Behavioural and Emotional Problems in Malaysian Children and Adolescents with Type 1 Diabetes Mellitus: A Cross-sectional Study in a Single Centre

Authors

  • Lee Ching Wong Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia https://orcid.org/0000-0001-5293-7186
  • Arini Nuran Idris Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia https://orcid.org/0000-0002-5217-4403
  • Norazlin Kamal Nor Department of Paediatrics, Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Malaysia https://orcid.org/0000-0001-9959-8089
  • Poi Giok Lim Hospital Tunku Azizah, Kuala Lumpur, Malaysia

DOI:

https://doi.org/10.15605/jafes.038.02.10

Keywords:

Type 1 Diabetes Mellitus, psychosocial, Child Behaviour Check List, CBCL

Abstract

Introduction. Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that requires a lifelong treatment regimen which may affect psychosocial development.

Objective. To identify behavioural and emotional problems in children and adolescents with T1DM.

Methodology. A cross-sectional study using the Child Behaviour Check List (CBCL) was conducted among all T1DM patients receiving treatment at the Paediatric Endocrine Unit, Hospital Tunku Azizah Kuala Lumpur, Malaysia.

Results. Forty T1DM patients were included. The mean age of the participants was 12.4 years (SD=2.69), with 52.5% males, and 75% Malay. The average duration of illness was 4.8 years, 9 were pre-pubertal, while mean HbA1c was 9.4%. Thirty-five percent of the respondents had parent-reported internalizing problems and 17.5% had parent-reported
externalizing problems. Those >12 years old had more internalizing problems (p=0.004) compared to those ≤12 years old. The differences were in the anxious/depressed syndrome subscale (p=0.001) and withdrawn/depressed syndrome subscale (p=0.015). There were no statistically significant differences in the 3 main global scores by gender, glycaemic control, duration of illness and pubertal status by univariate analysis.

Conclusion. T1DM patients >12 years old were at higher risk of developing psychosocial difficulties. This highlighted the benefit of screening of behavioural and emotional issues in children and adolescents with T1DM.

Downloads

Download data is not yet available.

Author Biographies

Lee Ching Wong, Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia

Paediatric Unit

Arini Nuran Idris, Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia

Paediatric Unit

Norazlin Kamal Nor , Department of Paediatrics, Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Malaysia

Child Development Centre

Poi Giok Lim, Hospital Tunku Azizah, Kuala Lumpur, Malaysia

Department of Paediatrics

References

Dantzer C, Swendsen J, Maurice-Tison S, Salamon R. Anxiety and depression in juvenile diabetes: A critical review. Clin Psychol Rev. 2003;23(6):787-800. https://pubmed.ncbi.nlm.nih.gov/14529698. https://doi.org/10.1016/s0272-7358(03)00069-2.

International Diabetes Federation. IDF Diabetes Atlas, 10th ed. Brussels, Belgium;2021

Grey M, Cameron ME, Lipman TH, Thurber FW. Psychosocial status of children with diabetes in the first 2 years after diagnosis. Diabetes Care. 1995;18(10):1330-6. https://pubmed.ncbi.nlm.nih.gov/8721933. https://doi.org/10.2337/diacare.18.10.1330.

Kovacs M, Goldston D, Obrosky DS, Drash A. Major depressive disorder in youths with IDDM. Diabetes Care. 1997;20(1):45-51. https://pubmed.ncbi.nlm.nih.gov/9028692. https://doi.org/10.2337/diacare.20.1.45.

Northam E, Anderson P, Adler R, Werther G, Warne G. Psychosocial and family functioning in children with insulin-dependent diabetes at diagnosis and one year later. J Pediatr Psychol. 1996;21(5):699-717. https://pubmed.ncbi.nlm.nih.gov/8936898. https://doi.org/10.1093/jpepsy/21.5.699.

Khandelwal S, Sengar GS, Sharma M, Choudhary S, Nagaraj N. Psychosocial illness in children with type 1 diabetes mellitus: Prevalence, pattern and risk factors. J Clin Diagn Res. 2016;10(9):SC05-8. https://pubmed.ncbi.nlm.nih.gov/27790539. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072039. https://doi.org/10.7860/JCDR/2016/21666.8549.

Zheng XP, Chen SH. Psycho-behavioral changes in children with type 1 diabetes mellitus. World Journal of Pediatrics. 203;9(3):261–5. https://pubmed.ncbi.nlm.nih.gov/23929255. https://doi.org/10.1007/s12519-013-0428-y.

Helgeson VS, Snyder PR, Escobar O, Siminerio L, Becker D. Comparison of adolescents with and without diabetes on indices of psychosocial functioning for three years. J Pediatr Psychol. 2007;32(7):794-806. https://pubmed.ncbi.nlm.nih.gov/17426042. https://doi.org/10.1093/jpepsy/jsm020.

Adili F, Larijani B, Haghighatpanah M. Diabetic patients: Psychological aspects. Ann N Y Acad Sci. 2006;1084:329-49. https://pubmed.ncbi.nlm.nih.gov/17151313. https://doi.org/10.1196/annals.1372.016.

Lernmark B, Persson B, Fisher L, Rydelius PA. Symptoms of depression are important to psychological adaptation and metabolic control in children with diabetes mellitus. Diabet Med. 1999;16(1):14-22. https://pubmed.ncbi.nlm.nih.gov/10229288. https://doi.org/10.1046/j.1464-5491.1999.00008.x.

Rewers A, Chase HP, Mackenzie T, et al. Predictors of acute complications in children with type 1 diabetes. JAMA. 2002;287(19):2511-8. https://pubmed.ncbi.nlm.nih.gov/12020331. https://doi.org.10.1001/jama.287.19.2511.

Anderson BJ, Vangsness L, Connell A, Butler D, Goebel-Fabbri A, Laffel LM. Family conflict, adherence, and glycaemic control in youth with short duration type 1 diabetes. Diabet Med. 2002;19(8): 635-42. https://pubmed.ncbi.nlm.nih.gov/12147143. https://doi.org/10.1046/j.1464-5491.2002.00752.x.

Farrell SP, Hains AA, Davies WH, Smith P, Parton E. The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes. J Adolesc Health. 2004;34(6):461-7. https://pubmed.ncbi.nlm.nih.gov/15145403. https://doi.org/10.1016/S1054-139X(03)00215-5.

Lernmark B, Dahlqvist G, Fransson P, et al. Relations between age, metabolic control, disease adjustment and psychological aspects in insulin-dependent diabetes mellitus. Acta Paediatr. 1996;85(7):818-24. https://pubmed.ncbi.nlm.nih.gov/8819548. https://doi.org/10.1111/j.1651-2227.1996.tb14159.x.

Stewart SM, Rao U, Emslie GJ, Klein D, White PC. Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus. Pediatrics. 2005;115(5):1315-9. https://pubmed.ncbi.nlm.nih.gov/15867041. https://doi.org/10.1542/peds.2004-1717.

Swerdlow AJ, Jones ME. Mortality during 25 years of follow-up of a cohort with diabetes. Int J Epidemiol. 1996;25(6):1250-61. https://pubmed.ncbi.nlm.nih.gov/9027532. https://doi.org/10.1093/ije/25.6.1250.

Achenbach TM, Rescorla LA. Manual for ASEBA School-Age Forms & Profiles, Research Center for Children, Youth, & Families, University of Vermont, Burlington, Vt, USA; 2001.

Abd Rahman FN, Daud TIM, Nik Jaafar NR, Shah SA, Tan SMK, Ismail WSW. Behavioral and emotional problems in a Kuala Lumpur children's home. Pediatr Int. 2013;55(4):422–7. https://pubmed.ncbi.nlm.nih.gov/23617604. https://doi.org/10.1111/ped.12115.

ElSayed NA, Aleppo G, Aroda VR, et al, American Diabetes Association. 14. Children and adolescents: Standards of care in diabetes—2023. Diabetes Care 2023; 46(Suppl 1):S230–53. https://pubmed.ncbi.nlm.nih.gov/36507640. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810473. https://doi.org/10.2337/dc23-S014.

Khandelwal A. A complete guide on sampling techniques for data science. September 22, 2021. https://www.analyticsvidhya.com/blog/2021/09/a-complete-guide-on-sampling-techniques/.

IBM Corp. Released 2013. IBM SPSS statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

Buchberger B, Huppertz H, Krabbe L, Lux B, Mattivi JT, Siafarikas A. Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology. 2016;70:70-84. https://pubmed.ncbi.nlm.nih.gov/27179232. https://doi.org/10.1016/j.psyneuen.2016.04.019.

Reynolds KA, Helgeson VS. Children with diabetes compared to peers: Depressed? Distressed? A meta-analytic review. Ann Behav Med. 2011;42(1):29-41. https://pubmed.ncbi.nlm.nih.gov/21445720. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140576. https://doi.org/10.1007/s12160-011-9262-4.

Eisenberg Colman MH, Quick VM, Lipsky LM, et al. Disordered eating behaviors are not increased by an intervention to improve diet quality but are associated with poorer glycemic control among youth with type 1 diabetes. Diabetes Care. 2018;41(4):869-75. https://pubmed.ncbi.nlm.nih.gov/29371234. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860841. https://doi.org/10.2337/dc17-0090.

Puri K, Sapra S, Jain V. Emotional, behavioral and cognitive profile, and quality of life of Indian children and adolescents with type 1 diabetes. Indian J Endocrinology and Metabolism. 2013;17(6):1078-83. https://pubmed.ncbi.nlm.nih.gov/24381888. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872689. https://doi.org/10.4103/2230-8210.122631.

Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: A meta-analytic review of the literature. Diabetes Care. 2000;23(7):934–42. https://pubmed.ncbi.nlm.nih.gov/10895843. https://doi.org/10.2337/diacare.23.7.934.

Cho E, Shin SH, Eun S-H, et al. Psychological characteristics of Korean children and adolescents with type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab. 2013;18(3):122-7. https://pubmed.ncbi.nlm.nih.gov/24904865. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027070. https://doi.org/10.6065/apem.2013.18.3.122.

Xiao-Ping Zheng, Shuo-Hui Chen. Psycho-behavioral changes in children with type 1 diabetes mellitus. World J Pediatr. 2013;9(3):261–5. https://pubmed.ncbi.nlm.nih.gov/23929255. https://doi.org/10.1007/s12519-013-0428-y.

Delamater AM, de Wit M, McDarby V, et al. ISPAD clinical practice consensus guidelines 2018. Psychological care of children and adolescents with type 1 diabetes. Pediatric Diabetes. 2018;19(Suppl. 27):237–49. https://pubmed.ncbi.nlm.nih.gov/30058247. https://doi.org/10.1111/pedi.12736.

Hadad S, Ali MM, Sayed TA. Psychological and behavioral complications in children and adolescents with type 1 diabetes mellitus in Sohag. Middle East Curr Psychiatry. 2021;28(37):1-8. https://doi.org/10.1186/s43045-021-00117-5.

Downloads

Published

2023-08-02

How to Cite

Wong, L. C., Idris, A. N. ., Kamal Nor , N. ., & Lim, P. G. (2023). Behavioural and Emotional Problems in Malaysian Children and Adolescents with Type 1 Diabetes Mellitus: A Cross-sectional Study in a Single Centre. Journal of the ASEAN Federation of Endocrine Societies, 38(2), 13–19. https://doi.org/10.15605/jafes.038.02.10

Issue

Section

Original Articles

Most read articles by the same author(s)