Associated factors with depression and sleep quality in T1DM patients

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition caused by the destruction of the pancreas' beta cells. It is one of the most common chronic diseases in children and requires continuous adaptation and management, including diet management, exercise, insulin injections, and monitoring of blood glucose levels. People with T1DM may experience psychosocial stress in managing their disease, with depression being one of the most common mental disorders among them. Managing psychosocial aspects, such as depression, is important for individuals with T1DM. Additionally, sleep quality can also be affected in individuals with T1DM and poor sleep can impact overall health and T1DM management.

This current study by Mi-Kyoung Cho and Mi Young Kim (2023) aims to investigate the relationship between resilience and the psychological and physical well-being of adults living with Type 1 diabetes mellitus (T1DM). Resilience has been described as the ability to manage and overcome the difficulties associated with living with T1DM, and is known to be a positive factor that can offset negative aspects such as depression and sleep disturbances. The study aims to explore the impact of resilience, along with other general and disease-related characteristics, on depression and sleep in adults with T1DM. The goal of the research is to provide important data that can be used in the development of interventions to address depression and sleep issues in individuals with T1DM.

Participants of the study were patients with T1DM who were members of an online T1DM community. The inclusion criteria for participants were: being diagnosed with T1DM for at least one year, managing diabetes at home, and being able to access the survey URL and respond to the survey voluntarily. The exclusion criteria were: having any mental or neurological disease, participation in any depression and sleep quality improvement programs, and hospitalization due to complications during the data collection period. A total of 157 participants were needed for the study and ultimately, 159 participants participated. To avoid bias, efforts were made during the recruitment process to ensure participants were selected fairly.

The study participants were characterized by various factors including age, sex, religion, occupation, duration of T1DM, presence or absence of T1DM complications (macrovascular and microvascular), education about diabetes, experience of diabetes camp, source of diabetes information, and recent HbA1c values. The study also measured depression using the Center for Epidemiologic Studies Depression Scale (CES-D) developed by Radloff and validated in Korean by Cho and Kim, which evaluates depressive symptoms experienced in the past seven days. Additionally, sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and validated in Korean by Choi et al. It measures sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medication, and daytime dysfunction over the past month. Lastly, resilience was assessed using a Korean version of the resilience scale developed by Wagnild and Young.

The study found that on average, T1DM patients had a moderate level of depression (average score of 23.77) and poor sleep quality (average score of 4.58). A positive relationship was found between depression and sleep quality, as well as a negative relationship between the total resilience score and depression. The study identified specific factors that were associated with depression in T1DM patients, such as a shorter duration of disease, longer sleep latency, longer sleep duration, higher degree of sleep disturbance, and lower resilience-acceptance of self and life sub-factors. These factors were found to explain 44.4% of the variance in depression. Similarly, the study identified factors associated with sleep quality in T1DM patients, such as a higher number of complications, lower resilience-personal competence sub-factors, and higher levels of depression. These factors were found to explain 37.4% of the variance in sleep quality.

Lastly, the results showed that a greater number of T1DM complications was associated with lower sleep quality, which is consistent with a previous study, which reported that a poorer health level predicted lower sleep quality among adults overall. The results suggest that interventions are necessary for alleviating depression and poor sleep quality in individuals with T1DM as they may be related to inadequate management of the disease.

References:

Cho, M. K., & Kim, M. Y. (2023). Associated factors with depression and sleep quality in T1DM patients: a cross-sectional descriptive study. BMC Psychiatry, 23(1), 18. https://doi.org/10.1186/s12888-023-04516-2