Academic journal article Journal of School Health

Correlates of Depressive Symptoms in Urban Youth at Risk for Type 2 Diabetes Mellitus

Academic journal article Journal of School Health

Correlates of Depressive Symptoms in Urban Youth at Risk for Type 2 Diabetes Mellitus

Article excerpt

INTRODUCTION

Rates of overweight in youth have increased at an alarming rate in recent decades, particularly in minority youth. (1) Overweight in youth affects physical health, including greater risk for developing type 2 diabetes mellitus (T2DM), and psychosocial functioning, including poor quality of life and low self-esteem. (2) Depressive symptoms in youth at risk for T2DM may affect the ability of youth to engage in healthy lifestyle behaviors to manage weight and reduce their risk for health problems. Thus, there is a need to determine the associations between depressive symptoms, health behaviors and attitudes, and clinical markers of risk.

Urban Youth at Risk for T2DM

Using age- and sex-specific reference data for body mass index (BMI), children above the 95th percentile are considered to be obese. The percentage of obese adolescents (aged 12-19) has tripled over the past decades, increasing from 5% in 1970 to more than 17% in 2006, with similar increases in girls and boys. (1,3) Furthermore, Hispanic male and Hispanic and black female adolescents are now significantly more likely to be overweight than non-Hispanic white adolescents. (1) The percentages of obese adolescents in 2003 to 2006 were 18.5% of black non-Hispanic boys, 27.7% of black girls, 17.3% of Hispanic (Mexican American) boys. and 14.5% of Hispanic girls. (1) Thus, rates of overweight in minority youth have increased at even higher rates than those for the general population.

The increases in overweight in minority youth place this population at greater risk for developing health problems, including T2DM. Obesity in adults is associated with metabolic abnormalities of insulin resistance, glucose intolerance, and dyslipidemia, and evidence for insulin resistance in overweight youth is mounting. (4) A study of overweight African-American girls aged 5 to 10, for example, demonstrated a significant relationship between overweight and insulin resistance. (5) Overweight children are not only at greater risk for health problems, (6) they are also at greater risk for psychosocial distress. (7)

Research supports the concept that obesity is associated with depressive symptoms in adolescents, and until recently, it was thought that depression was a consequence of obesity. (8,9) However, a study using a large, nationally representative sample of adolescents demonstrated that depressive symptoms predicted later obesity; adolescents who had depressive symptoms at baseline were twice as likely to be obese 1 year later, (10) Even after controlling for self-esteem, physical activity, parental obesity, and parental education, depressed mood remained a significant predictor of obesity. A longitudinal study of adolescent girls also found that depressive symptoms predicted onset of obesity, with each additional depressive symptom increasing the likelihood of becoming obese. (11) These findings suggest that depressive symptoms are an important predictor of obesity, but there is still a need to determine the pathways of risk to inform prevention strategies.

Research in adults strongly supports that depression predicts the onset of T2DM, increasing risk by 37%. (12) This relationship is thought to be due to the effects of depression on glucose dysregulation, resulting in the development of T2DM. (12) In adults with diabetes (type i and type 2), depression has been consistently and significantly related to poorer metabolic control (ie, higher glycosylated hemoglobin (HbA1c) levels). (13) One mechanism of risk may be the greater insulin resistance associated with depression. (14) Thus, there is a need to explore associations between depressive symptoms and clinical markers of risk (eg, HbA1c, insulin resistance) in youth.

Depressive Symptoms in Youth

The most common measure of depressive symptoms in youth is the Children's Depression Inventory (CDI). (15) A meta-analysis of children's scores on the CDI from 310 samples found no sex difference in children but a small effect (d = . …

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