson LR, Kaminski JW, Ghandour R, Smith C, et al. Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders in Early Childhood - United States,2011–2012. MMWR Morb Mortal Wkly Rep 2016;65:221–6. [DOI] [PubMed] [Google Scholar]
  • 26.Kovacs M, Goldston D, Obrosky DS, Bonar LK. Psychiatric Disorders in Youths With IDDM: Rates and Risk Factors. Diabetes Care 1997;20:36–44. [DOI] [PubMed] [Google Scholar]
  • 27.Leete P, Oram RA, McDonald TJ, Shields BM, Ziller C, Roep BO, et al. Studies of insulin and proinsulin in pancreas and serum support the existence of aetiopathological endotypes of type 1 diabetes associated with age at diagnosis. Diabetologia 2020;63:1258–67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Felner EI, Klitz W, Ham M, Lazaro AM, Stastny P, Dupont B, et al. Genetic interaction among three genomic regions creates distinct contributions to early- and late-onset type 1 diabetes mellitus. Pediatr Diabetes 2005;6:213–20. [DOI] [PubMed] [Google Scholar]
  • 29.Hathout EH, Hartwick N, Fagoaga OR, Colacino AR, Sharkey J, Racine M, et al. Clinical, autoimmune, and HLA characteristics of children diagnosed with type 1 diabetes before 5 years of age. Pediatrics 2003;111:860–3. [DOI] [PubMed] [Google Scholar]
  • 30.Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics 2008;121: e1258–66. [DOI] [PubMed] [Google Scholar]
  • 31.MacGillivray MH, Bruck E, Voorhess ML. Acute Diabetic Ketoacidosis in Children: Role of the Stress Hormones. Pediatric Research 1981;15: 99–106. [DOI] [PubMed] [Google Scholar]
  • 32.Lawrence JM, Standiford DA, Loots B, Klingensmith GJ, Williams DE, Ruggiero A, et al. Prevalence and Correlates of Depressed Mood Among Youth With Diabetes: The SEARCH for Diabetes in Youth Study. Pediatrics 2006;117:1348–58. [DOI] [PubMed] [Google Scholar]
  • 33.Hood KK, Beavers DP, Yi-Frazier J, Bell R, Dabelea D, McKeown RE, et al. Psychosocial burden and glycemic control during the first 6 years of diabetes: results from the SEARCH for Diabetes in Youth study. J Adolesc Health 2014;55:498–504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Nakhla M, Shulman R, Dimeglio L. Mental Health Matters: Limited Support Remains a Barrier to Optimal Care for Youth With Diabetes. Can J Diabetes 2021;45:379–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Hilliard ME, De Wit M, Wasserman RM, Butler AM, Evans M, Weiss-berg-Benchell J, et al. Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers. Pediatr Diabetes 2018;19:534–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Davidson KW, Alc antara C, Miller GE. Selected psychological comorbidities in coronary heart disease: Challenges and grand opportunities. Am Psychol 2018;73:1019–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Nakash O, Levav I, Aguilar-Gaxiola S, Alonso J, Andrade LH, Angermeyer MC, et al. Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys. Psychooncology 2014;23:40–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Puteikis K, Mameniskiene R, Jureviciene E. Neurological and Psychiatric Comorbidities in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021;16:553–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Visser SN, Danielson ML, Bitsko RH, Perou R, Blumberg SJ. Convergent validity of parent-reported attention-deficit/hyperactivity disorder diagnosis: a cross-study comparison. JAMA Pediatr 2013;167: 674–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Kogan MD, Vladutiu CJ, Schieve LA, Ghandour RM, Blumberg SJ, Zablotsky B, et al. The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics 2018;142. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary material
NIHMS1979829-supplement-Supplementary_material.docx (22.1KB, docx)

RESOURCES