Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
Janssen Pharmaceutical Companies of Johnson & Johnson, Solna, Sweden.
Diabetes Care. 2022 Sep 1;45(9):1987-1993. doi: 10.2337/dc21-1347.
To estimate the association and familial coaggregation of childhood-onset type 1 diabetes with depression, anxiety, and stress-related disorders.
This was a population-based cohort study with use of data from Swedish nationwide registers. A total of ∼3.5 million individuals born in Sweden 1973-2007 were linked to their biological parents, full siblings and half-siblings, and cousins. Cox models were used to estimate the association and familial coaggregation of type 1 diabetes with depression, anxiety, and stress-related disorders.
Individuals diagnosed with childhood-onset type 1 diabetes (n = 20,005) were found to be at greater risks of all outcomes: any psychiatric diagnosis (adjusted hazard ratio [aHR] 1.66 [95% CI 1.59-1.72]) or specific diagnoses of depression (1.85 [1.76-1.94]), anxiety (1.41[1.33-1.50]), and stress-related disorders (1.75 [1.62-1.89]), as well as use of antidepressants or anxiolytics (1.30 [1.26-1.34]), compared with individuals without type 1 diabetes. Overall, relatives of individuals with type 1 diabetes were at elevated risks of developing these outcomes, with the highest risks seen in parents (aHRs 1.18-1.25), followed by full siblings (aHRs 1.05-1.20), and the magnitudes of risk estimates appear proportional to familial relatedness.
These results support existing evidence that children and adolescents with type 1 diabetes are at greater risks of developing depression, anxiety, and stress-related disorders and indicate that shared familial factors might contribute to these elevated risks. Our findings highlight the need for psychological consulting for children and their families in diabetes care. Quantitative and molecular genetic studies are warranted to further understand the etiology of these psychiatric disorders in type 1 diabetes.
评估儿童期 1 型糖尿病与抑郁、焦虑和应激相关障碍的关联性和家族聚集性。
这是一项基于人群的队列研究，使用了来自瑞典全国登记处的数据。共有约 350 万 1973-2007 年出生于瑞典的个体与他们的亲生父母、全兄弟姐妹和同父异母/同母异父兄弟姐妹以及表兄弟姐妹建立了联系。采用 Cox 模型来评估 1 型糖尿病与抑郁、焦虑和应激相关障碍的关联性和家族聚集性。
患有儿童期 1 型糖尿病（n=20,005）的个体被发现罹患所有结局的风险更高：任何精神科诊断（校正风险比[aHR]1.66[95%CI 1.59-1.72]）或特定的抑郁诊断（1.85[1.76-1.94]）、焦虑（1.41[1.33-1.50]）和应激相关障碍（1.75[1.62-1.89]），以及使用抗抑郁药或抗焦虑药（1.30[1.26-1.34]）的风险也更高，与无 1 型糖尿病的个体相比。总体而言，1 型糖尿病患者的亲属罹患这些结局的风险升高，其中父母的风险最高（aHRs 1.18-1.25），其次是全兄弟姐妹（aHRs 1.05-1.20），风险估计值的大小似乎与家族相关性成正比。
这些结果支持现有的证据，即儿童和青少年 1 型糖尿病患者罹患抑郁、焦虑和应激相关障碍的风险更高，并表明共同的家族因素可能导致这些风险升高。我们的研究结果强调了在糖尿病护理中为儿童及其家庭提供心理咨询的必要性。需要进行定量和分子遗传学研究，以进一步了解 1 型糖尿病中这些精神障碍的病因。
