The Impact of Anxiety and Depression on the Pediatric Patients with Diabetes

Lavinia Alexandra Moroianu, Ion G. Motofei, Curis Cecilia, Raisa-Eloise Barbu, Alexandra Toma


Diabetes mellitus represents a vast pathology which attestation is known since ancient times and research made in the recent years reveals increasingly clear data on the connection between diabetes and psychiatric disorders. Diabetes can cause psychiatric disorders such as anxiety, depression, acute stress response and adjustment disorders, as well as organic personality disorders and/or affectivity disorders. There is an increase in diabetic patients worldwide and in the same time for the pediatric cases with diabetes. Moreover, there is an association between the development of anxiety and depression symptoms in patients with diabetic comorbidity and the association of these three entities represents an interesting subject in the medical world. The main purpose of this study is to deepen the knowledge about the association of three diseases in children, in order to establish a working algorithm applicable in current clinical practice. We were able to identify the severity of anxiety and depressive symptoms in patients with diabetes mellitus insulin dependent and no other psychiatric pathologies diagnosed before the study by applying the Hamilton A questionnaire, Beck Depression Inventory and Children’s Depression Inventory. There were analyzed correlations between their scale’s scores and the values of our patient’s glycemia, glycosylated hemoglobin, number of insulin doses per day and the calories consumed per day. This study makes an important contribution highlighting the  psychological aspects in the context of medical conditions, referring to the therapeutic relationship and approaching of the pediatric patient in a bio-psycho-social context, recognizing the complexity of the factors that contribute to a medical success in the pediatric field related to the type of special relationship in which several persons are involved incuding the relatives of the patients. Given the particularities of the individual with normal mental development during adolescence, recognized as a period of psychobiological crisis, it is important to realise a pattern of therapeutic interaction with this category of patients who associates anxiety- depression- diabetes.


Pediatric patients; Anxiety; Depression; Diabetes; Pediatric psychiatric disorders.

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Agrawal, J., Kumar, R., Malhi, P., & Dayal, D. (2016). Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India. Journal of Pediatric Endocrinology and Metabolism, 29(8), 893-899.

Ardeleanu V, Berbece S.I., Florescu I.P., Jecan R.C.(2017). The Use of Hyaluronic Acid Combined with Teosyal Redensity II for the Treatment of Dark Circles Under the Eyes. MATERIALE PLASTICE, 54, No.1, pp: 37-40.

Ardeleanu V, Chebac G.R., Georgescu C., Vesa D., Frîncu L., Frâncu L.D., Păduraru D.(2010). The modifications suffered by the peri-esophageal anatomical structures in the hiatal hernia disease: a qualitative and quantitative microanatomic study. Romanian Journal of Morphology and Embryology 51(4):765–770.

Ardeleanu V, Chicos S, Georgescu C., Tutunaru D. (2013). A Rare Case of Acute Abdomen: Garengeot Hernia. Chirurgia, 108(6):896-899.

Ardeleanu V., Dobre M., Georgescu E.M. (2015). Deep Facial Wrinkle Treatment Outcome After First Injection of Reticulated Hyaluronic Acid. REV. CHIM. (Bucharest),66, No. 12, Pp: 2129-2131;

Ardeleanu V., Francu L.L., Georgescu C. (2014), Neoangiogenesis. assessment in esophageal adenocarcinomas. Indian J Surg.

Ardeleanu V., Georgescu C., Frîncu L. D., Frâncu L.L., Vesa D. (2014) Angiogenesis as Prospective Molecular Biology Technique for Cancer Study. Romanian Biotehnological Letters. ISSN 1224 – 5984, pp: 9637-9648.

Bai, J. W., Lovblom, L. E., Cardinez, M., Weisman, A., Farooqi, M. A., Halpern, E. M., ... & Keenan, H. A. (2017). Neuropathy and presence of emotional distress and depression in longstanding diabetes: results from the Canadian study of longevity in type 1 diabetes. Journal of Diabetes and its Complications, 31(8), 1318-1324.

Baykara, B., Akay, A. P., Böber, E., Doğan, Ö., Abacı, A., Özbek, A., & Ergin, C. (2012). Psychosocial aspects of mothers of children with type 1 diabetes mellitus: the relationship with diabetic control. Anatolian Journal of Psychiatry, 13(1), 39-45.

Beck AT, Ward CH, Mendelson M et al. (1981). An invbentory for measuring depression, Arch.Gen.Psychiatry, ,4:561-571.

Beverly, E. A., Rennie, R. G., Guseman, E. H., Rodgers, A., & Healy, A. M. (2019). High prevalence of diabetes distress in a university population. The Journal of the American Osteopathic Association, 119(9), 556-568.

Borkovec T and Costello E. Efficacy of applied relaxation and cognitive behavioral therapy in the treatment of generalized anxiety disorder. J Clin Consult Psychol 1993; 61(4):611–19.

Buschur, E. O., Glick, B., & Kamboj, M. K. (2017). Transition of care for patients with type 1 diabetes mellitus from pediatric to adult health care systems. Translational pediatrics, 6(4), 373.

Caputo, A. (2013). Health demand in primary care context: What do people think about physicians?. Psychology, health & medicine, 18(2), 145-154.

Conversano, C. (2019). Psychological common factors in chronic diseases. Frontiers in Psychology, 10, 2727.

Di Giuseppe, M., Gennaro, A., Lingiardi, V., & Perry, J. C. (2019). The role of defense mechanisms in emerging personality disorders in clinical adolescents. Psychiatry, 82(2), 128-142.

Di Giuseppe, M., Miniati, M., Miccoli, M., Ciacchini, R., Orrù, G., Sterzo, R. L., ... & Conversano, C. (2020). Defensive responses to stressful life events associated with cancer diagnosis. Mediterranean Journal of Clinical Psychology, 8(1).

Dimitriu M.C.T.,Pantea-Stoian A.,Smaranda A.C.,Nica A.A.,Carap A.C.,Constantin V.D.,Davitoiu A.M.,Cirstoveanu C.,Bacalbasa N.,Bratu O.G.,Jacota-Alexe F.,Badiu C.D.,.Smarandache C.G,Socea B., Burnout syndrome in Romanian medical residents in time of the COVID-19 pandemic, Medical Hypotheses,Volume 144, November 2020, 109972.

Dobrica E.C.,Gaman M.A., Cozma M.A. et al. (2019) Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department‎.Medicina-Lithuania. 55(8).

Doneddu, A., Roberto, S., Pinna, V., Magnani, S., Ghiani, G., Sainas, G., ... & Lecis, R. (2020). Effect of combined mental task and metaboreflex activation on hemodynamics and cerebral oxygenation in patients with metabolic syndrome. Frontiers in Physiology, 11.

Duru, N. S., Civilibal, M., & Elevli, M. (2016). Quality of life and psychological screening in children with type 1 diabetes and their mothers. Experimental and Clinical Endocrinology & Diabetes, 124(02), 105-110.

Felício, J. S., de Souza, A. C. C. B., Koury, C. C., Neto, J. F. A., Miléo, K. B., Santos, F. M., ... & de Rider Brito, H. A. (2015). Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group. Diabetology & metabolic syndrome, 7(1), 1-9.

Grey M, Whittemore R, Tamborlane W. (2002). Depression in type 1 diabetes in children: natural history and correlates, Journal of Psychosomatic Research, 53(4):907–911, 2002.

Guicciardi, M., Crisafulli, A., Doneddu, A., Fadda, D., & Lecis, R. (2019). Effects of metabolic syndrome on cognitive performance of adults during exercise. Frontiers in psychology, 10, 1845.

Guicciardi, M., Lecis, R., Massidda, D., Lucina, C., Adelina, P., Pusceddu, M., & Francesca, S. (2019). Mixed effects of a six-month supervised exercise program in overweight and moderately obese adults with Type 2 diabetes mellitus.

Hainarosie R.,Zainea V., Rusescu A., et al. (2019). Management of infectious complications in diabetes mellitus mellitus patients.Romanian Journal Of Military Medicine 122(1): 46-51.

Hamilton M (2000): Hamilton Anxiety Rating Scale (HARS), Handbook of Psychiatric Measures, AJ Rush (Ed.), American Psychiatric Association.

Hassan K, Loar R, Anderson BJ, Heptulla RA. (2006). The role of socioeconomic status, depression, quality of life, and glycemic control in type 1 diabetes mellitus, The Journal of Pediatrics, 149(4):526–531.

Jecan R.C., Nicolau A., Florescu I.P., Ardeleanu V., Berbece S.I.. (2017) Use of Trichloroacetic Acid in Treating Facial Hyperpigmentation. Materiale plastice, 54, No.1 pp: 88-90.

Johnson B. , Eiser C , Young V , Brierley S. , Heller S. (Febr 2013). Prevalence of depression among young people with Type 1 diabetes: a systematic review, Diabetic Medicine UK, Volume30, Issue2, Pages 199-208.

Kafali, H. Y., Altinok, Y. A., Ozbaran, B., Ozen, S., Kose, S., Tahillioglu, A., ... & Goksen, D. (2020). Exploring emotional dysregulation characteristics and comorbid psychiatric disorders in type 1 diabetic children with disordered eating behavior risk. Journal of Psychosomatic Research, 131, 109960.

Khandelwal, S., Sengar, G. S., Sharma, M., Choudhary, S., & Nagaraj, N. (2016). Psychosocial illness in children with type 1 diabetes mellitus: prevalence, pattern and risk factors. Journal of clinical and diagnostic research: JCDR, 10(9), SC05.

Khemakhem, R., Dridi, Y., Hamza, M., Hamouda, A. B., Khlayfia, Z., Ouerda, H., ... & Maherzi, A. (2020). How do parents of children with type 1 diabetes mellitus cope and how does this condition affect caregivers’ mental health?. Archives de Pédiatrie.

Khemakhem, R., Dridi, Y., Hamza, M., Hamouda, A. B., Khlayfia, Z., Ouerda, H., ... & Maherzi, A. (2020). How do parents of children with type 1 diabetes mellitus cope and how does this condition affect caregivers’ mental health?. Archives de Pédiatrie.

Kikuchi Y, Iwase M, Fujii H, Ohkuma T, Kaizu S, Ide H, Jodai T, Idewaki Y, Nakamura U, Kitazono T. Association of severe hypoglycemia with depressive symptoms in patients with type 2 diabetes: the Fukuoka Diabetes Registry. BMJ Open Diabetes Res Care. 2015;3:e000063.

Kovacs, M., 1992. Children's Depression Inventory. North Tonawanda, NY: Multi-Health Systems, Inc.

López-Bastida, J., López-Siguero, J. P., Oliva-Moreno, J., Vázquez, L. A., Aranda-Reneo, I., Reviriego, J., ... & Perez-Nieves, M. (2019). Health-related quality of life in type 1 diabetes mellitus pediatric patients and their caregivers in Spain: an observational cross-sectional study. Current medical research and opinion, 35(9), 1589-1595.

Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988;14(1):61–8.

Manuel D, Schultz S. (2004). Health – related quality of life and health adjusted life expectancy of people with diabetes mellitus in Ontario, Canada, 1996-1997. Diabetes care , 27: 407-414

Martino, G., Caputo, A., Bellone, F., Quattropani, M. C., & Vicario, C. M. (2020). Going Beyond the Visible in Type 2 Diabetes Mellitus: Defense Mechanisms and their Associations with Depression and Health-Related Quality of Life. Frontiers in Psychology, 11, 267.

Martino, G., Langher, V., Cazzato, V., & Vicario, C. M. (2019). Psychological factors as determinants of medical conditions. Frontiers in psychology, 10, 2502.

Melin, E. O., Svensson, R., Thunander, M., Hillman, M., Thulesius, H. O., & Landin-Olsson, M. (2017). Gender, alexithymia and physical inactivity associated with abdominal obesity in type 1 diabetes mellitus: a cross sectional study at a secondary care hospital diabetes clinic. BMC obesity, 4(1), 21.

Merlo, E. M. (2019a). Opinion Article: The role of psychological features in chronic diseases, advancements and perspectives. Mediterranean Journal of Clinical Psychology, 7(3).

Merlo, E. M. (2019b). Adolescent phobia as a “mask object”. Mediterranean Journal of Clinical Psychology, 7(1).

Meurs M, Roest AM, Wolffenbuttel BH, Stolk RP, de Jonge P, Rosmalen JG. Association of Depressive and Anxiety Disorders With Diagnosed Versus Undiagnosed Diabetes: An Epidemiological Study of 90,686 Participants. Psychosom Med. 2016;78:233–241.

Mokhort, T. V., & Navmenova, Y. L. (2015). Metabolic control and depression in type 1 diabetes mellitus. Diabetes mellitus, 18(2), 47-53.

Motovilin, O. G. E., Lunyakina, O. V. E., Surkova, E. V., Shishkova, Y. A., Mel'nikova, O. G., & Mayorov, A. Y. E. (2012). Attitudes in patients with diabetes mellitus type 1 and type 2. Diabetes mellitus, 15(4), 51-58.

Moulton CD., Pickup JC., Ismail K. (2015). The link between depression and diabetes: the search for shared mechanisms, Lancet Diabetes and Endocrinology, Vol 3, Issue 6, pp 461-471.

Munkácsi, B., Papp, G., Felszeghy, E., Kovács, K. E., & Nagy, B. E. (2018). The associations between mental health, health-related quality of life and insulin pump therapy among children and adolescents with type 1 diabetes. Journal of Pediatric Endocrinology and Metabolism, 31(10), 1065-1072.

Mutlu, E. K., Mutlu, C., Taskiran, H., & Ozgen, I. T. (2015). Association of physical activity level with depression, anxiety, and quality of life in children with type 1 diabetes mellitus. Journal of Pediatric Endocrinology and Metabolism, 28(11-12), 1273-1278.

Ozkan S. (1995). Psychiatric Medicine, Consultation and Liaison in Psychiatry, editura Roche, pg 95–99

Pace, C. S., & Muzi, S. (2019). Binge-eating symptoms, emotional-behavioral problems and gender differences among adolescents: a brief report. Mediterranean Journal of Clinical Psychology, 7(2).

Pickup J, Williams G. (2003). Textbook of Diabetes, 3rd Edition. Blackwell Science Ltd.

Pop-Jordanova, N., & Gucev, Z. (2015). Some psychological aspects of T1DM in children and adolescents. prilozi, 36(3), 113-118.

Rasmussen, B., Hendrieckx, C., Clarke, B., Botti, M., Dunning, T., Jenkins, A., & Speight, J. (2013). Psychosocial issues of women with type 1 diabetes transitioning to motherhood: a structured literature review. BMC pregnancy and childbirth, 13(1), 218.

Rosa, V., Tomai, M., Lauriola, M., & Martino, G. (2019). Body mass index, personality traits, and body image in Italian pre-adolescents: An opportunity for overweight prevention. psihologija, 52(4), 379-393.

Rose MI, Firestone P, Heick HM, Faught AK., 1983, The effects of anxiety management training on the control of juvenile diabetes mellitus, Journal of Behavioral Medicine., Vol 6, Issue 4, pp 381–395.

Sancanuto, C., Tébar, F. J., Jiménez-Rodríguez, D., & Hernández-Morante, J. J. (2014). Factores psicosociales en la diabetes mellitus tipo 1 y su relación con el riesgo de desarrollar trastornos alimentarios en la infancia y la adolescencia. Avances en Diabetología, 30(5), 156-162.

Settineri, S. (2019). Clinical Psychology and adolescence. Mediterranean Journal of Clinical Psychology, 7(2).

Settineri, S., Frisone, F., Alibrandi, A., & Merlo, E. M. (2019a). Emotional suppression and oneiric expression in psychosomatic disorders: early manifestations in emerging adulthood and young patients. Frontiers in psychology, 10, 1897.

Settineri, S., Frisone, F., Alibrandi, A., Pino, G., Lupo, N. J., & Merlo, E. M. (2018). Psychological Types and Learning Styles. Mediterranean Journal of Clinical Psychology, 6(3).

Settineri, S., Frisone, F., Merlo, E. M., Geraci, D., & Martino, G. (2019b). Compliance, adherence, concordance, empowerment, and self-management: five words to manifest a relational maladjustment in diabetes. Journal of multidisciplinary healthcare, 12, 299.

Settineri, S., Merlo, E. M., Frisone, F., Alibrandi, A., Carrozzino, D., Diaconu, C. C., & Pappalardo, S. M. (2019c). Suppression Mental Questionnaire App: a mobile web service-based application for automated real-time evaluation of adolescent and adult suppression. Mediterranean Journal of Clinical Psychology, 7(1).

Stoian A.P., Bala C.,Rusu A. et al. (2018a). Gender Differences in the Association of Ferritin and 25-hydroxyvitamin D‎, Rev.Chim, 69(4): 864-869.

Stoian A.P., Elian V., Nitipir C., et al. (Mar 2017). Association between vitamin D insufficiency and metabolic syndrome‎. Conference: 3rd International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications (INTERDIAB) Location: Bucharest, Book Series: International Conference on Interdisciplinary Management of Diabetes Mellitus and its Complications 232-242.

Stoian A.P.,Mitrofan G., Colceag F., et al. (2018b) Oxidative Stress in Diabetes A model of complex thinking applied in medicine‎, Rev.Chim. 69(9): 2515-2519.

Strandberg RB., Graue M, Wentzel-Larsen T., Peyrot M., Rokne B.(2014) Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes, Journal of Psychosomatic Research, Vol 77, Issue 3, pp 174-179.

Suceveanu A.I.,Stoian, A.P., Parepa I., et al. (2018) Gut Microbiota Patterns in Obese and Type 2 Diabetes (T2D) Patients from Romanian Black Sea Coast Region‎ Rev.Chim., Bucuresti, 6(8): 2260-2267.

Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of consulting and clinical psychology, 70(3), 678.

Williams, C., Sharpe, L., & Mullan, B. (2014). Developmental challenges of adolescents with type 1 diabetes: The role of eating attitudes, family support and fear of negative evaluation. Psychology, health & medicine, 19(3), 324-334.

Zambanini A., Newson R., Maysei M., Feher M. (Dec 1999) Injection related anxiety in insulin treated diabetes, Diabetes Research and Clinical Prctice, Volume 46, Issue 3, Pages 239-246.

Zugravu C.A., Baciu A., Patrascu D. et al. (2012). Depression and diabetes: are there any consequences on self-care. ‎European Journal Of Public Health. 22(2):272-272.



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