Limited access to pediatric diabetes mental health care suggests a need to readily identify youth requiring referral. The current study aimed to establish a clinically meaningful cut-point on the PAID-Peds, a previously validated measure of diabetes distress in youth with type 1 diabetes (T1D).
The 20-item PAID-Peds has shown construct validity with measures of depressive symptoms, diabetes-specific family conflict (DSFC), and general quality of life (QoL). Higher scores (range 0-100) indicate more distress. ROC analyses in youth 8-17 years old compared PAID-Peds scores against established clinical cutoffs for depressive symptoms on the Center for Epidemiological Studies - Depression Scale (CES-D) and Depression Scale for Children (CES-DC) to identify a meaningful clinical cutoff for the PAID-Peds. Confirmation of the cutoff score included assessment of convergent validity with glycemic control and teen-reported measures of treatment adherence, diabetes specific family conflict, and QoL.
The sample included 427 youth ((M±SD) age 14.3±2.1 years, T1D duration 6.4±3.7 years, and A1c 8.4±1.1%); 49% were male, 83% white, 83% from 2-parent families, and 69% pump-treated. ROC analyses identified a cut-point of 41, with sensitivity of 79%, specificity of 69%, and negative predictive value (NPV) of 94%. Youth with PAID-Peds scores ≥41 (n=168) vs. <41 were more likely to be female (59 vs. 45%), perform less frequent BG monitoring (4.8 vs. 5.5x/day), and have higher A1c (8.6 vs. 8.2%) (p <.01 for all). Youth endorsing more distress (≥41 vs. <41) also reported lower adherence and QoL, and more DSFC (p <.001 for all).
The cutoff score of 41 on the PAID-Peds has acceptable sensitivity, specificity, and NPV, and warrants future assessment in clinical research and practice. Establishing a cut-point for clinically meaningful diabetes distress may help clinicians to identify youth at risk for poorer biomedical and psychosocial outcomes, thereby prompting timelier referral for mental health support.
P.V. Commissariat: None. L.J. Tinsley: None. L. Volkening: None. D.A. Butler: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..