Academic journal article East Asian Archives of Psychiatry

Psychiatric Morbidity in Chinese Adults with Type 1 Diabetes in Hong Kong

Academic journal article East Asian Archives of Psychiatry

Psychiatric Morbidity in Chinese Adults with Type 1 Diabetes in Hong Kong

Article excerpt


Type 1 diabetes (T1DM) is caused by beta-cell destruction in the pancreas, leading to absolute insulin deficiency. Unlike patients who suffer from type 2 diabetes (T2DM), individuals with T1DM present at a much younger age and depend on regular insulin injections for survival thereafter. (1) They face a lifetime of inconvenience and restraints in order to achieve optimal glycaemic control. They need to juggle insulin dose, diet, and exercise to maintain a near-normal blood sugar concentration to reduce the threat of long-term complications while avoiding the short-term disaster of disabling hypoglycaemia. Previous studies have shown that patients with T1DM experience greater levels of threat than those with T2DM (2): it is difficult for an individual with T1DM to live a normal life, and therefore not surprising to find that the rates of depression and anxiety are higher in those with T1DM than in healthy individuals. (3-5)

Psychiatric morbidities have long been proven to worsen glycaemic control, (6-8) resulting in higher complication rates, (9) decreased adherence to treatment regimen, and poorer quality of life. (10,11) The early identification of treatable psychiatric morbidity is therefore of paramount importance and can greatly improve clinical outcomes. (12,13)

Psychiatric morbidity is common in T1DM patients, and it is being intensively investigated in many countries, but few data are available from Asia and Hong Kong. The current study aimed to assess the prevalence of psychiatric morbidity in T1DM patients in Hong Kong, to identify associated factors, and to assess the usefulness of convenient self-rating screening tools in assisting physicians to identify patients who are in need of referral to psychiatric services.


Study Design

This was a cross-sectional study conducted in a diabetes specialist outpatient clinic at the Princess Margaret Hospital of the Hospital Authority in Hong Kong from August 2013 to January 2014. The clinic acts as a major local centre for the management of all T1DM patients and those with T2DM who require intensive care because their diabetes is not under control despite treatment supervised by general medical clinics. Approval for the present study was obtained from the hospital's Clinical Research Ethics Committee.


All patients who attended the diabetes clinic from August 2013 to January 2014 with a confirmed diagnosis of T1DM made by an endocrinologist were recruited to the study. According to the prevalence rate of depression found in a previous study, (3) 125 patients were needed for the current study. Patients were excluded if they were non-Chinese, unable to comprehend the Chinese language, or had significant cognitive impairment or communication difficulties.


All eligible patients were approached by the first author in person on the day of their follow-up, and written informed consent was obtained from those who agreed to participate. They were given the Chinese version of the Hospital Anxiety and Depression Scale (HADS) and the Chinese version of the 12-item General Health Questionnaire (GHQ-12) to complete before the interview. Characteristics of patients such as socio-demographic and clinical data were collected by the first author. The Chinese-bilingual version of the Structured Clinical Interview for the DSM-IV Axis I disorder (SCID) was administered by the first author who completed the required training in its use.

Data Analyses

The data from the present study were analysed using the Statistical Package for the Social Sciences Windows version 20.0 (SPSS Inc., Chicago [IL], US). Statistical analyses were performed in 2 stages. In the first stage, the variables were compared between: (1) T1DM patients with and without current psychiatric morbidity, (2) T1DM patients with and without current depressive disorders, and (3) T1DM patients with and without current anxiety disorders. …

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