Youth With Type 1 Diabetes Experienced a Higher Level of Anxiety During the COVID-19 Pandemic Compared to Healthy Control; A Cross-Sectional Study
Authors: Wade Caroline , Akinseye Leah , Anderson Tachele , Borky Thresa , Nelson Grace , Peravali Rahul , Smith-young Jamila , Witt Caitlin , Kim Ahlee 
Published: May 2021

Abstract
Background and Aims: Diabetes is highly associated with depression and anxiety. With the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of mental health issues in the general population appears to be increasing rapidly (1). Thus, we evaluated psychological heath in pediatric type 1 diabetes (T1D) patients and caregivers during the lockdown phase of the COVID-19 pandemic. Our objective was to compare the levels of depression and anxiety in youth with T1D and their caregivers to those of healthy controls. We hypothesized that youth with T1D would experience higher levels of depression and anxiety than healthy controls during the COVID-19 pandemic (Aim 1). We also explored potential causes of increased depression/anxiety in T1D (Aim 2). We aimed to further understand psychosocial well-being in T1D during the COVID-19 pandemic and identify mechanisms to support this population in global crises. Methods: A week after the start of Tennessee’s shelter-in-place order, we performed 15-minute phone surveys to screen for anxiety and depression in families with children with T1D (n=100, mean age of children=13.8 years, mean HbA1c=8.95%, Race=Caucasian (55%)/African American (43%)) and healthy children (mean age of children=5.7 years, Race=Caucasian (24%)/African American (69%)). Depression and anxiety were assessed by a standard assessment tool, the Patient Health Questionnaire (PHQ-4), a 4-item inventory rated on a 4-point Likert scale that briefly assesses depression and anxiety. Anxiety/depression-related variables were compared based on T1D status using the Chi-square test or t-test, as appropriate. The association between T1D and risk of anxiety and depression was examined using logistic regression adjusted for potential confounders. For families with T1D, additional questions were administered to identify specific concerns associated with T1D care. Results: Compared to controls, T1D was associated with a five times higher risk of anxiety in multivariable adjusted models, OR=5.02 (95% confidence interval: 1.83, 14.84), P=0.002. Additionally, 26/52 T1D families (50%) had significant concern for being at a higher risk for severe COVID-19 infection due to T1D and 14/52 T1D families (27%) were worried about obtaining insulin and diabetes supplies. Conclusions: Pediatric T1D is associated with an increased risk of anxiety but not depression in the acute phase of the COVID-19 pandemic. Elevated anxiety in T1D during the COVID-19 pandemic appears to be, at least in part, due to fear of higher risk of severe COVID-19 infection and uncertainty regarding access to insulin and diabetes supplies. Further studies to address mental health in T1D during global emergencies and advocacy to develop systems to ensure access to medical resources for pediatric T1D are warranted.
1. Stein MB. EDITORIAL: COVID-19 and Anxiety and Depression in 2020. Depress Anxiety. 2020;37(4):302.