Butwicka Agnieszka, Frisén Louise, Almqvist Catarina, Zethelius Björn, Lichtenstein Paul
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
Child and Adolescent Psychiatry Research Center, Stockholm, Sweden Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Diabetes Care. 2015 Mar;38(3):453-9. doi: 10.2337/dc14-0262. Epub 2015 Feb 3.
To assess the risk of psychiatric disorders and suicide attempts in children with type 1 diabetes and their healthy siblings.
We performed a population-based case-cohort study of individuals born in Sweden between 1973 and 2009. Children with type 1 diabetes (n = 17,122) and their healthy siblings (n = 18,847) were identified and followed until their 18th birthday. Their risk of psychiatric disorders was compared with that of matched control subjects.
The risk of psychiatric morbidity in children with type 1 diabetes compared with the general population was tripled within 6 months after the onset of diabetes (hazard ratio [HR] 3.0 [95% CI 2.7-3.4]) and doubled within the total observation period (HR 2.1 [95% CI 2.0-2.2]). An increased risk was noted in suicide attempts (HR 1.7 [95% CI 1.4-2.0]) and in most categories of psychiatric disorders. The risk of psychiatric disorders in probands declined from HR 2.7 (95% CI 2.2-3.3) for those in the cohort born 1973-1986 to 1.9 (95% CI 1.8-2.0) in those born 1997-2009. The risk for any psychiatric disorders among siblings of patients with type 1 diabetes was estimated to be HR 1.1 (95% CI 1.0-1.1), and there was no increased risk in any of the specific category of disorders.
Children with type 1 diabetes are at high risk of psychiatric disorders, which seems to be a consequence of the disease rather than due to a common familial etiology. The results support recommendations on comprehensive mental health surveillance in children with type 1 diabetes, especially in recently diagnosed children.
评估1型糖尿病患儿及其健康同胞患精神疾病和自杀未遂的风险。
我们对1973年至2009年在瑞典出生的个体进行了一项基于人群的病例队列研究。确定了1型糖尿病患儿（n = 17122）及其健康同胞（n = 18847），并对他们进行随访直至18岁生日。将他们患精神疾病的风险与匹配的对照对象进行比较。
与普通人群相比，1型糖尿病患儿在糖尿病发病后6个月内患精神疾病的风险增加了两倍（风险比[HR] 3.0 [95%可信区间2.7 - 3.4]），在整个观察期内增加了一倍（HR 2.1 [95%可信区间2.0 - 2.2]）。自杀未遂（HR 1.7 [95%可信区间1.4 - 2.0]）和大多数精神疾病类别中的风险均有所增加。先证者患精神疾病的风险从1973 - 1986年出生队列中的HR 2.7（95%可信区间2.2 - 3.3）降至1997 - 2009年出生队列中的1.9（95%可信区间1.8 - 2.0）。1型糖尿病患者同胞患任何精神疾病的风险估计为HR 1.1（95%可信区间1.0 - 1.1），且任何特定疾病类别中均无风险增加。
1型糖尿病患儿患精神疾病的风险很高，这似乎是疾病的结果而非共同的家族病因所致。这些结果支持对1型糖尿病患儿进行全面心理健康监测的建议，尤其是对近期确诊的患儿。
