Date of Award

4-12-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

William Tamborlane

Abstract

This study was undertaken to examine the efficacy of screening for depression in a pediatric diabetes clinic and how the yield of such screening compares with established screening protocols aimed at identifying early microvascular complications and associated autoimmune diseases. Two-hundred-fifteen children and adolescents 8-18 years old in the Yale Pediatric Diabetes Center were screened for depression using the Children's Depression Inventory (CDI), with information including gender, age, duration of diabetes, HbA1C, and results of other screening protocols compiled. A total of 8.4% of our cohort had CDI scores ≥13 indicative of clinically-significant depressive symptoms, with a range of 0-34. Depression scores were not associated with gender, age, or HbA1C. However, duration of diabetes showed a trend toward statistical significance (adjusted p=.068). Screening for depression using the CDI with a cutoff of ≥13 had similar positive testing rates as screening for microalbuminuria, hypercholesterolemia, thyroid dysfunction, and celiac sprue; in contrast, none of the clinic patients had evidence of retinopathy at their last ophthalmologic examination. These findings indicate that screening for depression in a pediatric diabetes clinic identifies a substantial number of youngsters with high levels of depressive symptoms and has a yield that is equal to or greater than other standard screening tests and examinations. Thus, screening appears to be warranted.

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