Abstract
Objective
A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors.
Methods
A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included.
Results
Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5–60.7%, n = 13 studies), anxiety (7–27.5%, n = 16 studies), and distress (14–86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality.
Conclusions
Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.
Keywords: Anxiety, COVID-19 pandemic, Distress, Depression, Mental health, Type 1 diabetes
1. Introduction
The COVID-19 pandemic has been established as an unprecedented threat to public health that has created significant psychological pressure. The economic recession, financial loss, and measures containing the spread of infection (i.e., home confinement and isolation, physical distancing, school and workplace closures, and social contact deprivation and related overuse of social media and the Internet) are psychological stressors that may lead to experiencing worry, uncertainty about the future, loneliness, and fear, along with developing negative psychological repercussions. According to recent literature, COVID-19 was found to seriously impact the mental health of the general population and to be associated with higher rates of anxiety, depression, and psychological distress [[1], [2], [3]].
People with type 1 diabetes (T1D), who are generally considered to be at greater risk for psychological difficulties [[4], [5], [6]], may be particularly vulnerable to the mental distress stemming from the uncertainties and fears associated with the virus's outbreak. In particular, difficulties in access to health services, risk of treatment interruption, fear of a greater vulnerability to infection due to suffering from a chronic disease, and fear of running out of diabetes supplies may be considered as potential stressors that are unique to individuals with T1D. It is necessary to consider that, on a daily basis, individuals with T1D must deal with a complex and challenging treatment regimen that requires frequent self-monitoring of blood glucose levels, carbohydrate controlling and counting, insulin administration, and adjustments of insulin doses based on food intake and physical activity. The general psychological burden of this psychologically demanding disease might have combined with the psychological stressors of a pandemic, burdening individuals with T1D with further psychological pressure and problems.
Additionally, it should be noted that in individuals with T1D, potential co-morbid psychopathology is generally recognized as being linked with a greater risk of poorer diabetes management and poorer physical health [7,8], which in turn may increase diabetes complications and, consequently, the cost of health care service.
Given that the psychological consequences of a pandemic may be more relevant and traumatic than pandemic itself—potentially leading to important psychosocial and economic impacts in subsequent years—as well as the potential severe and enduring effects of mental health problems on physical health (especially among individuals with T1D), the psychological impact of COVID-19 should be a priority for public health research, and it requires dedicated attention. Therefore, it is crucial to review existing studies on this topic as a first step to providing appropriate policies assisting people with T1D during this challenging time.
To date, there is a lack of systematic reviews focused specifically on the mental health effects experienced by individuals with T1D during the COVID-19 pandemic. Two previous reviews looked at pandemic-related psychological repercussions on people with diabetes and with chronic diseases, but they were somewhat limited in their depth [[9]: only 6 empirical studies on T1D; [10]: only 3 empirical studies on T1D] and in their distribution (neither appeared in a major electronic database).
The aim of the present systematic review is to analyze the extant literature, assessing the impact of the COVID-19 pandemic on the mental health of individuals with T1D. Specifically, the objectives of this study are: 1) to report the prevalence of main psychological problems and psychopathological disorders in individuals with T1D during the pandemic; 2) to identify sociodemographic and clinical factors associated with psychological/psychopathological problems.
2. Methods
A systematic search was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [11,12]. The protocol of this systematic review was registered with OSF (it is available on: osf.io/r87s6; https://archive.org/details/osf-registrations-jvadq-v1).
2.1. Search strategy
The following electronic databases was used in this search: PsycInfo, PsycArticles, ProQuest, Pubmed, WoS and Scopus; no date restrictions were used. The search strategy utilized search terms in titles and/or abstracts for diabetes (i.e., “type 1 diabetes”, “diabetic”, “insulin dependent diabetes mellitus”) in combination with terms for COVID-19 (i.e., “COVID-19”, “pandemic”, “lockdown”, “coronavirus”, “2019-ncov”, “sars-cov-2”, “cov-19”, “coronavirus disease 2019”, “coronavirus infection”, “2019 novel coronavirus infection”) and terms for psychological diseases (i.e., “mental health”, “mental illness”, “mental disorder”, “psychiatric illness”, “psychological impact”, “psychosocial disease”, “depression”, “anxiety”, “stress”). In addition, a manual search of relevant studies on Google Scholar was carried out.
The research was conducted from April 15 through May 15, 2022.
2.2. Study selection
The study selection process is shown in the PRISMA 2009 flow diagram (Fig. 1 ). The titles and abstract of each article were subjected to an initial screening evaluating their relevance. Case reports, treatment studies, commentaries, letters to editors, editorials, non-original studies (e.g., reviews and meta-analyses), books chapters, notes, guidelines, books chapters, and conference papers were excluded.
Fig. 1.
PRISMA Flow Diagram describing the study selection process.
After the initial screening, articles' full texts were assessed in more detail for their eligibility. The inclusion criteria were as follows: (1) observational studies (cohort, longitudinal, case–control, cross-sectional); (2) examination of mental health problems (and related aspects) in individuals with T1D; (3) the presentation of quantitative data; and (4) the availability of the full text in English. Studies were excluded if they: (1) only measured mental health problems in individuals with type 2 diabetes (T2D); (2) were not fully relevant (e.g., studies that focus exclusively on diabetes management outcomes and not on psychological/psychopathological aspects); (3) were not peer-reviewed; and (4) did not have full-text availability in English. Gray literature was not included.
Two investigators (CC and BP) independently assessed all articles for eligibility in an unblinded standardized manner, and any inconsistencies were discussed and resolved with a third investigator (AT).
2.3. Data collection process
A data extraction sheet was developed. From each study, the following relevant data were extracted: study citations (name of the first authors, year of publication), country where the study was carried out, participants' characteristics, study design, data collection period, sample size, assessment tools, data collection method, study findings (prevalence of psychological/psychopathological problems), and associated factors.
2.4. Risk of bias across studies
All articles that were deemed suitable for inclusion were assessed for quality/risk of bias in observational studies using the Newcastle–Ottawa Scale (NOS); the original scale was for cohort and case-control studies (scores of 0–9) [13] and was adapted for cross-sectional studies (scores of 0–10), as used in previously published literature [3,14]. This assessment was performed by three independent reviewers (AT, CC, and BP), and disagreements were resolved by consensus. Higher scores indicated research of better quality, while studies scoring <5 points were considered to have a high risk of bias [15].
2.5. Data synthesis
Because of the great methodological heterogeneity—especially in how mental health outcomes were measured and reported—no meta-analysis of the investigated studies was performed. Instead, findings were synthetized through a narrative approach and summarized in tables. Results were also stratified in such a way as to distinguish studies whose data were collected by using patient report measures vis-à-vis parent/healthcare report measures.
3. Results
3.1. Search results
Study identification through the database searches resulted in retrieving a total of 7640 publications. After the papers were put through extensive scrutiny of their titles and abstract, 100 underwent full-text screening; of those, 44 studies met the criteria to be included in the final sample for this systematic review (Fig. 1).
3.2. Study characteristics
The characteristics of the included studies and primary findings are summarized in Table 1 .
Table 1.
Characteristics and data of included studies (n = 44).
| Author (year) | Country | Study design (data collection period) | Sample size | Sample characteristics | Assessment tools (data collection method) | Prevalence n/tot (%) | Associated factors | Quality appraisal total score |
|---|---|---|---|---|---|---|---|---|
| [36] | US, Brazil, Iran | Cross-sectional (April 1st–June 30th 2020) |
1788 individuals with T1D (1099 US, 477 Brazil, 212 Iran) | Median age: (Iran) 29, (Brazil) 28.87, (US) 45 Gender: US (839 f), Brazil (396 f), Iran (160 f) Mean T1D duration: NR (median time of diagnosis: (US) 25, (Brazil) 14, (Iran) 11) |
The Type 1-Diabetes Distress Scale (T1-DDS) to assess diabetes distress. Diabetes Burnout Scale (DBS) to assess diabetes burnout. Patient Health Questionnaire (PHQ-8) to assess depressive symptoms. (Online survey via social media). |
The Iranian sample had the highest prevalence of high diabetes distress (57.1%), compared to Brazil (30.8%) and the US (13.4%) (p < .0001). The mean scores of diabetes burnout varied between the three countries (Iran = 3.0; Brazil = 2.6; US = 2.3; (p < .0001); in Iran, 50% reported moderate to severe burnout, compared to 30.8% in Brazil and 22.57% in US. 26.4% of US participants, 52.8% of Brazilian participants, and 60.9% of Iranian participants were classified as having moderately severe or severe depressive symptoms (p < .0001). |
Female, younger, single participants, with lower educational levels, higher HbA1c levels, and lower TiR, who experienced difficulties in access to or changes in diabetes self-care behaviors, are most likely to present lower levels of psychosocial well-being (as higher distress, levels of diabetes burnout, and depressive symptoms). | 5 |
| [52] | India | Cross-sectional (30th April – 10th May 2020) |
89 youths with T1D | Mean age: 19.61 ± 3.8 (range 12–24 years) Gender: 43 f Mean diabetes duration: 8.4 ± 5.0 years |
Perceived Stress Scale (PSS-10) to evaluate stress (Online survey via social media) |
51.7% (n = 46) reported moderate stress; 42.7% (n = 38) reported low stress; 5.5% (n = 5) reported severe stress. | Female participants, graduates and post-graduates, those who were employed, and those who were reportedly dissatisfied with pandemic-related information were found to have significantly higher PSS-10 scores. PSS-10 scores were positively correlated with age and HBA1C level within the preceding 3 months. Those with a higher mean PSS-10 score reported worsened glycemic control on SMBG in the preceding 4 weeks and more common self-reported worsening of glycemic control. |
4 |
| [33]† | Saudi Arabia | Cross-sectional (5th May 2020-21th April 2021) |
568 individuals with diabetes (T1D n = 316) 1598 individuals without diabetes |
Mean age with diabetes: NR (Age ≤ 30: 33%, 31–40: 12%, 41–50: 20%, >50: 35%) Gender (whole sample): 326 f Mean diabetes duration: NR (< 1: 10.81%, 1 – <5: 22.88%, 5 - <10: 20%, ≥ 10: 46.31%) |
Patient Health Questionnaire (PHQ-9) to assess symptoms of depression 7-item Generalized Anxiety Disorder (GAD-7) scale to assess symptoms of anxiety Participants were asked to choose from a list (designed ad hoc) of potential stressors/issues that concerned them the most during the COVID-19 outbreak and could have contributed to any anxiety or depression symptoms they may have. (Online survey via social media) |
(Participants with diabetes) 60.74% had depressive symptoms and 44.54% had anxiety symptoms during the COVID-19 outbreak (no differences between people with and without diabetes). Those who had their diabetes clinic visit canceled during the outbreak were more likely to report depression and anxiety symptoms compared to those who did not have an appointment canceled (both p < .01). The ORs of those with depression and anxiety symptoms were not significantly different for participants with diabetes who had their diabetes clinic visit canceled during the outbreak (OR, 1.28 [95% CI, 1.00, 1.64] and OR, 1.31 [95% CIs, 1.04, 1.65] for depression and anxiety, respectively) compared to those for people without diabetes. |
Individuals with diabetes who had their diabetes clinic visit canceled during the outbreak, who had no method of telecommunication with their diabetes care providers during the pandemic, who had HbA1c levels of ≥10%, and who reported having higher glucose levels during the outbreak than prior to the outbreak were more likely to report depression and/or anxiety symptoms. Fears of infection, running out of diabetes medications, or requiring hospitalization for hypoglycemia, hyperglycemia, or diabetic ketoacidosis, together with a lack of telecommunication with HCPs, and feeling worried when following the news about COVID-19 were all associated with significantly higher odds of having depression and anxiety symptoms. |
5 |
| [37] | Brazil | Cross-sectional (1 month after the disclosure of the national ordinance that standardizes the social distancing) |
120 individuals with diabetes (T1D n = 52) | Mean age (T1D): 45.0 ± 14.2 Gender (T1D): 25 f Mean T1D duration: 25.2 ± 11.5 |
Self-Report Questionnaire-20 (SRQ 20) to assess psychological distress Problem Areas in Diabetes Scale (B-PAID) to assess diabetes-related emotional distress Eating Attitudes Test (EAT-26) to assess the prevalence of eating disorders Mini Sleep Questionnaire (MSQ) to assess sleep disorders (Telephone interview) |
(T1D) 94.2% had some sign of a psychiatric disorder (assessed by a positive screening in at least one of the specific scales measured in the study): 32.7% had a positive screening for psychological distress (based on the SRQ 20), 78.8% for eating disorders, 28.8% for diabetes-related emotional distress, and 76.9% for sleeping disorders. (Whole sample): 6.7% showed suicidal ideation. |
BMI was found to have no impact on the interaction between positive screenings for eating and sleeping disorders and type of diabetes. | 7 |
| [16] | Saudi Arabia | Cross-sectional (after lockdown) |
143 Individuals with T1D | Mean age: 29.6 ± 1.8 Gender: 76 f Mean T1D duration: NR |
Ad hoc structured questionnaire evaluating psychological effects psychological impact of the epidemic period (Online questionnaire via e-mail) |
23% were affected psychologically by COVID-19. | No gender differences in psychological impact. | 1 |
| [31] | Saudi Arabia | Cross-sectional (30th October - 28th February 2021) |
164 children with T1D | Mean age: 12.45 ± 3.66 Gender: 90 f Mean T1D duration: NR |
Ad hoc two questions to assess psychological health (Telephone interview) |
COVID-19 lockdown did not have a negative effect on children's psychological status: 47% never experienced any symptoms suggestive of depression or change in mood during the lockdown (p = .123). | NR | 3 |
| [18] | Italy | Cross-sectional (30th May and 13th June 2020, i.e., when the restrictions ended, post- lockdown) |
50 individuals with T1D | Mean age: 40.7 ± 13.5 Gender: 19 f Mean T1D duration: 17.7 ± 9.7 |
Perceived stress scale (PSS) to evaluate perceived stress (Telephone interview) |
14% experienced severe and 61% moderate perceived stress. | Patients with higher perceived stress had greater frequency of severe hypoglycemia. | 6 |
| [19] | Italy | Cohort study⁎ (April 2020) |
48 individuals with T1D | Mean age: 42.4 ± 15.9 Gender: 23 f Mean T1D duration: NR |
General Health Questionnaire-12 items (GHQ-12) to assess general psychiatric well-being (Telephone interview) |
50% reported a score above the ≥4 cut-off level, indicating risk of mild psychological distress. | The total GHQ‐12 score did not differ according to changes in working habits. | 4 |
| [26] | US | Cohort study (15th March 2020 - 14th March 2021, 14th March is approximate day that COVID restrictions were imposed in Dallas County) |
About 1600 children and adolescents with T1D (evaluated in 1 year periods preceding and following the local imposition of COVID-related restrictions) | Mean age: 13.8 ± 3.6 Gender: 755 f Mean T1D duration: NR |
Patient Health Questionnaire-9 (PHQ-9), to assess depression (administered to patients with T1D >10 years who were seen in person). (In-person and virtual outpatient encounters) |
No significant change in incidence of depression during the first year of the COVID-19 pandemic (compared with the preceding year). | Female gender was the only demographic factor associated with PHQ-9 increased scores. | 7 |
| [21] | Italy | Cohort study⁎ (30th March - 12th April 2020, collection psychological data) |
117 youths with T1D | Mean age: 15.9 ± 2.3 Gender: 52 f Mean T1D duration: 7.9 ± 4.6 |
Test of anxiety and depression in childhood and adolescence (TAD) to screen the presence of anxiety and depression disorders (Telephone interview, online questionnaire via e-mail) |
14 participants (16%) had a significant score for depression, and 6 participants (7%) had a significant score for anxiety (score ≥ 115). | A higher score for depression and anxiety was associated with lower TIR (when adjusted for age, sex, and diabetes duration). | 6 |
| [43] | Poland | Cross-sectional (April 14th - May 11th, 2020, i.e., during the pandemic lockdown) |
20 individuals with T1Dwho asked for psychological intervention compared to 39 individuals with T1Dwho did not ask for psychological intervention |
Mean age (patients who asked for psychological consultation): 25 years Gender (patients who asked for psychological consultation): 13 f Mean T1D duration: NR |
ICD-10 to formulate psychiatric diagnosis The Coping Inventory for Stressful Situations (CISS) to assess coping style The State-Trait Anxiety Inventory (STAI) to measure trait and state anxiety. The Perceived Stress Scale-10 (PSS-10) to assess the perception of stress. The General Health Questionnaire-30 (GHQ-30) to identify minor psychiatric disorders (Telephone interview) |
7 were diagnosed with anxiety disorder and depression, 5 with a personality disorder, and 2 with an eating disorder (according to ICD-10). 10 of 20 patients who asked for psychological intervention (the other 10 chose to stay anonymous or refused to fill in the questionnaires) had higher levels of anxiety (state anxiety p = .043; trait anxiety p = .022), perceived stress (p = .001), and emotion-focused coping style (p = .001), as well as worse general mental health and higher scale scores (as fear and depression [p < .001], interpersonal relations [p = .01], and general functioning [p = .006) than those who did not seek psychological support. |
NR | 3 |
| [22] | Poland | Case-control (March 2020–May 2020, i.e., first months of pandemic) |
49 individuals with T1D 38 healthy controls |
Mean age (T1D): 29.8 ± 8.9; (control): 37.6 ± 11.8) Gender (T1D): 37 f; (control): 27 f Mean T1D duration 16.2 ± 7.3 |
Coping Inventory for Stressful Situations (CISS) to assess the coping style State-Trait Anxiety Inventory (STAI) to assess trait and state anxiety Perceived Stress Scale (PSS-10) to measure the perception of stress General Health Questionnaire-30 (GHQ-30) for identifying minor psychiatric disorders (Telephone interview, online questionnaire via e-mail) |
The level of stress in both groups (mean, T1D: 21.0 ± 4.1; control 22.2 ± 3.0) was higher than typical for population in non-stressful condition (as indicated by validation studies). No statistically significant differences were found between individuals with T1D and controls in coping style, perceived stress, and trait anxiety (all p > .05), apart from state anxiety (higher in the control group). |
Individuals with a T1D duration >10 years or who lived alone or with only one person more often used task-oriented coping style. Individuals with a T1D duration <10 years and women tended to more often use an avoidance strategy coping style. The global level of psychopathology (measured by GHQ-30) was higher in individuals with T1D who had levels of anxiety that were higher than the general population. Individuals with T1D with higher levels of GHQ (score ≥ 12) more often used emotion-oriented coping strategies, and their general level of anxiety was higher. |
4 |
| [27] | Brazil | Cross-sectional (July 2020) |
427 individuals with T1D | Mean age: NR Age range: 25–44 Gender: 406 f Mean T1D duration: NR |
Ad hoc questionnaire to assess stress for social isolation (Online questionnaire via social media) |
15% did not notice any stress, 50.4% realized little stress, 34.5% realized a lot of stress in the home environment. | Reporting little stress in the home environment was associated with maintaining physical activity; reporting a lot of stress in the home environment was associated with stopping physical activity. | 5 |
| [54] | Italy | Cohort study⁎ (pre-lockdown: 20th February 2020 - 10th March 2020; during lockdown: 11th - 30th March 2020) |
130 individuals with T1D (only n = 76 ≥ 18 years were assessed for psychological variables) | Median age: 45.0 Age range: 29.0–58.1 Gender: 37 f Median T1D duration (adults): 22 years (range: 14.3–30.8) |
10-Item Italian Perceived Stress Scale questionnaire (PSS) to assess the degree to which aspects of the life are perceived as uncontrollable, unpredictable, and overloaded (Telephone interview) |
Mean perceived stress (PSS) score: 14.5 (range 9.8–20)||. | Patients with worsened glucose variability (i.e., worse glucose management during lockdown compared to pre-lockdown) had significantly higher values in the PSS questionnaire than participants belonging to the group with improved variability. | 5 |
| [20] | Italy | Cross-sectional (18th May – 18th June 2020) |
71 children with T1D and their caregivers | Mean age (children): 10.8 ± 2.26; (parents): 43.1 ± 6 Gender (children): 32 f; (parents): 56 f Mean T1D duration: 5.69 ± 2.96 |
Ad hoc survey to evaluate psychological well-being General Health Questionnaire (GHQ-12) to assess caregivers' well-being Strengths and Difficulties Questionnaire (SDQ) to assess psychological functioning in children Spence Children Anxiety Scale (SCAS) to assess children's anxiety symptoms (6 dimensions: panic and agoraphobia, separation anxiety, fears of physical injury, social phobia, obsessive-compulsive problems, and generalized anxiety/overanxious symptoms. (In-person outpatient encounters) |
14.9% of children scored above the clinical cut-off for the SDQ (total score) and 6.7% for the SCAS total. 67.6%/76.5% of caregivers reported that their children's psychological/physical well-being was unvaried or improved immediately after the lockdown; 47.1% reported minor difficulties (as general health, measured by GHQ-12) immediately after the lockdown, 26.5% reported no difficulties, and 26.4% reported important impairment. 50%/63.8% of mothers reported (ad hoc survey) that their psychological/physical well-being was unvaried or improved immediately after the lockdown compared to the period before the COVID-19 pandemic. Children in primary school (7–10 years) had significantly higher separation anxiety scores (p = .006) and lower social anxiety (p = .003) compared with secondary school children (11–14 years). Girls scored significantly higher in fear of physical injury (p = .034), social anxiety (p = .015), and SCAS total score (p = .014) than boys. |
Separation anxiety showed positive association with the percentage of time above the range (as measured at the end of lockdown) and children who perceived fear of COVID-19 infection. Separation anxiety was negatively associated with the children's age, diabetes duration, percentage of time in range (as measured at the end of lockdown), children's autonomy in T1D management, and frequency of contacts with peers. Increases in children's separation anxiety symptoms were predicted by age (younger children), gender (female), diabetes duration (more recent T1D diagnosis), percentage of TiR as measured at the end of lockdown (less time spent in target range), and children's increased perceived fear of COVID-19 infection. |
5 |
| [56] | Egypt | Cross-sectional (after lockdown that started on March 2020) |
115 individuals with T1D and/or their caregivers | Age range: 0–18 years Gender: 62 f Mean T1D duration: NR (T1D duration range: 6 months - >5 years) |
Perceived stress scale-10 (PSS-10) to measure patients'/caregivers' level of stress§ (Online questionnaire) |
76.5% of patients/caregivers showed moderate stress, 23.5% high perceived distress. Severe stress was more evident among caregivers of infants and toddlers with diabetes (p = .017). |
Eating habits and overall diabetes control during the lockdown period was the worst among patients with a diabetes duration of 1–5 years. A significant positive correlation was noticed between PSS-10 and glycemic control (as indicated by HbA1C levels before and after lockdown). |
3 |
| [28] | US | Cohort study⁎ (April 2020) |
1382 individuals with diabetes (T1D n = 763) | Mean age (T1D): 53.3 ± 15.3 Gender (T1D): 546 f Mean T1D duration: 30.05 ± 16.50 |
Ad hoc questions to assess general and diabetes-related stress/distress (e.g., “compared to before the coronavirus pandemic, how would you describe your current overall level of stress or worry?”) (Online survey) |
(T1D) Compared to pre-pandemic, 86.6% reported higher general life stress; 61.8% higher diabetes-related distress; 61.2% reported to be somewhat or very concerned about employment or finances; 85.3% reported greater social isolation. |
A significant correlation was found between higher reported HbA1C levels and greater increases in diabetes-related stress compared to before the pandemic. No association between HbA1c and general life stress. |
2 |
| [34] | Poland | Cross-sectional (6th July - 22th July 2020) |
124 individuals with diabetes (T1D n = 90) (11% of questionnaires were filled in by parents of children with T1D) |
Median age (T1D): 20 (range 17–28) Gender (T1D): 75 f Mean T1D duration: NR (40% >10 years, 17% 5–10 years, 28% 2–5 years, 15% up to 2 years) |
Ad hoc questionnaire to assess stress levels (classified as follows: “low”, “medium”, “high”, and “very high”) (Online survey via social media) |
(T1D) 14% reported high/very high level of stress before pandemic, 29/32% at the beginning of the pandemic, 17/4% currently (p < .001) |
NR | 2 |
| [83] | Northeast Poland | Case-control (December 2020, the peak of the second wave of the COVID-19 pandemic) |
113 individuals with T1D 106 healthy individuals |
Median age (T1D): 25 Age range (T1D): 20–29 Median age (healthy): 22 Age range (healthy): 21–23 Gender (T1D): 113 f Mean T1D duration: NR (28% up to 5 years, 35% 5–10 years, 37% >10 years) |
Questions (in ad hoc survey) to evaluate stress levels; the responses were to refer to the last month preceding the completion of the questionnaire. (Online survey via social media) |
In women with T1D, 26% reported a low stress level, 44% a medium stress level, 23% a high stress level, and 7% a very high stress level. Stress levels distribution in individuals with T1D differed from controls (11% reported a low stress level, 44% a medium stress level, 32% a high stress level, and 13% a very high stress level) (p < .05). |
NR | 3 |
| [35] | Japan | Cohort study (April 16th - May 1st, 2020) |
34 individuals with T1D | Mean age: 59.1 ± 16.0 Gender: 23 f Mean T1D duration: 14.5 ± 16.0 |
Ad hoc questionnaire of six questions to assess how stress levels and lifestyles changed due to the COVID-19 pandemic. (In-person outpatient encounters) |
In 59.3% (19/32) of the participants, increased stress levels were observed during the COVID-19 pandemic. | Stress levels did not correlate with change in HbA1c levels or with change in body weight. | 4 |
| [39]† | Denmark | Cross-sectional (NR, described as “in the initial phase of the COVID-19 pandemic in Denmark”) |
2430 individuals with diabetes (T1D n = 471) | Mean age (whole sample): 61.6 ± 12.9 Gender (whole sample): 685 f Mean diabetes duration: NR |
Three-item UCLA Loneliness Scale to assess general loneliness Ad hoc two questions to assess COVID-specific worries, social relations, diabetes distress, mental health diabetes-related loneliness, diabetes-specific social support (from family, friends, people at work, healthcare professionals, other people in the community and people on social media, questions inspired by the Diabetes Attitudes, Wishes and Needs Support for Diabetes Self-Management Profile) Two-item Brief Diabetes Distress scale (DDS2) to assess diabetes distress (Online survey) |
(Whole sample) 8.5% suffered from mental illness. Participants were most frequently worried about ‘being overly affected due to diabetes if infected with COVID-19’ (56%). About 25% had moderate to high diabetes distress (DDS2 score > 2). 56.8% often or sometimes felt lonely, 28.8% felt isolated from others, 61.1% often or sometimes felt starved for company, 23.1% often or sometimes missed someone to talk to about diabetes, and 32.6% often or sometimes felt alone with their diabetes. 80.2% reported that they received moderate to high levels of support from family, friends, and people close to them; 35.4% received such support from people at work or school, 52.2% from their diabetes care team, 37.2% from other people in the community, 39.8% from other people with diabetes, and 40% from people on social media. |
Compared with people with low/no distress, people who reported moderate to high levels of distress were more likely to be worried about being overly affected if infected, about people with diabetes being characterized as a risk group, and about not being able to manage diabetes if infected. Participants who felt left out, isolated from others, starved for company, missed having someone to talk to about diabetes, and felt lonely with diabetes were more likely to experience worries compared to people who did not experience diabetes-related loneliness. |
6 |
| [17] | Denmark | Longitudinal⁎ (March 19th - June 25th 2020) |
1366 individuals with diabetes in Q1 (T1D n = 461). | Mean age (whole sample): 61.7 ± 12.8 Gender (whole sample): 580 f Mean diabetes duration (whole sample): 19.5 ± 15 |
Copenhagen Corona-Related Mental Health questionnaire diabetes-specific version to assess: worries about COVID-19, quality of life and feelings of social isolation (1–10-point VAS); psychological distress during the COVID-19 pandemic (adapted items form GAD-7, CES-D and Event Scale Revised); diabetes distress (two-items Brief Diabetes Distress Scale, DDS2); anxiety (Symptom Check List-revised anxiety subscale, SCL-ANX4); general loneliness (three-item UCLA Loneliness Scale, UCLA); diabetes-specific loneliness (two questions about the degree of feeling alone with diabetes and missing someone to talk to about diabetes, UCLA-D). (Online survey via e-mail, administered in six waves Q1-Q6) |
(Whole sample) Baseline: 11.7% reported having mental illness (anxiety, depression, or other diagnosis of psychiatric disorder); 24.6% had moderate to severe diabetes distress; 14.6% had a 20% risk or more of an anxiety disorder; 56.9%/61.2% often or sometimes felt lack of company/isolated from others; 28.7% often or sometimes felt left out; 23% often or sometimes missed having someone to talk to about diabetes; and 32% often or sometimes felt alone with their diabetes. In comparisons of COVID-19-specific worries from Q1 to Q5/Q6, feelings of social isolation, psychological distress, anxiety, and general loneliness all improved (p < .001), while diabetes-specific loneliness and diabetes distress remained stable (p > .05). Quality of life decreased at Q2 (p = .016), Q3 (p < .001), and Q4 (p = .002) compared to Q1, and remained at that level through Q6. Anxiety increased in respondents with T2D compared to respondents with T1D at Q2 (p = .024), Q3 (p = .025), and Q4 (p = .001) relative to Q1. |
Respondents with two or more diabetes complications had a greater increase at Q6 relative to Q1 in feelings of social isolation, a greater increase in diabetes distress at Q5, and a greater decrease in general loneliness at Q4, compared to respondents without complications. Respondents with high HbA1c levels (>70 mmol/mol / 11.1%) had increased diabetes-specific loneliness scores at Q5 and Q6 relative to Q1 compared to respondents with low HbA1c levels. Women had larger decreases in feelings of social isolation, anxiety, and psychological distress, and larger increases in quality of life, compared to men. |
5 |
| [57] | Saudi Arabia | Cross-sectional (June 21th -23th 2020, i.e., three days after the lockdown ended in Saudi Arabia). |
65 adults with T1D | Mean age: 30 ± 7.88 Gender: 46 f Mean T1D duration: 17.67 ± 6.89 |
Arabic versions of the Patient Health Questionnaire-9 (PHQ-9) to assess depression General Anxiety Disorder-7 (GAD-7) scales to measure anxiety. (Online survey via social media) |
23.1% had moderate to severe depression (PHQ-9 score ≥ 10), 29.2% had mild depression. 18.5% had moderate to severe anxiety (GAD-7 score ≥ 10), 24.6% had mild anxiety. 13% had combined moderate to severe depression and anxiety. |
Those who reported a previous diagnosis of mental disorder (6 patients, 9.2%) were significantly more likely to have moderate to severe depression and moderate to severe anxiety than those who did not have a history of mental disorders. | 3 |
| [40] | US (including Alaska and Hawaii) | Longitudinal (data from baseline collected from 29th May 2020 – 30th June 2020) |
2176 participants, 580 with diabetes (T1D n = 100) | Mean age (T1D): 42.96 ± 14.47 Gender (T1D): 72 f Mean T1D duration: NR (mean age at T1D diagnosis: 18.3 ± 9.89) |
Questions assessing the effects of COVID-19 on the participants. Diabetes Distress Scale-17 (DDS) to measure emotional burden, physician-related distress, regimen-related distress, and interpersonal distress specific to diabetes Patient Health Questionnaire depression scale (PHQ-8) to assess depressive symptoms according to DSM −5 criteria Generalized Anxiety Disorder (GAD-7) to assess symptoms of generalized anxiety disorder based on DSM-IV Perceived Stress Scale (PSS) to measure the perception of stress in the past month Brief Resilience Scale (BRS) to assess resilience (Online survey) |
(T1D) 32% had also a diagnosis of (comorbid) depression. 45.05%/20.88%/12.09% reported mild/moderate/severe depression (PHQ-8). 35.79%/33.68% reported moderate/high distress (DDS). 26% reported general anxiety (GAD). 59%/9% reported moderate/high stress (PSS). 2% reported low resilience/not low resilience. Adults reported higher levels of diabetes distress than the T2D group (p < .05). |
NR | 5 |
| [25] | Spain | Cohort study⁎ (14 days from 11th April 2020 onwards) |
50 individuals with T1D | Mean age: 43.4 ± 15.6 Gender: 27 f Mean T1D duration: 22.24 ± 12.21 |
Ad hoc questions to assess emotional patterns (Virtual outpatient encounters) |
48% stated that they had not noted any evident changes in their mood in relation to their diabetes or the potential emotional impact of the lockdown. 52% mentioned changes in different emotions, such as fear (28%), anxiety (22%), sadness (16%), and stress (16%). |
NR | 3 |
| [30] | France | Cross-sectional (23th - 28th April,2020, i.e., 38 days after the beginning of the lockdown in France) |
1378 individuals with T1D | Mean age: 45.6 ± 13.6 Gender: 866 f Mean T1D duration: NR |
NR (Online questionnaire via social media) |
Mean scores of anxiety and depression at the start of lockdown: anxiety = 6.1 ± 3.1; depression = 5.0 ± 3.7. | Individuals with improved glycemic control during lockdown had a higher anxiety score than those with worsened glucose control. | 3 |
| [48] | US | Cross-sectional (21th - 28th April 2020) |
667 individuals with diabetes (T1D n = 120) | Mean age (T1D): 45.96 ± 14.43 Age range (T1D): 20–87 Gender: (T1D) 80 f Median T1D duration: 26 (IQR: 23) |
Ad hoc questions designed to assess psychosocial aspects of participants' diabetes management (Online survey) |
(T1D) With regard to diabetes management, 7.5% felt the pandemic situation had made it “somewhat harder”; 4.17% found it “much harder” to remain in control of their hypoglycemia; 10.8% reported insufficient social support to help manage their hypoglycemia; 8.33% reported that accessing social support was “somewhat harder”; and 2.5% reported that accessing social support was “much harder”. |
NR | 2 |
| [55] | Netherlands | Cohort study⁎ (8–11 weeks after the start of lockdown period, started on March 15, 2020). |
435 individuals with diabetes (T1D n = 280) | Mean age (T1D): 50.1 ± 14.9 Gender (T1D): 129 f Mean T1D duration: 27.5 ± 15.1 |
Multiple items to assess the impact of the lockdown on psychological stress, including the Perceived Stress Scale (PSS) (Online questionnaire) |
(T1D) 33.6% reported elevated stress during self-lockdown (no differences between people with T1D and T2D). 27.5% reported elevated levels of anxiety (no differences between people with T1D and T2D). |
(Whole sample) Perceived stress was associated with HbA1c. People who reported more difficult glycemic control experienced higher stress during the lockdown period and needed more insulin than before the lockdown period. Anxiety for COVID-19 infection was not associated with the change in HbA1c. |
5 |
| [49] | UK | Cross-sectional (April 24th 2020 - August 31th 2020, i.e., the first lockdown and initial easing) |
773 individuals with diabetes (T1D n = 535) | Mean age (T1D): 44.4 ± 14.2 Gender (T1D): 365 f Mean T1D duration: NR |
Ad hoc questions to assess individuals experience and opinions about the impact of pandemic on people with diabetes. (Online survey) |
(T1D) 14.7% reported that they are confident that at that moment, their mental wellbeing had increased; 46.1% felt it was the same; and 39.1% felt it had decreased. 13.5% reported that, for them, it was very difficult to obtain information/advice applicable to them for their emotional wellbeing during the pandemic; 20.7% reported it as difficult, and 31.7% reported it as moderately difficult. 16.2% reported that for them, it was very difficult to obtain support applicable to them for emotional wellbeing; 25.5% reported it as difficult, and 27.4% reported it as moderately difficult. |
NR | 2 |
| [41] | Brazil | Cross-sectional (May–July 2020, i.e., the first months of the COVID- 19 pandemic) |
477 individuals with T1D | Mean age: 30.52 ± 9.22 Gender: 396 f Mean T1D duration: CW/North/Northeast 13.57 ± 9.02; Southeast 16.6 ± 10.13, South 12.53 ± 8.62 NR |
Diabetes Burnout Scale (DBS) to assess diabetes burnout Type 1 Diabetes Distress Scale (T1DDS) to assess diabetes distress Patient Health Questionnaire depression scale (PHQ-8) to assess depressive symptoms according to DSM −5 criteria for Major Depressive Disorder A single-item question about their perceived burnout and the response options (categorized as no, mild, moderate, or severe). (Online survey) |
Diabetes perceived burnout was reported as moderate or high for a great part of the study participants (32.3% in CW/North/Northeast; 30.9% in Southeast, and 25% in South). In 30.8% diabetes distress levels were moderate or high (35.4% in CW/North/Northeast; 29.2% in Southeast; 31.2% in South). >50% reported moderate-severe or severe diabetes distress (56.7% in CW/North/Northeast; 50% in Southeast; 64.6% in South). |
Higher diabetes burnout was associated with women, lower income, higher HbA1c levels, and shorter duration since T1D diagnosis. Difficulty accessing safe places to exercise, marital status (participants without a partner), male gender, younger age, and higher HbA1c levels were predictors of higher levels of diabetes distress. Difficulty accessing diabetes supplies and higher HbA1c levels were predictors of experiencing higher levels of depressive symptoms. |
5 |
| [53] | Turkey | Cross-sectional (during the COVID-19 pandemic) |
304 individuals with diabetes (T1D n = 141) | Mean age (T1D): 30.6 ± 11.4 Gender (T1D): 87 f Mean T1D duration: 12.0 ± 9.7 |
Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression Impact of Event Scale Revised (IES-R) questionnaire to assess distress and traumatic symptoms associated with a traumatic life event. (Online survey via social media) |
(T1D) 44.7% reported anxiety, 27.7% reported depression. No significant difference in anxiety between T1D and T2D (p = .73), the frequency of depression was found to be higher in individuals with T2D (p = .03). |
(Whole sample) Anxiety and acute stress were more common in women. A positive correlation was found between high body mass index (BMI) and anxiety and depression. HAD-Anxiety (HAD-A) and HAD-Total (HAD-T) scores were higher in patients whose financial income decreased during the pandemic. The duration of T1D was positively correlated with acute stress level (but not with anxiety or depression). A positive correlation was found between limitations on daily activities due to diabetes and anxiety, depression, and acute stress. Decreased financial income, stress, and depression were found to be associated with poor glycemic control during the pandemic. |
6 |
| [47]† | Bangladesh | Cross-sectional (15th November - 12th December 2020, i.e., the second wave of the COVID-19 pandemic) |
928 individuals with diabetes (T1D n = 433) | Mean age (whole sample): 52.48 ± 11.76 Age range (whole sample): 18–86 years Gender (whole sample): 449 f Mean diabetes duration (whole sample): 7.28 ± 5.96 |
Ad hoc items to assess COVID-19-specific diabetes worries, lifestyle and social support. (Online survey) |
(Whole sample): 81.1% were worried that people with diabetes have a higher risk of infection; 64.5% worried that they might not be able to manage their diabetes if infected; 17.8% worried about diabetes medications; 26.4% worried about lack of diabetes equipment; 27.4% worried about receiving inadequate treatment/diabetic care during the pandemic; 32% worried that they might not be able to manage their blood glucose level; 17.0% worried about possible food shortages. |
(Whole sample) COVID-19-specific diabetes worries were negatively correlated with social support. COVID-19-specific diabetes worries were higher among younger participants who lived in rural areas, had sleep disturbance, were smokers, were not physically active, had self-reported poor health status, and had multiple complications due to diabetes. COVID-19-specific diabetes worries were significantly associated with lower age, smoking, poor self-reported health status, presence of multiple diabetes complications, lack of social support, and eating more compared to the pre-pandemic period. |
6 |
| [45] | Iran | Cross-sectional (the first half of 2020, before and during lockdown) |
98 youths with T1D | Mean age: 13.56 ± 4.94 Gender: 50 f Mean T1D duration: 4.64 ± 3.31 years |
Depression, Anxiety and Stress Scale-21 Items to assess participants' stress levels (In-person outpatient encounters) |
44.9% of the participants had severe stress. 70% were upset about the closure of schools and staying home, and the key source of their dissatisfaction was that they had to take classes and exams online. |
NR | 3 |
| [23] | Italy | Cross-sectional (1st - 30th April 2020) |
138 youths with T1D 276 controls |
Mean age (T1D): 13.67 ± 3.21 Mean age (controls): 13.78 ± 3.01 Gender: 73 f Mean T1D duration: 5.98 ± 3.22 |
Children Eating Attitudes Test (ChEAT) to assess eating problems symptoms in children Eating Attitudes Test-26 (EAT-26) to assess eating problems symptoms in adolescents (Telephone interview, online questionnaire) |
8.69% (N = 12) of T1D participants had ChEAT/EAT-26 scores indicating presence of disordered eating. No differences in disordered eating between patients—whether children (total ChEAT score, p = .748) or adolescents (total EAT-26 score, p = .731)—and controls. In both groups, adolescents had lower Oral Control scores than children (T1D: p < .0001; controls: p < .0001). |
In T1D and controls gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores. | 6 |
| [50] | India | Cross-sectional (25th March -30th May 2020, i.e., 15 days after the lockdown) |
52 youths with T1D | Mean age: 11.9 ± NR Gender: 30 f Mean T1D duration: NR |
Ad hoc questions to assess psychological issues. (In-person outpatient encounters) |
48.1% described their psychological status as normal, 9.6% as irritable, 30.8% as happy, 11.5% as depressed. | NR | 3 |
| [46] | US | Cross-sectional (April 2020) |
100 youths with T1D and their caregivers 93 healthy children and their caregivers |
Mean age (T1D): 13.8 ± NR Mean age (controls): 5.3 ± NR Gender: NR Mean T1D duration: NR |
PHQ-4 to assess symptoms of depression and anxiety Additional qualitative questions to investigate specific T1D-associated concerns during the COVID-19 pandemic. Interviews administered to youths and caregivers (only caregivers when the subjects were < 14 years, both when ≥14 yrs) (Telephone interview) |
Individuals with T1D had a five times higher risk of anxiety (p = .002) than controls. 50% of responders (T1D group) reported concerns regarding the higher risk for severe COVID-19 due to T1D, and 27% of responders expressed worries about access to insulin and diabetes supplies. |
No significant association between T1D and depressive symptoms. Hemoglobin A1c (HbA1c) was not associated with anxiety or depressive symptoms. |
5 |
| [44]† | Singapore | Cross-sectional (June–October 2020) |
301 individuals with diabetes (T1D n = 79) | Age range (whole sample): 30–60 and above Gender (whole sample): 136 f Mean T1D duration: NR (duration T1D: 19% up to 5 years, 22.8% 5–9 years, 15.2% 10–14 years, 16.5% 15–20 years, 26.6% >20) |
DHP-18 18-item scale to assesses psychosocial and behavioral impact of living with diabetes in three domains: psychological distress (PD, six questions), barriers to activity (BTA, seven questions) and disinhibited eating (DE, five questions). (Online survey) |
(Whole sample) Disinhibited eating (DE) had the highest score (μ = 43.3, SD = 17.2), then barriers to activity (BTA) (μ = 34.5, SD = 18.1) and psychological distress (PD) (mean 20.6 ± 20.0). No significant difference in DHP-18 scales between T1D and T2D respondents. |
(Whole sample) Previous diagnosis of mental health conditions, T1D, number of diabetes-related comorbidities, Indian ethnicity, being less able to look after themselves when sick, and being less able to keep themselves mentally active were associated with higher PD scores, less or more frequent checking of BG, higher BTA, and higher disinhibited eating scores. Older age, low income, and ability to reach their doctor despite not going to the clinic were negatively associated with PD and BTA. The age groups of 40–49 years and 50–59 years, unemployed status, diabetes duration15–20 years and > 20 years, low income, unknown declared income, and being able to contact their doctor despite not going to the clinic were associated with lower barriers to activity scores and lower DE scores. |
6 |
| Data from parents/health care professionals | ||||||||
| [38] | Brazil | Cross-sectional (May 18th - June 9th 2020) |
381 parents of children and adolescent with T1D 383 parents of children and adolescent without T1D |
Mean age (parents): 39.9 ± 8.5 Mean age (children and adolescents with T1D): 11.8 ± 4.3 Gender (parents): 339 f Mean T1D duration: 5.0 ± 3.8 |
Ad hoc questions to assess pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care Self-Reporting Questionnaire (SRQ-20) to assess mental health disorders (Online questionnaire) |
Parents of youths with T1D most often expressed personal concern (84.4% vs. 78.3%, p = .041), child-related concern (92.6% vs 86.0%, p = .005), personal emotional burden (78.2% vs 65.3%, p < .001) and child-related emotional burden (75.2% vs. 57.1%, p < .001) than parents of youths without T1D. Positive screening for mental health disorders was found in 69.0% of parents of youths with T1D and in 50.3% of the parents of youths without T1D (p < .001 for the difference between groups). Regarding the diabetes-specific emotional burden related, 40.6% of parents of youths with T1D reported discontent in care sharing, 36.0% discontent in support, 41.8% discontent in appreciation, 48.3% exhaustion and 75.7% guilt problems. |
(Parents of youths with T1D) The presence of unsatisfactory relationships and of an unwelcoming family environment were predictors of having a greater likelihood of reporting emotional burden related to care sharing, support, appreciation, and exhaustion in diabetes care. The presence of a positive screening for a mental health disorder was a predictor for burden in all areas of diabetes care that were evaluated. |
6 |
| [51] | Germany | Longitudinal (December 2019–June 2020, i.e., before, during, and after the COVID-19 lockdown period) |
28 children with T1D and their caregivers | Median age (children): 8 Gender (children): 18 f Median T1D duration: 4 years (SD 2.2) |
Pediatric Quality of Life Inventory to assess quality of life (administered to parents) (In-person outpatient encounters) |
After 6 months of remote visits, patients' psychosocial health significantly improved (p = .04). | NR | 6 |
| [24] | Italy | Cross-sectional (March–May 2020) |
55 parents of 34 children with T1D | Mean age (mothers): 43.0 ± 4.2; (fathers): 45.6 ± 5.9 years Gender(parents): 30 mothers Mean T1D duration: NR |
Impact of Event Scale – Revised” (IES-R) questionnaire asking parents to express their emotions about the ongoing COVID-19 pandemic (Virtual outpatient encounters) |
Sixteen out of 55 parents (29.1%) had a score that allows to define a clinically relevant level of PTSD. Ten mothers and 6 fathers had a PTSD clinically relevant score, corresponding, respectively, to 28.4 and 24% of total mothers and fathers. |
Age significantly differed between parents reporting high levels of stress and those reporting symptom-free status (42 vs 45,5 years). | 2 |
| [42]† | 75 countries (UK, US, India, Canada, Italy, Australia, Belgium, Denmark, Spain, etc.). | Cross-sectional (21th April - 17th May 2020) |
303 responses from healthcare professionals taking care of children and young people with diabetes (from 215 diabetes centers) | Age range: 0–18 years Gender: NR Mean T1D duration: NR (T1D duration range: new onset - >10 years) |
Ah hoc survey/questions to evaluate the healthcare professionals' perceptions of parent's beliefs and psychological aspects faced. (Online survey) |
Anxiety and parental stress were the most reported psychological problems faced (31% and 24%, respectively); few patients (15%) did not face any problems. Reports also included: 8% depression, 7% insomnia/hypersomnia, 6% eating disorders, 4% panic attacks, 3.5% improved mood in patient/caregiver, and 0.5% denial, night terrors, and/or suicide attempts. | NR | 2 |
| [29] | 51 countries across all continents (members of the International Consortium for Pediatric Endocrinology) | Cross-sectional (December 3th 2020 -February 5th 2021) |
Healthcare professional from a convenience sample of 131 pediatric endocrine centers (n = 113 taking care youths T1D) 46 centres <100 patients, 39 centres 100–250 patients; 16 centres 251–500 patients; 12 centres >500 patients |
Mean age: NR Gender: NR Mean T1D duration: NR |
Ad hoc questions administered to healthcare professionals (136 responses assessed) (Online survey) |
General psychosocial and behavioral changes were commonly reported in patients with T1D; healthcare professionals reported in patients or caregivers the following problems: 61.1% anxiety; 54.0% parenting stress; 37.2% depression; 31.8% insomnia/hypersomnia or other sleep disruption; 22.1% eating disorders; 15% panic attacks; 5.3% suicide attempts; 3.5% improved mood; 27.4% no psychological problems. | NR | 2 |
| [84] | 27 countries across Europe | Cross-sectional (Early June to July 2020) |
1829 diabetes nurse (n = 992 working with both T1D and T2D, n = 135 with T1D) | Mean age: NR Gender: NR Mean T1D duration: NR |
Ad hoc survey administered to assess (according to nurse opinion) impact of COVID-19 on psychological health of people with diabetes (Online survey) |
48% of diabetes nurses felt that the risks of psychological problems in their patient populations (both T1D and T2D) had increased (anxiety, diabetes distress, and depression were reported to have increased significantly during the COVID-19 pandemic). Nurses rated the effect of the pandemic as having an extreme or very severe negative impact on diabetes care in general (Median 46.5% (IQR,20)) and with respect to psychological care (Median 31% (IQR,20)). |
NR | 2 |
| [32] | US | Cohort study (pre-pandemic: November 2017–December 2019; pandemic: June–July 2020) |
100 parents of children with T1D | Mean age (children): 6.74 ± 1.59; (parents): 36.41 ± 6.83 Gender (children): 60 f, (parents): 92 f Mean T1D duration: 2.95 ± 0.54 |
20-item Center for Epidemiological Studies-Depression Scale to assess depressive symptoms. 7-item Patient Reported Outcomes Measurement Information System Anxiety-Short Form (PROMIS-A) to assess anxiety symptoms. Two subscales of the Protective Factors Survey (i.e., Family Functioning/Resiliency and Social Support) to assess family and social support. Pandemic Parenting—Type 1 Diabetes (PP-T1D) survey to assess parents' COVID-19 experiences, COVID-19-specific distress (12 items measuring parents' own levels of anxiety, stress, depressive symptoms, eating, sleep, and activity specifically during the COVID-19 pandemic) and positive/negative diabetes-specific experiences. (Online questionnaire) |
Rates of elevated parents' depressive symptoms (CES-D scores) were similar pre-pandemic (24.30%) and during the COVID-19 pandemic (22.20%). | Parents of color, parents with college education, and parents whose children used CGM experienced significantly more negative diabetes-specific experiences, more COVID-19-specific distress (than non-Hispanic, white parents), and more parent depressive symptoms. More pre-pandemic depressive symptoms, lower social support, more anxiety, more life disruptions due to the COVID-19 pandemic, and strict social distancing practices were significantly correlated with more current depressive symptoms, fewer positive/more negative diabetes-specific experiences, and more COVID-19-specific distress. More pre-pandemic family/social support, COVID-19 exposure in non-immediate family members, and fewer life disruptions due to the COVID-19 pandemic were significantly correlated with more positive diabetes-specific experiences, fewer current depressive symptoms, and less COVID-19-specific distress. Fewer pre-pandemic depressive symptoms and more pre-pandemic social support predicted fewer depressive symptoms during the pandemic. |
6 |
Psychological data was collected once, without comparison with pre-pandemic data.
Results did not differentiate between individuals with T1D and individuals with T2D.
It is not clear how many questionnaires were completed by children and how many by parents.
As reported by Elhenawy and Eltonbary [56], scores of 0–13 were considered low stress, 14–26 were considered moderate stress, and 27–40 were considered high perceived stress.
The sample sizes of the studies included in this systematic review varied from 20 to 2430 participants (1788 with T1D), for a total of 24,467 participants.
The mean age of participants ranged from 5.3 to 61.7 years (range: 0–86 years); female participants (about n = 11,888, although some studies did not report gender distribution) were about 52.91% of the total sample. In terms of studies on individuals with diabetes (n = 37), participants in the majority were adults (n = 28, 75.7%, excluding studies conducted exclusively with parents/healthcare providers). In 9 studies, data were collected from children/adolescents; in n = 13 (35.13%), samples included individuals with T1D and T2D.
Of the 44 studies examined, n = 6 took place in US, n = 7 in Italy, n = 4 in Saudi Arabia, n = 4 in Brazil, n = 2 in India, n = 2 in Denmark, n = 4 in Poland, n = 1 in Egypt, n = 1 in Japan, n = 1 in Spain, n = 1 in France, n = 1 in the Netherlands, n = 1 in UK, n = 1 in Turkey, n = 1 in Bangladesh, n = 1 in Iran, n = 1 in Singapore, n = 1 in Germany, and n = 4 in several countries across Europe or all continents.
Most studies were cross-sectional (n = 30); the others (n = 14) followed a cohort/case-control study design. The data in the included studies were collected between March 2020 and April 2021. N = 26 studies collected data through online surveys, often via social media or via email (e.g., [16]; [17]); n = 7 studies collected data through telephone interview questionnaires (e.g., [18]; [19]); n = 5 studies collected data through in-person outpatient encounters (e.g., [20]); n = 3 collected data using both telephone interviews and an online questionnaire via e-mail or SMS [21, 22; 23]; n = 2 studies collected data through virtual outpatient encounters [24,25]; and n = 1 study compared patients' data collected through both in-person and virtual outpatient encounters [26].
3.3. Risk of bias within studies
The quality scores for studies ranged from 1 to 7 (see Supplemental 1, results of quality assessment according to NOS). Of the 44 studies, 22 were categorized as being at high risk of bias, mainly related to the selection of participants (e.g., online sampling affected the representativeness of the sample and the ascertainment of exposure), no estimated sample size, the number of non-respondents not being reported, or confounding factors not always being controlled. In addition, several studies (n = 13) evaluated main outcomes without using validated measures.
3.4. Measurement tools
Most studies assessed psychological problems using patient self-report measures (n = 24) or questions addressed to patients that were purposely designed to evaluate psychological issues (n = 12) (e.g., [27]; [28]). Other studies adopted parent-report measures (e.g., Pediatric Quality of Life Inventory) (n = 4) or ad hoc questions administered to healthcare providers (n = 3) (e.g., [29]). Only one study did not describe how the psychological data were collected [30].
In terms of standardized assessment tools, the Type 1 Diabetes Distress Scale (T1-DDS) and Problem Areas in Diabetes Scale (B-PAID) were adopted to assess diabetes-related emotional distress. The Self-Report Questionnaire-20 (SRQ 20), Perceived Stress Scale (PSS-10), and Impact of Event Scale Revised (IES-R) were used to evaluate psychological distress and other traumatic symptoms associated with a traumatic life event. The Diabetes Burnout Scale (DBS), Diabetes Health Profile (DHP-18) scale, and Hypoglycaemia Fear Survey were employed to assess the psychosocial and behavioral impact/burden of living with diabetes and the fear of hypoglycemia. The Patient Health Questionnaire (PHQ-8) and Center for Epidemiological Studies-Depression Scale (CES-D) were used to assess depressive symptoms. The State-Trait Anxiety Inventory (STAI), Generalized Anxiety Disorder (GAD-7) scale, Symptom Check List revised anxiety subscale (SCL-ANX4), Patient Reported Outcomes Measurement Information System Anxiety-Short Form (PROMIS-A) and Spence Children Anxiety Scale (SCAS) were adopted to assess anxiety symptoms. The Hospital Anxiety and Depression scale (HAD scale), Stress, Anxiety and Depression Scale (DASS-21) and Test of Anxiety and Depression in childhood and adolescence (TAD) were used to assess symptoms of stress, anxiety, and depression. The Self-Reporting Questionnaire (SRQ-20) and General Health Questionnaire-12 items (GHQ-12/30) were employed to assess general psychiatric well-being and minor psychiatric disorders and mental health disorders. The Eating Attitudes Test (EAT-26) and Children Eating Attitudes Test (ChEAT) were adopted to assess the prevalence of symptoms of eating problems. The Mini Sleep Questionnaire (MSQ) was employed to assess sleep disorders. The Pediatric Quality of Life Inventory (QOLID) and WHO-5 Well-being Index questionnaire were used to assess quality of life and general psychosocial health. The Strengths and Difficulties Questionnaire (SDQ) was used to assess psychological functioning in children. The Pandemic Parenting–Type 1 Diabetes (PP-T1D) survey and Impact of Event Scale–Revised (IES-R) questionnaire were used to assess emotions about the COVID-19 pandemic. The Coping Inventory for Stressful Situations (CISS) and the Brief Resilience Scale (BRS) were employed to assess coping styles and resilience, and the UCLA Loneliness Scale was used to assess general loneliness. Finally, the Protective Factors Survey (specifically, the Family Functioning/Resiliency and Social Support subscales) was used to assess family and social support.
3.5. Evidence for psychological problems and psychopathological disorders
Overall, the findings of the included studies suggested that COVID-19 was associated with a number of negative mental health outcomes. The most commonly evaluated mental outcomes were distress, depression, and anxiety.
In particular, depression symptoms were assessed in 17 of the 44 studies examined. The prevalence of depressive symptoms varied from 11.5% to 60.9% (moderate to severe). However, two of the 17 studies indicated that the whole sample or about half the sample of children and adolescents had never experienced any depressive symptoms and had reported no significant change in incidence of depression during the COVID-19 pandemic compared with preceding years [26,31]. One study conducted with parents of children with T1D showed that elevated rates of parents' depressive symptoms pre-pandemic were similar to those during the COVID-19 pandemic [32]. In addition, one study assessed depression and anxiety without mentioning the method adopted to assess anxiety/depression symptoms and reported only mean and SD, failing to specify whether those scores were clinically significant [30].
Anxiety symptoms were assessed in 16 of the 44 studies evaluated. The prevalence of anxiety symptoms in participants with T1D varied from 7 to 27.5%, although they were particularly high in a Saudi Arabia sample including individuals with T1D and T2D evaluated during the COVID-19 outbreak [33].
Twenty-one studies (2 studies of parental distress) indicated that psychological distress/stress is present in individuals with T1D, reporting prevalence rates ranging from 14% to 86.6%. In five studies—which carried out a comparison to pre-pandemic levels—stress levels were reported as being increased [17,25,28,34,35]. Additionally, eight of the 44 studies focused on diabetes distress/burnout experienced during the pandemic, which was described as moderate to high and moderate to severe [17,28,[36], [37], [38], [39], [40], [41]].
Anxiety (depression and parental stress were also among the most common problems reported in patients with T1D by health care professionals [29,42].
Some studies evaluated other psychological problems, such as eating problems, which were assessed in six studies [23,29,37,[42], [43], [44]], PTSD (in parents of children with T1D) [24], sleep disorders [29,42], and—albeit at low rates—suicidal ideation/attempts, according to reports by patients with T1D or their healthcare professionals [29,37,42].
Some studies assessed COVID-specific worries, indicating that compared to the period before the COVID-19 pandemic, individuals with T1D reported fear of physical injury [20], being somewhat or very concerned about employment or finances [28], being upset about the closure of schools [45], worrying about access to insulin and diabetes supplies, and facing the higher risk for severe COVID-19 due to T1D [46]. Moreover, individuals with diabetes (both T1D and T2D) reported being worried about being severely affected (due to their diabetes) if they were to become infected with COVID-19 [39], about having a higher risk of infection, about not being able to manage their diabetes if infected, and about receiving inadequate treatment/diabetic care during the pandemic [47]. In addition, parents of youths with T1D expressed personal concern, child-related concern, personal emotional burden, and child-related emotional burden more often than parents of youths without T1D [38].
Other studies reported that participants perceived greater social isolation [28], felt isolated, felt lonely, missed having someone to talk to about diabetes, felt alone with their diabetes [17,39], and received insufficient social and emotional support [48,49].
In contrast, in a small number of studies (n = 8), data was reported that did not indicate that COVID-19 was associated with negative mental outcomes. As already mentioned in the paragraph on depressive symptoms, two studies on children and adolescents with T1D showed that COVID-19 lockdowns did not have a negative effect on children's psychological status, with no significant change in incidence of depression during the first year of the COVID-19 pandemic [26,31]. Similarly, in one cohort study, rates of parents' elevated depressive symptoms were similar pre-pandemic and during the COVID-19 pandemic, according to caregivers' opinions [32]. In another study, almost half of individuals with T1D stated that they had not noted any evident changes in their mood in relation to their diabetes or the potential emotional impact of the lockdown [25]. In a small sample of youths with T1D, up to nearly half of the participants described their psychological status as normal, and as happy [50]. In another study, most caregivers reported that their children's psychological/physical well-being was unvaried or improved immediately after the lockdown [20]. In a separate longitudinal study, compared to the enrollment period that occurred before the COVID-19 pandemic, patients' psychosocial health significantly improved after six months of remote visits, according to parents' opinions [51]. In another study, individuals with T1D did not differ from controls in trait anxiety, coping style, and perceived stress when assessed at the beginning of pandemic [22].
3.6. Evidence for sociodemographic and clinical factors associated with psychological problems
Negative mental health outcomes were frequently associated with the female gender [17,23,26,36,41,52,53]. In one study conducted in the first months of the pandemic, only male gender was found to be a predictor of high level of diabetes distress [41]. Alqahtani et al. [16] reported no gender differences in individuals with T1D who were psychologically affected by COVID-19.
Data about age are conflicting, indicating either a positive [23,44,52] or a negative association [20,36,41,47] with psychological problems.
Similarly, one study described lower education [36] and two studies described higher education [32,52] as being associated with increased psychological problems.
In some studies, those with decreased/low financial income [41,44,53] were described as most likely to present lower levels of psychosocial well-being (as diabetes burnout, anxiety, depressive symptoms, and distress).
In terms of clinical factors, several studies reported that worse glycemic control/higher HbA1c levels were associated with negative mental health outcomes [17,28,33,36,41,52,54,55]. Associations between higher stress/depression/anxiety and greater frequency of hypoglycemia [18] and lower time in range (TiR) [20,21] were also described. Three studies did not describe correlations between stress levels/anxiety and changes in HbA1c levels [35,46,55]. In addition, one study [30] indicated that individuals with T1D with improved glycemic control during lockdown had higher anxiety scores than those with worsened glucose control. With inconsistent results, some studies focused on the role of diabetes duration [20,41,53,56] and that of BMI; the latter was described both as having no association with psychological problems [35,37] and as being positively correlated with anxiety and depression [53].
Additionally, during the outbreak, low levels of psychosocial well-being, depression and/or anxiety symptoms, and high diabetes distress were more likely to be presented by: those who experienced obstacles around access to or changes in diabetes self-care behaviors (e.g., diabetes clinic visits canceled, no method of telecommunication with diabetes care providers, insufficient ability to reach doctors) [33,36,44]; those who required hospitalization for poor diabetes control [33]; those who had complications due to diabetes or comorbidities [17,44,47]; those who stopped (or did not engage in) physical activity [27,47], or struggled to access safe places to exercise [41]; and those who reported a previous diagnosis of a mental disorder [44,57]. Higher distress and depression and/or anxiety symptoms were also reported by those who were dissatisfied with (or worried by) pandemic-related information [33,52], those who were worried about being overly affected if infected, and those who were worried about not being able to manage their diabetes if infected, compared to those who were not [39]. Higher diabetes distress, depression, and separation anxiety symptoms were associated with greater difficulties in accessing diabetes supplies [41], fear of infection, lower autonomy in T1D management, and lower frequency of contact with peers [20].
According to parents' opinions, the presence of unsatisfactory relationships and of unwelcoming family environments were predictors of having a greater likelihood of reporting emotional burden [38]; lower pre-pandemic family support, more life disruptions due to the pandemic, and having children who use continuous glucose monitoring (CGM) were associated with more negative diabetes-specific experiences, more parent depressive symptoms, and more COVID-19-specific distress [32].
Ethnicity (parents of color, e.g., being Indian) was associated with higher psychological problems and more negative diabetes-specific experiences during the pandemic [32,44].
4. Discussion
To the best of the authors' knowledge, this is the first comprehensive systematic review focusing on the impact of the COVID-19 pandemic on the mental health of individuals with T1D.
The studies examined in the present review showed that during the COVID-19 pandemic, people with T1D had impaired mental health, particularly symptoms of depression, anxiety, and distress. Rates of psychological problems varied across studies as a result of the use of different measurement scales and methods to assess these problems. However, the studies reported prevalence data (depression: 11.5–60.9%; anxiety: 7–27.5%, up to 44.54% for sample composed of both types of diabetes; distress/stress: 14–86.6%) that generally concur with the evidence recently reported by systematic reviews on the impact of COVID-19 on mental health in the general population (depression: 2.2–63.8%; anxiety: 1.8–50.9%; psychological distress: 34.43–38%; stress: 8.1–81.9%) ([2,3,58,59], data from Asia, Europe, China, Spain, Italy, Iran, the US, Turkey, Nepal, Denmark etc.). It should be noted that the prevalence rates of psychological symptoms described here are relatively higher than the rates reported in pre-COVID-19 studies with people with T1D (depression: 9–54%; anxiety: 13–38%; diabetes distress: 24–67%) [5,6,[60], [61], [62]].
COVID-19 emergency restrictions—including school closures, mandatory long-term lockdowns and home quarantine, reduction of social communication, social distancing measures—difficulties in getting referrals to physicians, limited contact with friends and relatives, relevant changes in lifestyle, and fear of being infected have exacerbated anxiety in populations globally, leading to mental health disorders in all types of individuals [59]. Such conditions can make the management of everyday life extremely challenging and can themselves cause increased anxiety and stress—especially in individuals with T1D, who are generally described as more vulnerable to poor mental health outcomes and more susceptible to experiencing psychological problems [4,6,63]. Extensive research has already described a high prevalence of symptoms of depression and anxiety in individuals with T1D, as well as such symptoms' negative impact on glycemic control, adherence to medical treatment, and risk of diabetes complications [[64], [65], [66]]. It is reasonable to expect that the COVID-19 pandemic has introduced new challenges to people with T1D in addition to the pre-existing challenges imposed by the demands and management of their chronic illness, leading them to experience high levels of mental health problems, such as depression and distress. Unsurprisingly, in line with the present data, research evidence indicates that, in general, the COVID-19 pandemic negatively impacted chronically ill patients' outcomes and the quality of care [67], resulting in delayed diagnosis and care (e.g., in the case of cancer), a negative toll on the patients' mental health [68,69], and a consequently increased risk of mortality rates [70].
In interpretations of the present results, it should be also considered that, particularly at the start of the COVID-19 epidemic, many media outlets spread news about the greater vulnerability of people with chronic diseases and with diabetes if infected. Although evidence proved no higher risk of infection with COVID-19 among youths with T1D [71], this could have favored additional fear, distress, and anxiety in these people. Unsurprisingly, it was also reported in the general population that COVID-19 media exposure was associated with an increase in anxiety levels and stress [72].
Several sociodemographic and clinical factors were described as being associated with psychological and psychopathological problems. As described in the general population [3,73,74], women and those with lower household incomes tended to be more vulnerable to developing symptoms of mental health problems during the pandemic. The fact that women represent a high percentage of the workforce sectors negatively affected by the pandemic [3], and that they are generally (according to epidemiological studies) at a higher risk of depression and are more vulnerable to stress [59,75], can reasonably explain the association with the former; the obvious consequences of low income on general well-being and on ability to cope with stressful events can reasonably explain the association with the latter.
Similarly, consistent with evidence from previous studies, worse glycemic control, difficulties in diabetes self-care behaviors, and complications were described as being significantly associated with lower levels of psychosocial well-being [4,76].
Given the conflicting results regarding age from the included studies, no conclusions can be drawn about the impact of COVID-19 and age differences, despite the importance of considering developmental differences in responses to COVID-19.
5. Strengths and limitations
This review contributes to a deeper understanding of the associations between COVID-19-related emotional reactions and mental health outcomes in people with T1D. In particular, this research presented a systematic review and synthesis of the evidence on COVID-19's impact on the mental health of individuals with T1D, providing a comprehensive picture of the state of research together with the main findings and methods adopted in investigations of this topic. In addition, the main sociodemographic and clinical factors associated with psychological/psychopathological problems were identified, providing further suggestions for addressing the mental health problems that arose or worsened during the pandemic.
This review has several limitations that must be considered. Half of the included studies are of unsatisfactory methodological quality, which should be considered when interpreting their results. Due to methodological heterogeneity across studies, this review does not carry out a meta-analysis of the magnitude and consistency of the mental health outcomes described. Most reviewed studies were cross-sectional, preventing any postulation about causal inferences and direction of the relationship between T1D, COVID-19, and psychological problems. Heterogeneity in measurement methods, lack of longitudinal data, and the fact that most included studies evaluated psychological reactions/problems/symptoms—i.e., they did not aim to make a specific diagnosis of mental disorders—limit the generalizability of the findings and have implications for practice. Some results come from studies that did not differentiate findings by individuals with T1D from individuals with T2D. Of the 44 studies examined, eleven included very small samples (n 20–71), which warrants caution in interpreting their findings as a result of the limited statistical power. Lastly, the fact that most studies were conducted online may yield imprecise, and possibly inaccurate, ratings of psychological data, as this prevents the possibility for participants to ask for clarification on questions they did not fully understand; additionally, it may have favored a selection bias in the population studied in terms of ease in Internet accessibility.
Future research should be conducted to address these limitations—especially follow-up studies post-pandemic, which can be helpful to evaluate the long-term psychological impacts of the COVID-19 pandemic.
6. Conclusions
The findings in the present review suggest that the COVID-19 pandemic had a negative impact on the mental health of people with T1D, whose general psychological conditions were described as worse and often characterized by depression, distress, and anxiety. Given that the literature has well established that psychological factors adversely affect the management of T1D [77,78], it is necessary to take appropriate measures to improve medical and psychological services that aim to support individuals with T1D in appropriately coping with the burdens and difficulties caused by the pandemic. Medical assistance should be provided by clinicians working in a multidisciplinary team in which psychologists are involved in T1D patients' care/management and are actively part of the medical staff support, as they may play a key role in detecting emerging psychological difficulties early. Regardless of the presence of manifesting psychopathological symptoms, T1D management requires that periodical psychological screening and assessment of patients' mental status (also including caregivers and family members) be routine [79]. In this way, in line with a patient-centered care approach and within an integrated multidisciplinary approach, each intervention can be tailored to address individuals' needs and problems, as well as the aspects of the diabetes regimen (e.g., dietary restrictions, the interference of symptoms such as hypoglycemia with daily activities) that can create psychological burden and or affect regimen adherence.
Continually monitoring the psychological conditions of individuals with T1D—both at periodic intervals and when a change occurs in disease, treatment, or life circumstances—is the only way to effectively care for and manage the emotionally and physically demanding chronic pathology of T1D [4], especially in the difficult yet critical time that is the COVID-19 pandemic.
Telemedicine care activities can also be implemented to facilitate care and ensure continuity of assistance for vulnerable populations, such as individuals with T1D. To this end, recent evidence has indicated that telemedicine video consultations are a useful opportunity to preserve access to a healthcare provider in a challenging time, such as a pandemic, and are a helpful approach to maintaining a supportive doctor-patient relationship in a virtual context [80]. Overall, digital mental health interventions (e.g., web-based interventions, app-based mobile health), which overcome the difficulties of delivering traditional in-person interventions under pandemic restrictions, may generally improve mental health care access and can be considered a useful tool for mitigating the psychological consequences of the COVID-19 pandemic on the population and for promoting mental health, as recently highlighted [81,82]. As such, digital approaches in mental health may play a key role in supporting individuals with T1D as they face the psychological burden of diabetes, and this useful approach can be made available not only in response to or during the COVID-19 crisis but in general routine care, as an integral component/supplementary service of healthcare delivery.
Funding
This work was supported by the project DiabEaT1, which received funding from University of Campania “Luigi Vanvitelli” through the program V:ALERE 2019, funded with D.R. 906 del 4/10/2019, prot. n. 157264, October 17, 2019.
Declaration of Competing Interest
None.
Acknowledgments
The authors wish to thank Dr. Martina Lombardi, who assisted in the literature analysis of the manuscript.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jpsychores.2023.111206.
Appendix A. Supplementary data
Supplementary material
References
- 1.Jones E., Mitra A.K., Bhuiyan A.R. Impact of COVID-19 on mental health in adolescents: a systematic review. Int. J. Environ. Res. Public Health. 2021;18(5):2470. doi: 10.3390/ijerph18052470. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Nearchou F., Flinn C., Niland R., Subramaniam S.S., Hennessy E. Exploring the impact of COVID-19 on mental health outcomes in children and adolescents: A systematic review. Int. J. Environ. Res. Public Health. 2020;17(22):8479. doi: 10.3390/ijerph17228479. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Xiong J., Lipsitz O., Nasri F., Lui L., Gill H., Phan L., Chen-Li D., Iacobucci M., Ho R., Majeed A., McIntyre R.S. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J. Affect. Disord. 2020;277:55–64. doi: 10.1016/j.jad.2020.08.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Delamater A.M., de Wit M., McDarby V., Malik J.A., Hilliard M.E., Northam E., Acerini C.L. ISPAD clinical practice consensus guidelines 2018: psychological care of children and adolescents with type 1 diabetes. Pediatr. Diabetes. 2018;19(Suppl. 27):237–249. doi: 10.1111/pedi.12736. [DOI] [PubMed] [Google Scholar]
- 5.Hagger V., Hendrieckx C., Sturt J., Skinner T.C., Speight J. Diabetes distress among adolescents with type 1 diabetes: a systematic review. Curr. Diab. Rep. 2016;16(1):9. doi: 10.1007/s11892-015-0694-2. [DOI] [PubMed] [Google Scholar]
- 6.Rechenberg K., Whittemore R., Grey M. Anxiety in youth with type 1 diabetes. J. Pediatr. Nurs. 2017;32:64–71. doi: 10.1016/j.pedn.2016.08.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Luyckx K., Seiffge-Krenke I., Hampson S.E. Glycemic control, coping, and internalizing and externalizing symptoms in adolescents with type 1 diabetes: a cross-lagged longitudinal approach. Diabetes Care. 2010;33(7):1424–1429. doi: 10.2337/dc09-2017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Northam E.A., Matthews L.K., Anderson P.J., Cameron F.J., Werther G.A. Psychiatric morbidity and health outcome in Type 1 diabetes--perspectives from a prospective longitudinal study. Diabet. Med. 2005;22(2):152–157. doi: 10.1111/j.1464-5491.2004.01370.x. [DOI] [PubMed] [Google Scholar]
- 9.Alencar D.C., Ribeiro L.M.S., Carvalho L., Rocha G.S.T., Sousa E.O., Ibiapina A.R. Mental health of people with diabetes during the COVID-19 pandemic period: integrative review. Revista Eletronica de Enfermagem. 2022;24(67537):1–9. doi: 10.5216/ree.v24.67537. [DOI] [Google Scholar]
- 10.Sheykhangafshe F.B., Esmaeilinasab M. Psychological implications of coronavirus disease 2019 outbreak in patients with chronic diseases: A systematic review. Chronic Dis. J. 2021;9(3):132–143. doi: 10.22122/cdj.v9i3.629. [DOI] [Google Scholar]
- 11.Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gøtzsche P.C., Ioannidis J.P., et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J. Clin. Epidemiol. 2009;62(10):e1–e34. doi: 10.1136/bmj.b2700. [DOI] [PubMed] [Google Scholar]
- 12.Moher D., Liberati A., Tetzlaff J., Altman D.G., PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7) doi: 10.1371/journal.pmed.1000097. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Wells G.A., Shea B., O’Connell D., Peterson J., Welch V., Losos M., Tugwell P. The Ottawa Hospital Research Institute; 2000. The Newcastle-Ottawa scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses.http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm Available from: [Google Scholar]
- 14.Modesti P.A., Reboldi G., Cappuccio F.P., Agyemang C., Remuzzi G., Rapi S., Perruolo E., Parati G., ESH Working Group on CV Risk in Low Resource Settings Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One. 2016;11(1) doi: 10.1371/journal.pone.0147601. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Luchini C., Stubbs B., Solmi M., Veronese N. Assessing the quality of studies in meta-analyses: advantages and limitations of the Newcastle Ottawa scale. World J Meta-Anal. 2017;5(4):80–84. doi: 10.13105/wjma.v5.i4.80. [DOI] [Google Scholar]
- 16.Alqahtani M., Al Othman A.O., Alqahtani A.M., AlQahtani A., Asiri F., Mesfer A.M., Alshehri S.D., Al-Fifi S.H. Effect of COVID-19 on control of T1DM patients in Aseer region of Saudi Arabia. J. Fam. Med. Prim. Care. 2021;10(4):1737–1740. doi: 10.4103/jfmpc.jfmpc_2333_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Madsen K.P., Willaing I., Rod N.H., Varga T.V., Joensen L.E. Psychosocial health in people with diabetes during the first three months of the COVID-19 pandemic in Denmark. J. Diabetes Complicat. 2021;35(4) doi: 10.1016/j.jdiacomp.2021.107858. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Barchetta I., Cimini F.A., Bertoccini L., Ceccarelli V., Spaccarotella M., Baroni M.G., Cavallo M.G. Effects of work status changes and perceived stress onglycaemiccontrol in individuals with type 1 diabetes during COVID-19 lockdown in Italy. Diabetes Res. Clin. Pract. 2020;170 doi: 10.1016/j.diabres.2020.108513. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Caruso I., Di Molfetta S., Guarini F., Giordano F., Cignarelli A., Natalicchio A., Perrini S., Leonardini A., Giorgino F., Laviola L. Reduction of hypoglycaemia, lifestyle modifications and psychological distress during lockdown following SARS-CoV-2 outbreak in type 1 diabetes. Diabetes Metab. Res. Rev. 2021;37(6) doi: 10.1002/dmrr.3404. [DOI] [PubMed] [Google Scholar]
- 20.Di Riso D., Bertini S., Spaggiari S., Olivieri F., Zaffani S., Comerlati L., Marigliano M., Piona C., Maffeis C. Short-term effects of COVID-19 lockdown in Italian children and adolescents with type 1 diabetes mellitus: the role of separation anxiety. Int. J. Environ. Res. Public Health. 2021;18(11):5549. doi: 10.3390/ijerph18115549. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Cusinato M., Martino M., Sartori A., Gabrielli C., Tassara L., Debertolis G., Righetto E., Moretti C. Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes. J. Pediatr. Endocrinol. Metabol. 2021;34(9):1089–1093. doi: 10.1515/jpem-2021-0153. [DOI] [PubMed] [Google Scholar]
- 22.Cyranka K., Matejko B., Klupa T., Małecki M., Cyganek K., Kieć-Wilk B., Dudek D. Type 1 diabetes and COVID-19: the level of anxiety, stress and the general mental health in comparison to healthy control. Cukrzyca typu 1 i COVID-19: poziom lęku, stresu i ogólnego stanu zdrowia psychicznego u pacjentów w porównaniu z grupą kontrolną. Psychiatr. Pol. 2021;55(3):511–523. doi: 10.12740/PP/OnlineFirst/133356. [DOI] [PubMed] [Google Scholar]
- 23.Troncone A., Chianese A., Zanfardino A., Cascella C., Piscopo A., Borriello A., Rollata S., Casaburo F., Testa V., Iafusco D. Disordered eating behaviors in youths with type 1 diabetes during COVID-19 lockdown: an exploratory study. J. Eat. Disord. 2020;8(1):1–12. doi: 10.1186/s40337-020-00353-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Carducci C., Rapini N., Deodati A., Pampanini V., Cianfarani S., Schiaffini R. Post-traumatic stress disorder (PTSD) in parents of children with type 1 diabetes during Covid-19 pandemic. Ital. J. Pediatr. 2021;47(1):176. doi: 10.1186/s13052-021-01126-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Pla B., Arranz A., Knott C., Sampedro M., Jiménez S., Hernando I., Marazuela M. Impact of COVID-19 lockdown on glycemic control in adults with type 1 diabetes mellitus. J. Endocrine Soc. 2020;4(12):bvaa149. doi: 10.1210/jendso/bvaa149. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Choudhary A., Adhikari S., White P.C. Impact of the COVID-19 pandemic on management of children and adolescents with type 1 diabetes. BMC Pediatr. 2022;22(1):124. doi: 10.1186/s12887-022-03189-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.de Vasconcelos P., Gomes D.L., Uliana G.C., Silva Costa E., A. A. Social distancing, physical activity, and COVID-19: implications for type 1 diabetes mellitus in Brazil. Int. J. Environ. Res. Public Health. 2021;18(23):12819. doi: 10.3390/ijerph182312819. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Fisher L., Polonsky W., Asuni A., Jolly Y., Hessler D. The early impact of the COVID-19 pandemic on adults with type 1 or type 2 diabetes: A national cohort study. J. Diabetes Complicat. 2020;34(12) doi: 10.1016/j.jdiacomp.2020.107748. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Elbarbary N.S., Dos Santos T.J., de Beaufort C., Wiltshire E., Pulungan A., Scaramuzza A.E. The challenges of managing pediatric diabetes and other endocrine disorders during the COVID-19 pandemic: results from an international cross-sectional electronic survey. Front. Endocrinol. 2021;12 doi: 10.3389/fendo.2021.735554. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Potier L., Hansel B., Larger E., Gautier J.F., Carreira D., Assemien R., Lantieri O., Riveline J.P., Roussel R. Stay-at-home orders during the COVID-19 pandemic, an opportunity to improve glucose control through behavioral changes in type 1 diabetes. Diabetes Care. 2021;44(3):839–843. doi: 10.2337/dc20-2019. [DOI] [PubMed] [Google Scholar]
- 31.Alsalman A.A., Aldossari M.R., Alomani Z.D., Alkhunaizi S.I., Aljardah Z.A., Almousa F.A., Kalalah Z.A. Impact of coronavirus disease lockdown on children with type 1 diabetes mellitus in Al-Khobar, Saudi Arabia. Cureus. 2022;14(1) doi: 10.7759/cureus.21350. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Wang C.H., Hilliard M.E., Carreon S.A., Jones J., Rooney K., Barber J.R., Tully C., Monaghan M., Streisand R. Predictors of mood, diabetes-specific and COVID-19-specific experiences among parents of early school-age children with type 1 diabetes during initial months of the COVID-19 pandemic. Pediatr. Diabetes. 2021;22(7):1071–1080. doi: 10.1111/pedi.13255. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Al-Sofiani M.E., Albunyan S., Alguwaihes A.M., Kalyani R.R., Golden S.H., Alfadda A. Determinants of mental health outcomes among people with and without diabetes during the COVID-19 outbreak in the Arab gulf region. J. Diab. 2021;13(4):339–352. doi: 10.1111/1753-0407.13149. [DOI] [PubMed] [Google Scholar]
- 34.Grabia M., Markiewicz-Żukowska R., Puścion-Jakubik A., Bielecka J., Nowakowski P., Gromkowska-Kępka K., Mielcarek K., Socha K. The nutritional and health effects of the COVID-19 pandemic on patients with diabetes mellitus. Nutrients. 2020;12(10):3013. doi: 10.3390/nu12103013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Hosomi Y., Munekawa C., Hashimoto Y., Okamura T., Takahashi F., Kawano R., Nakajima H., Majima S., Senmaru T., Nakanishi N., Ushigome E., Hamaguchi M., Yamazaki M., Fukui M. The effect of COVID-19 pandemic on the lifestyle and glycemic control in patients with type 1 diabetes: a retrospective cohort study. Diabetol. Int. 2021;13(1):1–6. doi: 10.1007/s13340-021-00507-4. Advance online publication. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Abdoli S., Silveira M., Doosti-Irani M., Fanti P., Miller-Bains K., Pavin E.J., Cardoso E.B., Vardanjani L.R., Noorian K., Hessler D. Cross-national comparison of psychosocial well-being and diabetes outcomes in adults with type 1 diabetes during the COVID-19 pandemic in US, Brazil, and Iran. Diabetol. Metab. Syndr. 2021;13(1):63. doi: 10.1186/s13098-021-00681-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Alessi J., de Oliveira G.B., Franco D.W., Brino Amaral B., Becker A.S., Knijnik C.P., Kobe G.L., de Carvalho T.R., Telo G.H., Schaan B.D., Telo G.H. Mental health in the era of COVID-19: prevalence of psychiatric disorders in a cohort of patients with type 1 and type 2 diabetes during the social distancing. Diabetol. Metab. Syndr. 2020;12:76. doi: 10.1186/s13098-020-00584-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Alessi J., de Oliveira G.B., Feiden G., Schaan B.D., Telo G.H. Caring for caregivers: the impact of the COVID-19 pandemic on those responsible for children and adolescents with type 1 diabetes. Sci. Rep. 2021;11(1):6812. doi: 10.1038/s41598-021-85874-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Joensen L.E., Madsen K.P., Holm L., Nielsen K.A., Rod M.H., Petersen A.A., Rod N.H., Willaing I. Diabetes and COVID-19: psychosocial consequences of the COVID-19 pandemic in people with diabetes in Denmark-what characterizes people with high levels of COVID-19-related worries? Diab. Med. J. British Diab. Associat. 2020;37(7):1146–1154. doi: 10.1111/dme.14319. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Myers B.A., Klingensmith R., de Groot M. Emotional correlates of the COVID-19 pandemic in individuals with and without diabetes. Diabetes Care. 2022;45(1):42–58. doi: 10.2337/dc21-0769. [DOI] [PubMed] [Google Scholar]
- 41.Silveira M., Pavin E.J., Cardoso E.B., Fanti P., Abdoli S. Emotional burden and care of adults with type 1 diabetes during the COVID-19 pandemic in Brazilian regions. J. Diabetes Complicat. 2021;35(12) doi: 10.1016/j.jdiacomp.2021.108053. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Elbarbary N.S., Dos Santos T.J., de Beaufort C., Agwu J.C., Calliari L.E., Scaramuzza A.E. COVID-19 outbreak and pediatric diabetes: perceptions of health care professionals worldwide. Pediatr. Diabetes. 2020;21(7):1083–1092. doi: 10.1111/pedi.13084. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Cyranka K., Dudek D., Małecki M.T., Matejko B., Klupa T. Psychological crisis intervention for COVID-19 lockdown stress in patients with type 1 diabetes mellitus: survey study and qualitative analysis. JMIR Mental Health. 2021;8(6) doi: 10.2196/28097. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Yeoh E., Tan S.G., Lee Y.S., Tan H.H., Low Y.Y., Lim S.C., Sum C.F., Tavintharan S., Wee H.L. Impact of COVID-19 and partial lockdown on access to care, self-management and psychological well-being among people with diabetes: A cross-sectional study. Int. J. Clin. Pract. 2021;75(8) doi: 10.1111/ijcp.14319. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Tehrani H.T., Razavi Z., Salimi S., Farahi H., Bazmamoun H., Soltanian A.R. Impact of coronavirus disease 2019 outbreak on children and adolescents with type 1 diabetes mellitus. J. Res. Health Sci. 2021;21(4) doi: 10.34172/jrhs.2021.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Wade C., Burton E.T., Akinseye L., Nelson G., Smith-Young J., Kim A. Increased anxiety symptoms in pediatric type 1 diabetes during the acute phase of COVID-19 lockdown. J. Pediatr. Endocrinol. Metab. 2022;35(5):627–630. doi: 10.1515/jpem-2022-0002. [DOI] [PubMed] [Google Scholar]
- 47.Sujan M., Tasnim R., Islam M.S., Ferdous M.Z., Apu M., Musfique M.M., Pardhan S. COVID-19-specific diabetes worries amongst diabetic patients: the role of social support and other co-variates. Primary Care Diab. 2021;15(5):778–785. doi: 10.1016/j.pcd.2021.06.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Ratzki-Leewing A.A., Ryan B.L., Buchenberger J.D., Dickens J.W., Black J.E., Harris S.B. COVID-19 hinterland: surveilling the self-reported impacts of the pandemic on diabetes management in the USA (cross-sectional results of the iNPHORM study) BMJ Open. 2021;11(9) doi: 10.1136/bmjopen-2021-049782. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Sauchelli S., Bradley J., England C., Searle A., Whitmarsh A. Exploring support needs of people living with diabetes during the coronavirus COVID-19 pandemic: insights from a UK survey. BMJ Open Diabetes Res. Care. 2021;9(1) doi: 10.1136/bmjdrc-2021-002162. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Verma A., Rajput R., Verma S., Balania V., Jangra B. Impact of lockdown in COVID 19 on glycemic control in patients with type 1 Diabetes Mellitus. Diab. Metab. Syndrome. 2020;14(5):1213–1216. doi: 10.1016/j.dsx.2020.07.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Braune K., Boss K., Schmidt-Herzel J., Gajewska K.A., Thieffry A., Schulze L., Posern B., Raile K. Shaping workflows in digital and remote diabetes care during the COVID-19 pandemic via service design: prospective, longitudinal, open-label feasibility trial. JMIR mHealth and uHealth. 2021;9(4) doi: 10.2196/24374. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 52.Agarwal N., Harikar M., Shukla R., Bajpai A. COVID-19 pandemic: a double trouble for Indian adolescents and young adults living with type 1 diabetes. Int. J. Diab. Develop. Countr. 2020;40(3):346–352. doi: 10.1007/s13410-020-00869-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Sisman P., Polat I., Aydemir E., Karsi R., Gul O.O., Cander S., Ersoy C., Erturk E. How the COVID-19 outbreak affected patients with diabetes mellitus? Int. J. Diab. Develop. Countr. 2022;42(1):53–61. doi: 10.1007/s13410-021-00992-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Di Dalmazi G., Maltoni G., Bongiorno C., Tucci L., Di Natale V., Moscatiello S., Laffi G., Pession A., Zucchini S., Pagotto U. Comparison of the effects of lockdown due to COVID-19 on glucose patterns among children, adolescents, and adults with type 1 diabetes: CGM study. BMJ Open Diabetes Res. Care. 2020;8(2) doi: 10.1136/bmjdrc-2020-001664. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 55.Ruissen M.M., Regeer H., Landstra C.P., Schroijen M., Jazet I., Nijhoff M.F., Pijl H., Ballieux B., Dekkers O., Huisman S.D., de Koning E. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ Open Diabetes Res. Care. 2021;9(1) doi: 10.1136/bmjdrc-2020-002035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56.Elhenawy Y.I., Eltonbary K.Y. Glycemic control among children and adolescents with type 1 diabetes during COVID-19 pandemic in Egypt: a pilot study. Int. J. Diab. Develop. Countr. 2021;41(3):389–395. doi: 10.1007/s13410-021-00968-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 57.Magliah S.F., Zarif H.A., Althubaiti A., Sabban M.F. Managing type 1 diabetes among Saudi adults on insulin pump therapy during the COVID-19 lockdown. Diab. Metab. Syndrome. 2021;15(1):63–68. doi: 10.1016/j.dsx.2020.12.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 58.Panchal U., Salazar de Pablo G., Franco M., Moreno C., Parellada M., Arango C., Fusar-Poli P. The impact of COVID-19 lockdown on child and adolescent mental health: systematic review. Eur. Child Adolesc. Psychiatry. 2021:1–27. doi: 10.1007/s00787-021-01856-w. Advance online publication. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 59.Salari N., Hosseinian-Far A., Jalali R., Vaisi-Raygani A., Rasoulpoor S., Mohammadi M., Rasoulpoor S., Khaledi-Paveh B. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Glob. Health. 2020;16(1):1–11. doi: 10.1186/s12992-020-00589-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 60.Buchberger B., Huppertz H., Krabbe L., Lux B., Mattivi J.T., 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: 10.1016/j.psyneuen.2016.04.019. [DOI] [PubMed] [Google Scholar]
- 61.Roy T., Lloyd C.E. Epidemiology of depression and diabetes: a systematic review. J. Affect. Disord. 2012;142(Suppl):S8–S21. doi: 10.1016/S0165-0327(12)70004-6. [DOI] [PubMed] [Google Scholar]
- 62.Subasinghe S.S., Bongetti E., O’Brien C.L., Silberberg C., Maclsaac R.J., Ward G., Jenkins A.J., O’Neal D.N., Best J.D., Loh M.M., Salzburg M., Ski C.F., Thompson D.R., Castle D. A review of the prevalence and associations of depression and anxiety in type 1 diabetes mellitus. J. Diab. Metabol. Disord. 2015;2(7):007. doi: 10.24966/DMD-201X/100007. [DOI] [Google Scholar]
- 63.Reynolds K.A., Helgeson V.S. Children with diabetes compared to peers: depressed? Distressed? A meta-analytic review. Annals Behav. Med. Publicat. Soc. Behav. Med. 2011;42(1):29–41. doi: 10.1007/s12160-011-9262-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 64.Buchberger B., Huppertz H., Krabbe L., Lux B., Mattivi J.T., 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: 10.1016/j.psyneuen.2016.04.019. [DOI] [PubMed] [Google Scholar]
- 65.Farooqi A., Gillies C., Sathanapally H., Abner S., Seidu S., Davies M.J., Polonsky W.H., Khunti K. A systematic review and meta-analysis to compare the prevalence of depression between people with and without Type 1 and Type 2 diabetes. Prim. Care Diab. 2022;16(1):1–10. doi: 10.1016/j.pcd.2021.11.001. [DOI] [PubMed] [Google Scholar]
- 66.Hood K.K., Rausch J.R., Dolan L.M. Depressive symptoms predict change in glycemic control in adolescents with type 1 diabetes: rates, magnitude, and moderators of change. Pediatr. Diabetes. 2011;12(8):718–723. doi: 10.1111/j.1399-5448.2011.00771.x. [DOI] [PubMed] [Google Scholar]
- 67.Scheidt-Nave C., Barnes B., Beyer A.K., Busch M.A., Hapke U., Heidemann C., Imhoff M., Mumm R., Paprott R., Steppuhn H., von Berenberg-Gossler P., Kraywinkel K. Care for the chronically ill in Germany - the challenges during the COVID-19 pandemic. J.Health Monit. 2021;5(Suppl. 10):2–27. doi: 10.25646/7168. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 68.Boutros M., Moujaess E., Kourie H.R. Cancer management during the COVID-19 pandemic: choosing between the devil and the deep blue sea. Crit. Rev. Oncol. Hematol. 2021;167 doi: 10.1016/j.critrevonc.2021.103273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 69.Powis M., Milley-Daigle C., Hack S., Alibhai S., Singh S., Krzyzanowska M.K. Impact of the early phase of the COVID pandemic on cancer treatment delivery and the quality of cancer care: a scoping review and conceptual model. J. Int. Soc. Qual. Health Care. 2021;33(2):mzab088. doi: 10.1093/intqhc/mzab088. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 70.Malagón T., Yong J.H.E., Tope P., Miller W.H., Jr., Franco E.L., McGill Task Force on the Impact of COVID-19 on Cancer Control and Care Predicted long-term impact of COVID-19 pandemic-related care delays on cancer mortality in Canada. Int. J. Cancer. 2022;150(8):1244–1254. doi: 10.1002/ijc.33884. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 71.d’Annunzio G., Maffeis C., Cherubini V., Rabbone I., Scaramuzza A., Schiaffini R., Minuto N., Piccolo G., Maghnie M. Caring for children and adolescents with type 1 diabetes mellitus: Italian Society for Pediatric Endocrinology and Diabetology (ISPED) statements during COVID-19 pandemia. Diabetes Res. Clin. Pract. 2020;168 doi: 10.1016/j.diabres.2020.108372. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 72.Gao J., Zheng P., Jia Y., Chen H., Mao Y., Chen S., Wang Y., Fu H., Dai J. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One. 2020;15(4) doi: 10.1371/journal.pone.0231924. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 73.Lei L., Huang X., Zhang S., Yang J., Yang L., Xu M. Comparison of prevalence and associated factors of anxiety and depression among people affected by versus people unaffected by quarantine during the COVID-19 epidemic in southwestern China. Med. Sci. Monit. 2020;26 doi: 10.12659/MSM.924609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 74.Wang Y., Di Y., Ye J., Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol. Health Med. 2020;26(1):13–22. doi: 10.1080/13548506.2020.1746817. [DOI] [PubMed] [Google Scholar]
- 75.Sareen J., Erickson J., Medved M.I., Asmundson G.J., Enns M.W., Stein M., Leslie W., Doupe M., Logsetty S. Risk factors for post-injury mental health problems. Depress. Anxiety. 2013;30(4):321–327. doi: 10.1002/da.22077. [DOI] [PubMed] [Google Scholar]
- 76.van Duinkerken E., Snoek F.J., de Wit M. The cognitive and psychological effects of living with type 1 diabetes: a narrative review. Diab. Med. J. British Diab. Associat. 2020;37(4):555–563. doi: 10.1111/dme.14216. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 77.Hilliard M.E., Yi-Frazier J.P., Hessler D., Butler A.M., Anderson B.J., Jaser S. Stress and A1c among people with diabetes across the lifespan. Curr. Diab. Rep. 2016;16(8):67. doi: 10.1007/s11892-016-0761-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 78.Hood K.K., Beavers D.P., Yi-Frazier J., Bell R., Dabelea D., Mckeown R.E., Lawrence J.M. 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(4):498–504. doi: 10.1016/j.jadohealth.2014.03.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 79.Young-Hyman D., de Groot M., Hill-Briggs F., Gonzalez J.S., Hood K., Peyrot M. Psychosocial care for people with diabetes: a position statement of the American diabetes association. Diabetes Care. 2016;39(12):2126–2140. doi: 10.2337/dc16-2053. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 80.Troncone A., Cascella C., Chianese A., Zanfardino A., Casaburo F., Piscopo A., Rosanio F.M., di Candia F., Franzese A., Iafusco D., Mozzillo E. Doctor-patient relationship in synchronous/real-time video-consultations and in-person visits: an investigation of the perceptions of Young people with type 1 diabetes and their parents during the COVID-19 pandemic. Int. J Behav. Med. 2022:1–10. doi: 10.1007/s12529-021-10047-5. Advance online publication. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 81.Rauschenberg C., Schick A., Hirjak D., Seidler A., Paetzold I., Apfelbacher C., Riedel-Heller S.G., Reininghaus U. Evidence synthesis of digital interventions to mitigate the negative impact of the COVID-19 pandemic on public mental health: rapid Meta-review. J. Med. Internet Res. 2021;23(3) doi: 10.2196/23365. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 82.Riboldi I., Cavaleri D., Calabrese A., Capogrosso C.A., Piacenti S., Bartoli F., Crocamo C., Carrà G. Digital mental health interventions for anxiety and depressive symptoms in university students during the COVID-19 pandemic: A systematic review of randomized controlled trials. Revista de Psiquiatria y Salud Mental. 2022 doi: 10.1016/j.rpsm.2022.04.005. Advance online publication. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 83.Grabia M., Puścion-Jakubik A., Markiewicz-Żukowska R., Bielecka J., Mielech A., Nowakowski P., Socha K. Adherence to mediterranean diet and selected lifestyle elements among young women with type 1 diabetes mellitus from Northeast Poland: A case-control COVID-19 survey. Nutrients. 2021;13(4):1173. doi: 10.3390/nu13041173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 84.Forde R., Arente L., Ausili D., De Backer K., Due-Christensen M., Epps A., Fitzpatrick A., Grixti M., Groen S., Halkoaho A., Huber C., Iversen M.M., Johansson U.B., Leippert C., Ozcan S., Parker J., Paiva A.C., Sanpetreanu A., Savet M.A., Rosana S.C.…FEND COVID-19 consortium The impact of the COVID-19 pandemic on people with diabetes and diabetes services: A pan-European survey of diabetes specialist nurses undertaken by the foundation of European Nurses in diabetes survey consortium. Diabet. Med. 2021;38(5) doi: 10.1111/dme.14498. [DOI] [PMC free article] [PubMed] [Google Scholar]
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