Girls with Type 1 Diabetes More Likely to Have Suicidal Ideation

Though the threat of suicide ideation (SI) may be a greater expressed risk in children suffering from debilitating disease, researchers recently discovered that children with type 1 diabetes (T1D) do not have greater SI rates than the general population.

In a study led by Harpreet Nagra, MD, a pediatrician with PeaceHealth Medical Group in Bellingham, WA, researchers considered the feasibility and effectiveness of screening for SI in children and adolescents with T1D. They prosed that, because of youths’ access to insulin coupled with “limited forethought and higher impulsivity during childhood and adolescence,” screening for SI should be considered a greater importance.

Their data were presented at the 2018 American Diabetes Association (ADA) 78^th Annual Scientific Sessions in Orlando, FL, this week.

Researchers obtained the data of children aged 11-18 years old with T1D from a regional diabetes center. Participants were screened for behavioral health measures using the Patient Health Questionnaire-9 (PHQ-9). More specifically, their response to question 9 of the survey — “Thoughts that you would be better off dead or of hurting yourself in some way” — were gauged by researchers.

A total of 587 patients completed the questionnaire, comprising of 289 males and 298 females. Mean patient glycated hemoglobin (HbA1c) levels were 9.1% (SD = 2.2).

A significant relationship between gender and SI endorsement was indicated in females, as twice as many female participants (n= 52) reported SI endorsement as males (n= 26). SI was also significantly associated HbA1c, according to researchers.

Approximately 13% of participants screened positive for SI, with three-fourths of that population having SI for several days in the week prior to their examination. An approximate 20% of the SI-indicated population had ideations for more than half the days in the last week, and had received an onsite referral and telephone call-up.

Another 5% of the SI-indicated population reported ideations nearly daily in the week prior to the questionnaire. They received on-site clinical assessment, with 1 participant requiring emergency services.

The study comes a year following a similar study, which analyzed the prevalence of depression and diabetes-related stress in patients with T1D. In analyzing terminal hospital records of 100 organ donors to have lived with the disease, researchers found that 8% died from a documented suicide. The average age of those who committed suicide was 21 years old, with donors having had diabetes for a mean of 9 years. Similarly, researchers noted, a T1D registry in the United Kingdom found that 6% of all patient deaths are due to suicide.

But the researchers at ADA concluded that, despite concerns with access to insulin therapy and the significant rate reported by the female population, SI rates in youths with T1D were consistent with the general age population. They advocated for continued screening in the pediatric patient population.

In an interview with MD Mag at the 2018 ADA meeting, Andrea Dunaif, MD, chief of the Hilda and J. Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine, noted that one of the greater drivers of worsened quality of life in females with diabetes or polycystic ovary syndrome (PCOS) is obesity.

“I think there really needs to be a much more widespread attention to looking at quality of life issues,” Dunaif said. “Women have a greater risk for depression, and have much higher prevalence rates of depression than men do.”

These rates similarly extend into suicidal behavior.

“I think it behooves physicians to explore that in more detail,” Dunaif said.

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