̽��ֱ�� of Cambridge - National Institute for Health Research (NIHR) Applied Research Collaboration East of England

‘Diabetes distress’ increases risk of mental health problems among young people living with type 1 diabetes

cjb250 — Wed, 17 Jul 2024 09:00:45 +0000

̽��ֱ��findings highlight the urgent need for monitoring and support for the mental health of young people diagnosed with type 1 diabetes.

According to the charity JDRF, there are 8.7 million people living with type 1 diabetes around the world, including over 400,000 people in the UK. It is a chronic, life-threatening condition, usually diagnosed in childhood, that has a life-long impact.

Currently, people with type 1 diabetes rely on a routine of finger-prick blood tests and insulin injections or infusions, because their pancreas no longer produces insulin itself, although recent developments in artificial pancreas technology are helping transform this care.

Previous studies have shown potential links between childhood-onset type 1 diabetes and a number of mental health disorders in adulthood. However, it is not clear whether these links can be best explained by the impacts of living with the condition and its treatment, or whether underlying common biological mechanisms may be implicated, for example the impact of unstable blood sugar levels on the developing adolescent brain.

To help answer this question, a team of researchers turned to data from over 4,500 children with type 1 diabetes on a national register in the Czech Republic and from large-scale European DNA studies.Their findings are published today in Nature Mental Health.

From the national register data, the researchers found that children diagnosed with type 1 diabetes – compared to children without the condition – were over twice as likely to develop a mood disorder and more than 50% more likely to develop an anxiety disorder. They were also more than four times more likely to develop behavioural syndromes including eating and sleep disorders

Conversely, children with type 1 diabetes were at a much lower risk of developing psychotic disorders, such as schizophrenia – almost half the risk compared to their peers.

̽��ֱ��findings are consistent with the results from two other national register studies in Sweden and in Denmark, suggesting that the results would likely apply to other countries, too, including the UK.

̽��ֱ��team used a statistical technique known as Mendelian Randomisation to probe causal links between type 1 diabetes and these various psychiatric disorders, but found little evidence in support of a common underlying biological mechanism.

Tomáš Formánek, a PhD student at the ̽��ֱ�� of Cambridge and the National Institute of Mental Health, Klecany, Czech Republic, said: “Although we found a concerning increase in the risk of mental health problems among people living with type 1 diabetes, our study – and others before it – suggests this is unlikely to be the result of common biological mechanisms. This emphasises the importance of prevention and sustained attention to the mental health needs of children and young people with type 1 diabetes.”

̽��ֱ��researchers say that mental health problems in later life may be a result of children with type 1 diabetes being forced to make significant changes to their lives, with a constant focus on monitoring their food intake and a need to check blood sugar levels and administer insulin injections. This often leaves these children feeling excluded from social events and singled-out by peers, teachers and even family members.

Dr Benjamin Perry from the Department of Psychiatry, ̽��ֱ�� of Cambridge, said: “We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. This can include extreme frustration with blood sugars and feelings of isolation and can lead to burnout, hopelessness, and a feeling of lack of control. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult lives.”

Professor Peter Jones, also from the Department of Psychiatry, ̽��ֱ�� of Cambridge, added: “Our findings emphasise the urgent need to support children diagnosed with type 1 diabetes, look out for signs of mental health problems and offer timely, expert help. That way, it may be possible to help these children early, before these problems fully take root.”

̽��ֱ��research was supported by the National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridgeshire and Peterborough NHS Foundation Trust and the Ministry of Health, Czech Republic, with additional funding from Wellcome and the UKRI Medical Research Council.

Reference
Formánek, T et al. Childhood-Onset Type 1 Diabetes and Subsequent Adult Psychiatric Disorders: A Nationwide Cohort and Genome-wide Mendelian Randomization Study. Nature Mental Health; 17 July 2024; DOI: 10.1038/s44220-024-00280-8

Children diagnosed with type 1 diabetes are at significantly higher risk of a number of mental health issues, including mood and anxiety disorders, a study from a team in the UK and the Czech Republic has found.

We know that people diagnosed with type 1 diabetes can experience ‘diabetes distress’. It’s little wonder, then, that they are at risk of compounding mental health problems, spanning into their adult lives

Benjamin Perry

kyotokushige

Teenager With Type 1 Diabetes Takes at Home Test

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Mindfulness can improve mental health and wellbeing – but unlikely to work for everyone

cjb250 — Mon, 11 Jan 2021 19:00:26 +0000

Mindfulness is typically defined as ‘the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment’. It has become increasingly popular in recent years as a way of increasing wellbeing and reducing stress levels.

In the UK, the National Health Service offers therapies based on mindfulness to help treat mental health issues such as depression and suicidal thoughts. However, the majority of people who practice mindfulness learn their skills in community settings such as universities, workplaces, or private courses. Mindfulness-based programmes are frequently promoted as the go-to universal tool to reduce stress and increase wellbeing, accessible to anyone, anywhere.

Many randomised controlled trials (RCTs) have been conducted around the world to assess whether in-person mindfulness training can improve mental health and wellbeing, but the results are often varied. In a report published today in PLOS Medicine, a team of researchers from the Department of Psychiatry at the ̽��ֱ�� of Cambridge led a systematic review and meta-analysis to examine the published data from the RCTs. This approach allows them to bring together existing – and often contradictory or under-powered – studies to provide more robust conclusions.

̽��ֱ��team identified 136 RCTs on mindfulness training for mental health promotion in community settings. These trials included 11,605 participants aged 18 to 73 years from 29 countries, more than three-quarters (77%) of whom were women.

̽��ֱ��researchers found that in most community settings, compared with doing nothing, mindfulness reduces anxiety, depression and stress, and increases wellbeing. However, the data suggested that in more than one in 20 trials settings, mindfulness-based programmes may not improve these outcomes.

Dr Julieta Galante from the Department of Psychiatry at the ̽��ֱ�� of Cambridge, the report’s first author, said: “For the average person and setting, practising mindfulness appears to be better than doing nothing for improving our mental health, particularly when it comes to depression, anxiety and psychological distress – but we shouldn’t assume that it works for everyone, everywhere.

“Mindfulness training in the community needs to be implemented with care. Community mindfulness courses should be just one option among others, and the range of effects should be researched as courses are implemented in new settings. ̽��ֱ��courses that work best may be those aimed at people who are most stressed or in stressful situations, for example health workers, as they appear to see the biggest benefit.”

̽��ֱ��researchers caution that RCTs in this field tended to be of poor quality, so the combined results may not represent the true effects. For example, many participants stopped attending mindfulness courses and were not asked why, so they are not represented in the results. When the researchers repeated the analyses including only the higher quality studies, mindfulness only showed effects on stress, not on wellbeing, depression or anxiety.

When compared against other ‘feel good’ practices such as exercise, mindfulness fared neither better nor worse. Professor Peter Jones, also from Cambridge’s Department of Psychiatry, and senior author, said: “While mindfulness is often better than taking no action, we found that there may be other effective ways of improving our mental health and wellbeing, such as exercise. In many cases, these may prove to be more suitable alternatives if they are more effective, culturally more acceptable or are more feasible or cost effective to implement. ̽��ֱ��good news is that there are now more options.”

̽��ֱ��researchers say that the variability in the success of different mindfulness-based programmes identified among the RCTs may be down to a number of reasons, including how, where and by whom they are implemented as well as at whom they are targeted. ̽��ֱ��techniques and frameworks taught in mindfulness have rich and diverse backgrounds, from early Buddhist psychology and meditation through to cognitive neuroscience and participatory medicine – the interplay between all of these different factors can be expected to influence how effective a programme is.

̽��ֱ��number of online mindfulness courses has increased rapidly, accelerated further by the COVID-19 pandemic. Although this review has not looked at online courses, studies suggest that these may be as effective as their offline counterparts, despite most lacking interactions with teacher and peers.

Dr Galante added: “If the effects of online mindfulness courses vary as widely according to the setting as their offline counterparts, then the lack of human support they offer could cause potential problems. We need more research before we can be confident about their effectiveness and safety.”

̽��ֱ��research was mainly funded by the National Institute for Health Research.

Reference
Galante, J et al. Mindfulness-based programmes for mental health promotion in adults in non-clinical settings: A systematic review and meta-analysis of randomised controlled trials. PLOS Medicine; 11 Jan 2021; DOI: 10.1371/journal.pmed.1003481

Mindfulness courses can reduce anxiety, depression and stress and increase mental wellbeing within most but not all non-clinical settings, say a team of researchers at the ̽��ֱ�� of Cambridge. They also found that mindfulness may be no better than other practices aimed at improving mental health and wellbeing.

Mindfulness training in the community needs to be implemented with care. Community mindfulness courses should be just one option among others

Julieta Galante

World Economic Forum

Mindfulness meditation

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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