Longitudinal Relationships Between Depression and Chronic Illness in Adolescents: An Integrative Review.
Katherine Zheng, Cilgy Abraham, Jean-Marie Bruzzese and 1 others
PMID 32171610WHAT IT FOUND
Adolescents with chronic illness and elevated depressive symptoms were later more likely to have poorer diabetes control, lower medication adherence, more hospitalization, pain, disability, and lower quality of life, though findings varied by illness.
Key findings
01A one-unit increase in CDI score predicted a 0.11% increase in HbA1c over six months and a 1.18% increase over three years.
02In type 2 diabetes, adolescents above the CDI cut-off at baseline were more likely to demonstrate low medication adherence than high medication adherence at 48-month follow-up (17% vs. 12%).
03Adolescents with type 1 diabetes above the CES-D cut-off score were 2.5 times more likely to be hospitalized than adolescents below the cut-off score over two years.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a review of observational cohort studies, so it does not show that treating depression improves chronic illness outcomes. Most studies measured depressive symptoms with self-report instruments rather than a confirmed diagnosis of depression. The evidence is heavily focused on diabetes; 70% of adolescents in the review had diabetes, so it says little about asthma, epilepsy, cystic fibrosis, congenital heart disease, juvenile idiopathic arthritis, or sickle cell disease. Findings were inconsistent across illness types, including no significant relationship between depressive symptoms and HbA1c in one type 2 diabetes study and no pain or disability relationship in sickle cell disease. Several studies lacked a comparison group, did not control for demographic or illness factors, had high attrition, or were rated poor quality. Only 11 cohort studies were included, and samples for illnesses other than diabetes were small. Non-English articles and conference proceedings were excluded.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that treating adolescent depression will improve chronic illness outcomes. The review only synthesized observational associations, and some studies found no relationship between depressive symptoms and HbA1c.