Frequency and risk factors of depression in type 1 diabetes in a developing country

Background: Living with type 1 diabetes, especially in developing countries, can feel overwhelming for parents and children because constant vigilance is required for proper care with an inadequacy of resources. Our aim was to investigate the frequency and risk factors of depressive symptoms in children and adolescents with type 1 diabetes. Methods: The study was conducted using epidemiologic studies Depression Scale Questionnaire for Children (CESDC) on 86 patients with type 1 diabetes from the Diabetes Clinic in Alexandria University Children's Hospital, Egypt. Logistic regression models were used to detect the predictors of depression. Results: In the current study 45 children (52.3%) had scores >= 15 indicating a depressive state. Children who had depression were found to have a significantly longer duration of diabetes (5.84 +/- 2.53 year), a higher mean total daily insulin dose (1.36 +/- 0.45 unit/kg), HbA(1c) level (9.84 +/- 1.75) and were less frequently treated with a basal bolus insulin regimen (35.56%); p <= 0.001. A multivariate logistic regression model showed that HbA(1c) is the only significant predictor for depression (p < 0.001). HbA(1c) at a cutoff point of 8.6 could predict depression in type 1 diabetic children with specificity of 71.8%, sensitivity of 78.6%, (area under the curve [AUC] = 0.8) and p-value <= 0.001. Conclusions: Children and adolescents with type 1 diabetes have high frequency of depressive symptoms in a developing country. Poor glycemic control is the most significant predictor for depression in these patients.