We're in the final days of May — National Mental Health Awareness Month — and earlier this month, I shared my own personal struggles in dealing with depression and diabetes. But that was through my lens as an adult with diabetes. What about children and adolescent PWDs?
We all know that being a teenager is no picnic, and adding diabetes to the mix can sometimes be a recipe for disaster. And depression.
Studies show that adults with diabetes are at nearly double the risk for depression, and that nearly 30% of all PWDs also have depression. Nearly one in seven children with diabetes self-report having depressive symptoms, a stat that's nearly double the incidence in non-diabetic kids.
Raising children with diabetes is already a huge challenge, and we wondered about the added nuances of dealing with depression in a child or youth as opposed to in adults. So we reached out to two experts in the field: Sarah Jaser, a research scientist from the Yale School of Nursing; and Debbie Butler, a psychologist at Joslin Diabetes Center. Both offered some great advice and confirmed that depression in adults or children isn't really all that different than in older folks.
Although, sometimes depression can look like garden-variety irritation in those adolescent years, which makes the whole thing... even more difficult for parents trying to raise a child or teen with diabetes.
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Depression > Diabetes > Attitude
We're all pretty familiar with the "vicious cycle" here: Not only can diabetes increase the risk of depression, but depression can also increase a variety of risks with diabetes. When diabetes management goes downhill, that can lead to hospitalizations from DKA or eventual D-complications, no matter what your age.
"It's important for parents to know that depression in youth with type 1 diabetes can have important medical complications," says Sarah Jaser at Yale.
Jaser is currently studying a group of adolescents with type 1 diabetes and their mothers to examine the relationship between diabetes and depression. In her study, adolescents who were able to cope with diabetes in a healthy way, such as using problem-solving strategies, have fewer depressive symptoms. But adolescents who use avoidance or wishful thinking in their diabetes have more depressive symptoms.
So what it boils down to is that denial doesn't work; what helps is having a proactive attitude about coping with bad days and setbacks.
Not Just 'The Blues'
How do you know if your child is suffering from true depression? Differentiating between "the blues" and clinical depression can be tough. Although diabetes management factors — like a high A1c — can indicate depression, there are plenty of other typical signs of depression that show in both kids and adults, including:
- Feelings of sadness, hopelessness, excessive crying or outbursts
- Losing interest in activities they enjoy, like sports or spending time with friends
- Low energy or exhaustion
- Having trouble sleeping or excessive sleepiness
- Changes in appetite, like eating more than usual or eating less
- Decrease in productiveness, like a drop in grades, cutting class or missing school
"It's also important to note that, in children, depression can show up as irritability rather than sadness," Jaser says.
Screening & Getting Help
Children, especially teenagers, are not necessarily the most forthcoming about asking for help. So what are some strategies for getting to the root of the problem with your adolescent?
Yale researcher Jaser suggests parents talk to the child about what they've noticed, in an interested but non-judgmental tone, i.e. "You've been in your room a lot lately, crying more than usual, not spending as much time with friends, etc." Hopefully this can open the door for the child to talk about how he or she is feeling without being put on the spot.
Somewhat surprisingly, the American Diabetes Association recommends screening for depression once a year, starting at age 10 (!) This isn't exactly new, as the ADA released this statement in a 2005 issue of Diabetes Care (along with many other recommendations for children with diabetes, if you're curious).
Jaser says that screenings should be done by a social worker or psychologist (folks who are professionally trained), but nurses or health care providers can also do the screening. It's obviously not the only way to catch depression, though. Thankfully many PWDs come forward to seek out a therapist on their own, like I did before being diagnosed with depression.
"Talk Therapy" Helps
Although medication can work for children with depression, both of our experts believe that counseling, or "talk therapy," is the best first step. They say the family is often very important in making the therapy successful, as well.
"I'm a firm believer in trying counseling first, and that if someone does go on medication, that they should continue to stay in counseling," Butler from Joslin says. "Even if medication works, you still have to cope with the same problems."
Professional diagnosis and treatment is always crucial when dealing with depression, in other words, the success rate is very low for people who just try to "deal with it on their own." And therapy treatments and medication are certainly not one-size-fits-all; they have to handled on a case-by-case basis depending on the severity of the depression.
There are also some good "non-clinical" ways to get emotional support for a child dealing with diabetes, like connecting and sharing feelings with peers. Nicole, a mom of a 13-year-old with diabetes who's had bouts of depression, wrote on the ChildrenwithDiabetes.com forum that one of the best treatments for her daughter came from friends with diabetes.
She wrote, "Try as I might, it will never be possible for me to understand what it is like to have type 1. This is where camp was a huge blessing for us... she was able to meet other kids her age going through the same things, experiencing the same feelings... and she learned that she will be okay."
D-Parents: Try Easing Up
For awhile now, psychologists and PWDs themselves have been advising parents not to be too hard on their kids and teens, and now the Yale group has evidence to support that.
"Our results suggest that parenting is related to depressive symptoms in adolescents — when mothers use a lot of lecturing or nagging in their interactions, adolescents report more depressive symptoms," Jaser explains. "Warm, supportive parenting is linked with better outcomes, but it can sometimes be hard to describe. The easiest thing for parents to do is to make an effort to praise what the child is doing well (e.g., 'you're doing a great job checking your blood sugar before dinner')."
In Butler's practice at Joslin, she's found that working with adolescents to find out what exactly they need help with can sometimes do the job when teens are feeling burned out. She says that other researchers have confirmed that parents "mean well, but the support often comes out in the wrong way."
"So (support style) is what a counselor can really help with," Debbie says. "It's a different formula for every patient, family and situation."
Jaser believes that it's important to make sure diabetes isn't always the focus of your interactions with your child. "I hear from a lot of kids and parents that the first questions parents ask when kids come home from school are about diabetes management, but kids don't want to talk about and think about diabetes all the time. If parents lead with questions about the child's interests (e.g., sports, music, theater, video games), then kids may be more receptive to later questions about diabetes management," she says.
No one likes to think about the possibility of complications impacting our lives at any point. It's, well... depressing! But clearly, clinical depression is one effect of diabetes that can hit us in the here and now and needs to be addressed. Kids aren't immune, and as the experts and PWDs like myself say, sharing is often the first step in addressing depression. So, if you've dealt with depression in your adolescent (or yourself) we would love to hear your experiences and advice for others!