Family Structure is Associated with Mental Health and Attention Deficit (Hyperactivity) Disorders in Adolescents with Type 1 Diabetes

Abstract

Objective To analyze the cross-sectional associations of family structure with mental health and attention deficit (hyperactivity) disorders (AD(H)D) in 11- to 17-year-old adolescents with early-onset type 1 diabetes participating in one of three baseline surveys as part of an ongoing cohort study.

Methods Parents (n=1,631) completed the Strengths and Difficulties Questionnaire to screen for their child’s mental health and answered questions about their child’s diagnosis of AD(H)D. Associations between mental health or AD(H)D and family structure were analyzed using multivariable logistic regression analyses adjusted for various personal and diabetes-related variables.

Results Compared to adolescents living with both parents, adolescents living with one parent and his/her partner had 2.35 (95% confidence interval 1.32; 4.21) higher odds of abnormal screening result and 2.08 (1.09; 3.95) higher odds of a borderline screening result while adolescents living with a single parent had 1.84 (1.07; 3.17)/1.08 (0.53; 2.21) higher odds of abnormal/borderline screening results. The odds ratios for diagnosed attention deficit (hyperactivity) disorder were 2.17 (0.98; 4.84) for adolescents living with one parent and his/her partner and 1.27 (0.54; 3.01) for those living with a single parent vs. both parents.

Conclusions Our results indicate higher odds of mental health problems and AD(H)D in adolescents with type 1 diabetes who do not live with both parents; this finding was most pronounced in individuals living with one parent and his/her partner vs. both parents. Longitudinal studies are needed to verify our results and elucidate the underlying mechanisms.

Key words

attention deficit hyperactivity disorder - ADHD - adolescence - psychology - T1D - childhood diabetes

• References

• 1 International Society for Pediatric and Adolescent Diabetes (ISPAD). Consensus Guidelines for the management of Type 1 Diabetes mellitus in Children and Adolescents. 2000
• 2 Garrett C, Ismail K. Forgotten: Mental health interventions in type 1 diabetes. Lancet 2020; 395: 115
• 3 Ducat L, Philipson LH, Anderson BJ. The mental health comorbidities of diabetes. JAMA 2014; 312: 691-692
• 4 Feldman HM, Reiff MI. Clinical practice. Attention deficit-hyperactivity disorder in children and adolescents. N Engl J Med 2014; 370: 838-846
• 5 Kapellen TM, Reimann R, Kiess W. et al. Prevalence of medically treated children with ADHD and type 1 diabetes in Germany - Analysis of two representative databases. J Pediatr Endocrinol Metab 2016; 29: 1293-1297
• 6 Butwicka A, Frisén L, Almqvist C. et al. Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: A population-based cohort study. Diabetes Care 2015; 38: 453-459
• 7 Chen H-J, Lee Y-J, Yeh GC. et al. Association of attention-deficit/hyperactivity disorder with diabetes: A population-based study. Pediatr Res 2013; 73: 492-496
• 8 Macek J, Battelino T, Bizjak M. et al. Impact of attention deficit hyperactivity disorder on metabolic control in adolescents with type1 diabetes. J Psychosom Res 2019; 126: 109816
• 9 Mazor-Aronovitch K, Pinhas-Hamiel O, Pivko-Levy D. et al. Dual diagnosis of type 1 diabetes mellitus and attention deficit hyperactivity disorder. Pediatr Diabetes 2021; 22: 649-655
• 10 Hilgard D, Konrad K, Meusers M. et al. Comorbidity of attention deficit hyperactivity disorder and type 1 diabetes in children and adolescents: Analysis based on the multicentre DPV registry. Pediatr Diabetes 2017; 18: 706-713
• 11 Prinz N, Bächle C, Becker M. et al. Insulin pumps in type 1 diabetes with mental disorders: Real-life clinical data indicate discrepancies to recommendations. Diabetes Technol Ther 2016; 18: 34-38
• 12 Sawyer MG, Reece CE, Sawyer ACP. et al. Has the prevalence of child and adolescent mental disorders in Australia changed between 1998 and 2013 to 2014?. J Am Acad Child Adolesc Psychiatry 2018; 57: 343-350.e5
• 13 Stenmark H, Bergström E, Hägglöf B. et al. Mental problems and their socio-demographic determinants in young schoolchildren in Sweden, a country with high gender and income equality. Scand J Public Health 2016; 44: 18-26
• 14 Erhart M, Weimann A, Bullinger M. et al. Psychological comorbidity in children and adolescents with chronic somatic diseases. Bundesgesundheitsbl 2011; 54: 66-74
• 15 Steinbach A, Kuhnt A-K, Knüll M. The prevalence of single-parent families and stepfamilies in Europe: Can the Hajnal line help us to describe regional patterns?. The History of the Family 2016; 21: 578-595
• 16 Statistisches Bundesamt. Alleinerziehende in Deutschland 2017. Wiesbaden: 2018. https://www.destatis.de/DE/Presse/Pressekonferenzen/2018/Alleinerziehende/pressebroschuere-alleinerziehende.pdf?__blob=publicationFile&v=3 2018
• 17 United States Census Bureau. Historical living arrangements of children. Table CH-1: Living arrangements of children under 18 years old: 1960 to present https://www.census.gov/data/tables/time-series/demo/families/children.html
• 18 Härkönen J, Bernardi F, Boertien D. Family dynamics and child outcomes: An overview of research and open questions. Eur J Population 2017; 33: 163-184
• 19 Stahl A, Straßburger K, Lange K. et al. Health-related quality of life among German youths with early-onset and long-duration type 1 diabetes. Diabetes Care 2012; 35: 1736-1742
• 20 Janitza S, Klipker K, Hölling H. Age-specific norms and validation of the German SDQ parent version based on a nationally representative sample (KiGGS). Eur Child Adolesc Psychiatry 2020; 29: 123-136
• 21 Kuhn C, Aebi M, Jakobsen H. et al. Effective mental health screening in adolescents: Should we collect data from youth, parents or both?. Child Psychiatry Hum Dev 2017; 48: 385-392
• 22 Essau CA, Olaya B, Anastassiou-Hadjicharalambous X. et al. Psychometric properties of the Strength and Difficulties Questionnaire from five European countries. Int J Methods Psychiatr Res 2012; 21: 232-245
• 23 Vostanis P. Strengths and Difficulties Questionnaire: Research and clinical applications. Curr Opin Psychiatry 2006; 19: 367-372
• 24 youthinmind. Scoring the Strengths & Difficulties Questionnaire for age 4-17 or 18+; https://sdqinfo.org/py/sdqinfo/b3.py?language=Englishqz(USA)
• 25 Becker A, Rothenberger A, Sohn A. et al. Six years ahead: A longitudinal analysis regarding course and predictive value of the Strengths and Difficulties Questionnaire (SDQ) in children and adolescents. Eur Child Adolesc Psychiatry 2015; 24: 715-725
• 26 Schlack R, Hölling H, Kurth B-M. et al. Die prävalenz der aufmerksamkeitsdefizit-/hyperaktivitätsstörung (ADHS) bei kindern und Jjgendlichen in Deutschland. Erste Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KiGGS). Bundesgesundheitsbl 2007; 50: 827-835
• 27 Bohn B, Karges B, Vogel C. et al. 20 Years of pediatric benchmarking in Germany and Austria: Age-dependent analysis of longitudinal follow-up in 63,967 children and adolescents with type 1 diabetes. PLoS ONE 2016; 11: e0160971
• 28 Baechle C, Stahl-Pehe A, Castillo K. et al. Association of family structure with type 1 diabetes therapy and outcomes: A population-based survey. Pediatr Diabetes 2021; 22: 482-494
• 29 Fajardo-Bullón F, Rasskin-Gutman I, León-Del Barco B. et al. International and Spanish findings in scientific literature about minors’ mental health: Predictive factors using the Strengths and Difficulties Questionnaire. Int J Environ Res Public Health 2019; 16: 1603
• 30 Schlack R, Mauz E, Hebebrand J. et al. Has the prevalence of parent-reported diagnosis of attention deficit hyperactivity disorder (ADHD) in Germany increased between 2003-2006 and 2009-2012? Results of the KiGGS-study: First follow-up (KiGGS Wave 1). Bundesgesundheitsbl 2014; 57: 820-829
• 31 Stahl-Pehe A, Lange K, Bächle C. et al. Mental health problems among adolescents with early-onset and long-duration type 1 diabetes and their association with quality of life: A population-based survey. PLoS ONE 2014; 9: e92473
• 32 VanderWeele TJ. Principles of confounder selection. Eur J Epidemiol 2019; 34: 211-219
• 33 Eilander MMA, Snoek FJ, Rotteveel J. et al. Parental Diabetes Behaviors and Distress Are Related to Glycemic Control in Youth with Type 1 Diabetes: Longitudinal Data from the DINO Study. J Diabetes Res 2017; 2017: 1462064
• 34 Kristensen LJ, Birkebaek NH, Mose AH. et al. Symptoms of emotional, behavioral, and social difficulties in the danish population of children and adolescents with type 1 diabetes--results of a national survey. PLoS ONE 2014; 9: e97543
• 35 Polanczyk GV, Willcutt EG, Salum GA. et al. ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis. Int J Epidemiol 2014; 43: 434-442
• 36 Dybdal D, Tolstrup JS, Sildorf SM. et al. Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: A population-based cohort study. Diabetologia 2018; 61: 831-838
• 37 Bernardi F, Härkönen J, Boertien D. Effects of family forms and dynamics on children’s well-being and life chances: Literature review. Working Paper Series. 2013
• 38 Ravens-Sieberer U, Otto C, Kriston L. et al. The longitudinal BELLA study. Design, methods and first results on the course of mental health problems. Eur Child Adolesc Psychiatry 2015; 24: 651-663
• 39 Yazar A, Akın F, Akça ÖF. et al. The effect of attention deficit/hyperactivity disorder and other psychiatric disorders on the treatment of pediatric diabetes mellitus. Pediatr Diabetes 2019; 20: 345-352
• 40 Boritz TZ, Sheikhan NY, Hawke LD. et al. Evaluating the effectiveness of the Family Connections program for caregivers of youth with mental health challenges, part I: A quantitative analysis. Health Expect 2021; 24: 578-588
• 41 Jiménez L, Hidalgo V, Baena S. et al. Effectiveness of structural-strategic family therapy in the treatment of adolescents with mental health problems and their families. Int J Environ Res Public Health 2019; 16: 1255
• 42 Cooper MN, Lin A, Alvares GA. et al. Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up. Pediatr Diabetes 2017; 18: 599-606
• 43 Visser SN, Danielson ML, Bitsko RH. et al. Convergent validity of parent-reported attention-deficit/hyperactivity disorder diagnosis: A cross-study comparison. JAMA Pediatr 2013; 167: 674-675
• 44 Bøe T, Øverland S, Lundervold AJ. et al. Socioeconomic status and children's mental health: Results from the Bergen Child Study. Soc Psychiatry Psychiatr Epidemiol 2012; 47: 1557-1566
• 45 Mullins LL, Wolfe-Christensen C, Chaney JM. et al. The relationship between single-parent status and parenting capacities in mothers of youth with chronic health conditions: The mediating role of income. J Pediatr Psychol 2011; 36: 249-257