Evidence-Based Research: Depression and T1DM in Juveniles, University

This report presents an evidence-based review of the influence of treatment modalities and disease knowledge on depression in juveniles with Type 1 Diabetes Mellitus (T1DM). The study analyzes four research papers, including randomized controlled trials and qualitative studies, focusing on adolescents below 18 years old with T1DM. The PICOT question guided the search, examining how different treatment modalities and knowledge of T1DM affect depression rates. The findings reveal that coping skills training can reduce anxiety, depression, and stress; less frequent blood glucose monitoring is associated with depression; and nurses should consider children's experiences and feelings. The report recommends integrating coping skills training, assessing blood glucose monitoring practices, and providing multidisciplinary diabetes care customized to cultural barriers. The research underscores the importance of addressing both the physiological and psychological aspects of T1DM management in juveniles.

Running head: EVIDENCE BASED PRACTICE RESEARCH
EVIDENCE BASED PRACTICE RESEARCH: INFLUENCE OF TREATMENT
MODALITIES AND KNOWLEDGE ON DEPRESSION ACROSS JUVENILES WITH TYPE
1 DIABETES MELLITUS
Name of the Student:
Name of the University:
Author note:

1EVIDENCE BASED PRACTICE RESEARCH
Introduction
According to the World Health Organization (WHO 2018), type 1 diabetes mellitus
(T1DM) also named as juvenile diabetes or childhood onset or insulin-dependent diabetes, is a
metabolic condition characterized by deficient secretion of insulin across adolescents, and thus
requires daily insulin injections for management. While the exact cause of T1DM is unknown,
the WHO (2018) denotes its key symptoms to be: polyuria, polydipsia, and persistent hunger,
loss of weight, fatigue and progressive changes in vision. In addition to the common symptoms
of high blood glucose level, it has been researched that adolescents having juvenile diabetes are
susceptible to psychological problems like depression (Buchberger et al. 2016). As per the
review by Badescu et al. (2016), approximately 40% of patients with T1DM have reported to be
inflicted with mental health concerns like depression and depression.
While the exact pathologies underlying depression has not been extensively research, it
has been evidenced that the inadequate knowledge and different treatment modalities, such as the
need to follow a strict routine of insulin injections, can affect an individual’s daily life and result
in a mental health issue known as diabetes distress. Diabetes distress is associated with increased
stress and anxiety in an individual which can harm the quality of daily life and wellbeing and
thus lead to a loss of pleasure in favorable activities and depression (Gilsanz et al. 2018). The
following paper will thus discuss on the findings acquired from current literature which have
explored the influence of different treatment modalities and knowledge on depression across
juveniles with T1DM.

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Aim
This study aims to identify current, evidence based literature which have examined the
possible influence of differences in treatment modalities and disease knowledge on the rate or
severity of depression across juveniles with T1DM. This was done with the help of a
comprehensive search strategy as per the following PICOT question.
PICOT Question
Articles for the evidence based research were searched as per the following PICOT
question, which read as: “How do different treatment modalities and knowledge of type 1
DM influence the rate of Depression amongst juveniles?” The following components of the
PICOT question were thus as follows:
 P: Population: Adolescents and children below 18 years and diagnosed with T1DM.
 Intervention: Different treatment modalities and coping strategies for T1DM such as
frequent blood glucose monitoring, educational sessions to improve T1DM knowledge.
 Comparison: Absence of any different treatment modalities and coping strategies for
T1DM.
 Outcome: Rate or severity of depression symptoms.
Literature Search Strategy
Based on the above PICOT question, an electronic search strategy was conducted using
key words like ‘type 1 diabetes mellitus’, ‘juvenile diabetes’, ‘depression’, ‘coping strategies’,
‘knowledge’, ‘education’ and ‘blood glucose’, across databases like CINANHL. To ensure that
recent articles with the most updated research were obtained, the publication year limit for the
articles was set as 2008 to 2020. To further ensure that academic, peer reviewed and scholarly

3EVIDENCE BASED PRACTICE RESEARCH
articles were obtained in English, additional limiters in the form of ‘English’ and ‘peer reviewed’
were set prior to implementing the search strategy (McGowan et al. 2016). Thus, as a result, a
total of 4 articles were obtained, of which two were qualitative and two were quantitative in
nature.
Characteristics of Papers
Aim of Research Papers
The randomized controlled trial by Edraki, Rambod and Molazem (2018), evaluated the
effectiveness of coping skills education on changing the levels of anxiety, depression, self-
efficacy and stress across adolescents with T1DM. The quantitative study by McGrady et al.
(2009), evaluated relationships between symptoms of depression and control of hyperglycemic
and whether this association is mediated by blood glucose monitoring treatment modalities. The
qualitative study by de Cássia Sparapani, Jacob and Nascimento (2015), aimed to understand
how children managed T1DM and the feelings and thoughts which they experienced. The
qualitative study by Maslalpak et al. (2010), aimed to assess the perspectives held by Iranian
female adolescents with T1DM regarding barriers to having an optimum quality of life (QoL).
Sample Size and Target Population
The sample size and target population by Edraki, Rambod and Molazem (2018) was 100
adolescents with T1DM. The sample size and target population by McGrady et al. (2009) was
276 adolescents with T1DM. The sample size and target population de Cássia Sparapani, Jacob
and Nascimento (2015), was 150 children, aged 7 to 12 years with T1DM. The sample size and
target population by Maslalpak et al. (2010) was 20 Iranian female adolescents with T1DM.

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Findings
The randomized controlled trial by Edraki, Rambod and Molazem (2018) found that the
average scores of anxiety, depression and stress in adolescents receiving coping skills, as per the
General Self-Efficacy questionnaire and Depression, Anxiety, and Stress Scales, were 6.44±7.01,
5.41±4.58 and 7.46±7.01 as compared to 18.28±10.51, 19.73±11.80 and 21.10±10.94 in the
group not receiving this intervention. The quantitative study by McGrady et al. (2009) found that
adolescents with depression engaged in less frequent monitoring of blood glucose levels which
reduce their glycemic control (p = 0.004). The qualitative study by de Cássia Sparapani, Jacob
and Nascimento (2015) found that the major feelings faced by children with T1DM were feeling
that one has less knowledge, fear, insecurity, pain, shame, prejudice, rejection and worrying
about future long term symptoms. Lastly, the qualitative study by Maslalpak et al. (2010) found
that some of the key barriers faced by Iranian adolescents with T1DM was family problems,
social stereotypes on T1DM, negative emotions on care and treatment and feelings of uncertainty
for the future.
Recommendations
The study by Edraki, Rambod and Molazem (2018) suggests that integration of coping
skills training as a part of community management programs can help adolescents with T1DM
cope with depression. The study by McGrady et al. (2009) recommends that assessing the
practice of blood glucose monitoring will help to understand the severity of depression and
T1DM symptom in adolescents. The study by de Cássia Sparapani, Jacob and Nascimento
(2015) suggests that nurses must not only assess physical symptoms of T1DM but must also
consider interacting with children to understand their fears and experiences. The study by

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Maslalpak et al. (2010) recommends that nurses must deliver multidisciplinary diabetes care to
T1DM adolescents which are customized to their cultural barriers and perceptions.
Conclusion
This paper gives a comprehensive insight into current evidence based research exploring
the rate of depression in juveniles with T1DM. Thus, as per the above findings, it can be
understood that T1DM is not only accompanied physiological symptoms but also psychological
symptoms of depression. These symptoms can further be influenced due to differences in
treatment modalities and knowledge of the disease in adolescents with T1DM. To conclude, it is
recommended that nurses consider the experiences and feelings of juveniles as well as the
importance of coping strategies in juveniles with T1DM.

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References
Bădescu, S.V., Tătaru, C., Kobylinska, L., Georgescu, E.L., Zahiu, D.M., Zăgrean, A.M. and
Zăgrean, L., 2016. The association between diabetes mellitus and depression. Journal of
medicine and life, 9(2), p.120.
Buchberger, B., Huppertz, H., Krabbe, L., Lux, B., Mattivi, J.T. and Siafarikas, A., 2016.
Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and
meta-analysis. Psychoneuroendocrinology, 70, pp.70-84.
de Cássia Sparapani, V., Jacob, E. and Nascimento, L.C., 2015. What is it like to be a child with
type 1 diabetes mellitus. Pediatr Nurs, 41(1), pp.17-23.
Edraki, M., Rambod, M. and Molazem, Z., 2018. The effect of coping skills training on
depression, anxiety, stress, and self-efficacy in adolescents with diabetes: a randomized
controlled trial. International journal of community based nursing and midwifery, 6(4), p.324.
Gilsanz, P., Karter, A.J., Beeri, M.S., Quesenberry, C.P. and Whitmer, R.A., 2018. The
bidirectional association between depression and severe hypoglycemic and hyperglycemic events
in type 1 diabetes. Diabetes care, 41(3), pp.446-452.
Maslakpak, M.H., Anoosheh, M., Fazlollah, A. and Ebrahim, H., 2010. Iranian diabetic
adolescent girls’ quality of life: perspectives on barriers. Scandinavian journal of caring
sciences, 24(3), pp.463-471.
McGowan, J., Sampson, M., Salzwedel, D.M., Cogo, E., Foerster, V. and Lefebvre, C., 2016.
PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of clinical
epidemiology, 75, pp.40-46.

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McGrady, M.E., Laffel, L., Drotar, D., Repaske, D. and Hood, K.K., 2009. Depressive symptoms
and glycemic control in adolescents with type 1 diabetes: mediational role of blood glucose
monitoring. Diabetes care, 32(5), pp.804-806.
WHO. (2018). Diabetes. Retrieved 1 April 2020, from https://www.who.int/news-room/fact-
sheets/detail/diabetes.

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Appendices
Appendix A: Search Strategy
Appendix B: Level of Evidence
Article Reference Level of Evidence
de Cássia Sparapani, V., Jacob, E. and
Nascimento, L.C., 2015. What is it like to be
a child with type 1 diabetes mellitus. Pediatr
Nurs, 41(1), pp.17-23.
Level VI : evidence obtained from a single
descriptive, quantitative or qualitative study
Edraki, M., Rambod, M. and Molazem, Z.,
2018. The effect of coping skills training on
depression, anxiety, stress, and self-efficacy
in adolescents with diabetes: a randomized
controlled trial. International journal of
community based nursing and
Level VI : evidence obtained from a single
descriptive, quantitative or qualitative study
Date March 2020
Research Topic
The influence of differences in treatment modalities and disease knowledge on
the rate or severity of depression across juveniles with T1DM.
Search Strategy Keywords/concepts Synonyms/alternative terminology
Type 1 Diabetes
Mellitus
T1DM OR “juvenile diabetes” OR “insulin
dependent diabetes”
Coping Strategies “education program* OR “treatment* OR “blood
glucose monitoring* OR “disease knowledge*
Depression “depressive symptoms” OR “depressive condition”
Limits and
Type of
material
required
2008 -2020
English language
Peer-reviewed journal articles
Databases
sourced and
searched
CINAHL Complete

9EVIDENCE BASED PRACTICE RESEARCH
midwifery, 6(4), p.324.
Maslakpak, M.H., Anoosheh, M., Fazlollah,
A. and Ebrahim, H., 2010. Iranian diabetic
adolescent girls’ quality of life: perspectives
on barriers. Scandinavian journal of caring
sciences, 24(3), pp.463-471.
Level VI : evidence obtained from a single
descriptive, quantitative or qualitative study
McGrady, M.E., Laffel, L., Drotar, D.,
Repaske, D. and Hood, K.K., 2009.
Depressive symptoms and glycemic control in
adolescents with type 1 diabetes: mediational
role of blood glucose monitoring. Diabetes
care, 32(5), pp.804-806.
Level VI : evidence obtained from a single
descriptive, quantitative or qualitative study