Background: Adolescents and young adults (AYAs) with T1D are at risk for elevated depressive symptoms. Health care providers (HCPs) are in a unique position to discuss mental health (MH) and T1D self-care during routine diabetes medical visits.
Objective: Evaluate the frequency and content of MH discussions during medical visits.
Methods: Data were drawn from a longitudinal study of AYA-HCP communication and T1D care. Secondary analyses include evaluation of 108 medical visits (M duration=22.5 min; n=8 HCPs) with 33 AYAs with T1D (48.5% male; 45.5% non-Hispanic White; M age=17.5±1.1 yrs; M clinic visits=3.27). 22 AYAs self-reported elevated depressive symptoms using the Center for Epidemiologic Studies-Depression scale (M CES-D score=22.6±8.3); a matched sample of 11 AYAs without elevated depressive symptoms was selected for comparison (M CES-D score=5.7±3.9). Medical visits were audio-recorded, transcribed, and coded by trained coders to identify and characterize MH discussions.
Results: Coding of transcripts identified 43/108 medical visits (39.8%) with ≥ 1 MH discussion. AYAs with elevated depressive symptoms were as likely to have a MH discussion (42.6%) as AYAs without elevated depressive symptoms (35.0%; p=.43); the elevated group had 2.48 distinct MH conversations/visit compared to 1.64 distinct MH conversations/visit for the non-elevated group (p=.10). MH discussions were initiated most often by HCPs (67.4%), followed by AYAs (23.3%) and parents (9.3%). MH resources were provided in 60.5% of all visits with MH discussion, including: referral for MH services (76.9%), general MH education (30.8%), and recommendation to continue current MH services (26.9%).
Discussion: MH content is commonly discussed in routine T1D care. Results suggest a need to increase HCP-delivered resources for AYAs with MH concerns. Evaluation of MH discussions can improve the quality of AYA-HCP communication around MH symptoms and, ultimately, improve diabetes care.
M. Monaghan: Research Support; Self; American Diabetes Association. C. Wong: None. D.L. Polyakov: None. M. Rose: None.
American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.); National Institutes of Health (R03DK110259)