Psychiatric disorders during early adulthood in those with childhood onset type 1 diabetes: Rates and clinical risk factors from population-based follow-up: COOPER et al.
Open accessAbstract
AIM: To determine the incidence of and risk factors for psychiatric disorders in early adulthood in patients with childhood onset type 1 diabetes (T1D). METHODS: In this retrospective-cohort study, we identified a population-based childhood onset T1D cohort and an age and sex matched (5:1) non-diabetic comparison cohort. Data linkage was used to access inpatient hospitalization data, mental health support service data, and mortality data to follow-up both cohorts into early adulthood. RESULTS: The mean age of T1D diagnosis was 9.5 years (SD 4.1), with a mean age at end of follow-up of 26.4 years (SD 5.2, max 37.7). The diagnosis of any psychiatric disorder was observed for 187 of 1302 (14.3%) in the T1D cohort and 400 of 6422 (6.2%) in the comparison cohort [adjusted hazard ratio (HR) 2.3; 95% CI 1.9, 2.7]. Anxiety, eating, mood, and personality and behaviour disorders were observed at higher rates within the T1D cohort. Comorbid psychiatric disorders were more frequent, at the cohort level, within the T1D cohort (2-3 disorders 3.76% vs 1.56%) and service utilization was higher (15+ contacts 6.8% vs 2.8%); though these differences did not remain when restricted to only those individuals diagnosed during follow-up. A history of poor glycaemic control was associated with an increased risk of anxiety, mood, and 'any' disorder (HR ranging from 1.35 to 1.42 for each 1% increase in mean paediatric HbA1c). CONCLUSION: Our findings highlight the need for access to mental health support services as part of routine patient care for young adults with T1D, and for better predictive tools to facilitate targeting at-risk patients with early intervention programs.
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Autism spectrum disorder was measured in 4 studies using medical records or registers, with prevalence ranging from 0.67% to 1.58%.
“N = 4 [20,32,40,57] studies measured autism spectrum disorder (ASD) using medical records or registers and reported prevalence ranging from 0.67% to 1.58%.”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
Among studies with healthy controls for depressive disorders, 2 using registers or medical records reported prevalence from 0.61% to 2.54%.
“and n = 2 [20,21] utilised registers or medical records and prevalence ranged from 0.61% to 2.54%.”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
For feeding and eating disorders with healthy controls, prevalence ranged from 0.20% to 0.27% in 2 register/medical record studies.
“and 0.20% to 0.27% in n = 2 studies using medical records or registers [20,21].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
Two studies with healthy controls for schizophrenia spectrum and other psychotic disorders using registers reported prevalence from 0.05% to 0.90%.
“N = 2 studies included a comparison group of healthy controls using medical records or registers with the prevalence ranging from 0.05% to 0.90% [20,21].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
For intellectual disability, one diagnostic interview study reported prevalence of 5.56% and one patient register study reported 0.74%.
“Specifically, n = 2 [20,22] reported on intellectual disability, of which one study used a diagnostic interview and reported a prevalence of 5.56% and the second study used a patient register and reported 0.74% prevalence.”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
One study with healthy controls for autism spectrum disorder reported a prevalence of 0.41%.
“N = 1 study included a comparison group of healthy controls, where the prevalence reported was 0.41% [20].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
For intellectual disability with healthy controls, one diagnostic interview study reported prevalence of 2.22% and one register study reported 0.43%.
“N = 2 studies included a comparison group of healthy controls, of which one study used diagnostic interviews and reported a prevalence of 2.22% [22] and the second study used a register, reporting a 0.43% prevalence [20].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
For ADHD with healthy controls, one diagnostic interview study reported prevalence of 2.22% and one register study reported 0.80%.
“N = 2 reported on healthy controls, n = 1 used a diagnostic interview with a prevalence of 2.22% [22], and n = 1 used a register with a prevalence of 0.80% [20].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
Somatic symptom and related disorders were reported in 2 studies; one diagnostic interview reported prevalence of 1.91% and one patient register reported 0.16%.
“N = 2 studies reported on somatic symptoms and related disorders [20,23].One study [23] used a diagnostic interview and reported a prevalence of 1.91% and the other study [20] used a patient register and reported a prevalence of 0.16%.”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
For anxiety disorders with healthy controls, 2 register/medical record studies reported prevalence from 0.63% to 3.82%.
“and those using medical records or registers (n = 2) ranged from 0.63% to 3.82% [20,21].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
Disruptive, impulse control and conduct disorder were reported in 8 studies; 7 diagnostic interview studies reported prevalence from 2.9% to 16.48% and 1 patient register study reported 0.27%.
“N = 8 [20,22,31,34,42,45,52,59] studies reported on disruptive, impulse control and conduct disorder.Specifically, studies examined oppositional defiant disorder n = 5, conduct disorder n = 5 and antisocial personality disorder n = 1.N = 7 studies utilised diagnostic interviews and reported a prevalence range of 2.9% to 16.48% and n = 1 studies used a patient register and reported a prevalence of”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
One study measured dissociative disorders; Butwicka et al. [20] using Swedish registers reported 0.05% diagnosed among 17,122 people with type 1 diabetes.
“Only n = 1 study measured dissociative disorders.Butwicka et al. [20] used the Swedish National Patient Register and Swedish Childhood Diabetes Register and reported of 17,122 people with type 1 diabetes, 0.05% were diagnosed with dissociative disorders.”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of schizophrenia spectrum and other psychotic disorders based on interviews was 0.25% (95% CI 0.00-0.81) across 3 studies with a total sample size of 584.
“| | 3 | Interviews | 584 | 0.25 | 0.00-0.81 | 14.15% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of anxiety disorders based on registers was 0.79% (95% CI 0.66-0.92) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes | 2 | Registers | 18,424 | 0.79 | 0.66 0.92 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of depressive disorders based on interviews was 4.58% (95% CI 3.67-5.48) across 2 studies with a total sample size of 2091.
“| | 2 | Interviews | 2091 | 4.58 | 3.67-5.48 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of depressive disorders based on registers was 0.61% (95% CI 0.60-0.62) across 2 studies with a total sample size of 1,703,033.
“| Healthy controls [20-23] | 2 | Registers | 1,703,033 | 0.61 | 0.60-0.62 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of schizophrenia spectrum and other psychotic disorders based on registers was 0.04% (95% CI 0.01-0.07) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes [20,21,31,34,58] | 2 | Registers | 18,424 | 0.04 | 0.01-0.07 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
Substance-related and addictive disorders were reported in 9 studies; 7 diagnostic interview studies reported prevalence from 0.00% to 34.67% and 2 register/medical record studies reported 0.92% and 2.16%.
“N = 9 [20,21,23,31,34,38,42,52,58] studies reported on the prevalence of substance-related and addictive disorders.Where specified, n = 5 reported alcohol-related, n = 1 was cannabis-related, n = 1 was tobacco-related, n = 1 was medication-related, and n = 1 not specified.N = 7 studies used diagnostic interviews and reported prevalence ranging from 0.00% to 34.67% and n = 2 studies used patient”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of depressive disorders based on interviews was 14.35% (95% CI 10.65-18.05) across 18 studies with a total sample size of 1250.
“| [20-23,29-31,34-39,41,42,44,45,48,52,53,55,58,59] | 18 | Interviews | 1250 | 14.35 | 10.65-18.05 | 91.18% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of schizophrenia spectrum and other psychotic disorders based on registers was 0.05% (95% CI 0.04-0.05) across 2 studies with a total sample size of 1,703,033.
“| Healthy controls [20,21] | 2 | Registers | 1,703,033 | 0.05 | 0.04-0.05 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
For substance-related and addictive disorders with healthy controls, one diagnostic interview study reported prevalence of 4.1% and two register studies reported 0.7% to 0.8%.
“N = 3 studies included a comparison group of healthy controls, n = 1 study used a diagnostic interview and recorded a prevalence of 4.1% [23] and n = 2 used patient registers and reported a prevalence ranging from 0.7% to 0.8% [20,21].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of feeding and eating disorders based on registers was 0.60% (95% CI 0.50-0.73) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes [20-26,31,33,34,43,45,50-52,54] | 2 | Registers | 18,424 | 0.60 | 0.50-0.73 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of trauma-and stressor-related disorders based on registers was 0.57% (95% CI 0.46-0.69) across 1 study with a total sample size of 17,122.
“| Type 1 diabetes [20,31,34,48,52,58] | 1 | Registers | 17,122 | 0.57 | 0.46-0.69 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of anxiety disorders based on registers was 0.63% (95% CI 0.62-0.65) across 2 studies with a total sample size of 1,703,033.
“| Healthy controls [20-23] | 2 | Registers | 1,703,033 | 0.63 | 0.62-0.65 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of anxiety disorders based on interviews was 12.56% (95% CI 8.87-16.24) across 15 studies with a total sample size of 2156.
“| [20-23,30,31,34,35,38,42,44,45,48,52,53,58,59] | 15 | Interviews | 2156 | 12.56 | 8.87 16.24 | 88.97% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of trauma-and stressor-related disorders based on interviews was 1.17% (95% CI 0.02-2.33) across 5 studies with a total sample size of 796.
“| | 5 | Interviews | 796 | 1.17 | 0.02-2.33 | 57.07% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of feeding and eating disorders based on interviews was 6.60% (95% CI 4.11-9.09) across 14 studies with a total sample size of 2004.
“| | 14 | Interviews | 2004 | 6.60 | 4.11-9.09 | 86.75% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of dissociative disorders based on registers was 0.05% across 1 study with a total sample size of 17,122.
“| Type 1 diabetes [20] | 1 | Registers | 17,122 | 0.05 | | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of anxiety disorders based on interviews was 9.02% (95% CI 7.79-10.25) across 2 studies with a total sample size of 2046.
“| | 2 | Interviews | 2046 | 9.02 | 7.79-10.25 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of somatic symptom and related disorders based on interviews was 1.92% (95% CI 0.88-4.12) across 1 study with a total sample size of 313.
“| | 1 | Interviews | 313 | 1.92 | 0.88-4.12 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of somatic symptom and related disorders based on registers was 0.16% (95% CI 0.11-0.24) across 1 study with a total sample size of 17,122.
“| Type 1 diabetes [20,23] | 1 | Registers | 17,122 | 0.16 | 0.11-0.24 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of feeding and eating disorders based on registers was 0.27% (95% CI 0.27-0.28) across 2 studies with a total sample size of 1,703,033.
“| Healthy controls [20-26] | 2 | Registers | 1,703,033 | 0.27 | 0.27-0.28 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of feeding and eating disorders based on interviews was 1.25% (95% CI 0.00-2.84) across 5 studies with a total sample size of 3581.
“| | 5 | Interviews | 3581 | 1.25 | 0.00-2.84 | 90.73% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of substance-related and addictive disorders based on interviews was 3.87% (95% CI 1.9-6.66) across 7 studies with a total sample size of 1173.
“| | 7 | Interviews | 1173 | 3.87 | 1.9-6.66 | 88.03% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of substance-related and addictive disorders based on registers was 1.98% (95% CI 1.77-2.18) across 2 studies with a total sample size of 18,424.
“| Type 1 diabetes [20,21,23,31,34,38,42,52,58] | 2 | Registers | 18,424 | 1.98 | 1.77-2.18 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of substance-related and addictive disorders based on interviews was 4.11% across 1 study with a total sample size of 2046.
“| | 1 | Interviews | 2046 | 4.11 | - | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In healthy controls, the pooled prevalence of substance-related and addictive disorders based on registers was 0.83% (95% CI 0.81-0.84) across 2 studies with a total sample size of 1,703,033.
“| Healthy controls [20,21,23] | 2 | Registers | 1,703,033 | 0.83 | 0.81-0.84 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of disruptive, impulse-control and conduct disorders based on interviews was 6.43% (95% CI 3.32-9.55) across 7 studies with a total sample size of 786.
“| | 7 | Interviews | 786 | 6.43 | 3.32-9.55 | 70.46% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
In people with type 1 diabetes, the pooled prevalence of disruptive, impulse-control and conduct disorders based on registers was 0.27% (95% CI 0.20-0.36) across 1 study with a total sample size of 17,122.
“| Type 1 diabetes [20,22,31,34,42,45,52,59] | 1 | Registers | 17,122 | 0.27 | 0.20-0.36 | N/A |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of disruptive, impulse-control and conduct disorders in people with type 1 diabetes based on interviews was 70.46%.
“| | 7 | Interviews | 786 | 6.43 | 3.32-9.55 | 70.46% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of trauma-and stressor-related disorders in people with type 1 diabetes based on interviews was 57.07%.
“| | 5 | Interviews | 796 | 1.17 | 0.02-2.33 | 57.07% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of anxiety disorders in people with type 1 diabetes based on interviews was 88.97%.
“| [20-23,30,31,34,35,38,42,44,45,48,52,53,58,59] | 15 | Interviews | 2156 | 12.56 | 8.87 16.24 | 88.97% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of feeding and eating disorders in people with type 1 diabetes based on interviews was 86.75%.
“| | 14 | Interviews | 2004 | 6.60 | 4.11-9.09 | 86.75% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of feeding and eating disorders in healthy controls based on interviews was 90.73%.
“| | 5 | Interviews | 3581 | 1.25 | 0.00-2.84 | 90.73% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of substance-related and addictive disorders in people with type 1 diabetes based on interviews was 88.03%.
“| | 7 | Interviews | 1173 | 3.87 | 1.9-6.66 | 88.03% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of schizophrenia spectrum and other psychotic disorders in people with type 1 diabetes based on interviews was 14.15%.
“| | 3 | Interviews | 584 | 0.25 | 0.00-0.81 | 14.15% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
The heterogeneity (I2) for the pooled prevalence of depressive disorders in people with type 1 diabetes based on interviews was 91.18%.
“| [20-23,29-31,34-39,41,42,44,45,48,52,53,55,58,59] | 18 | Interviews | 1250 | 14.35 | 10.65-18.05 | 91.18% |”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [20]
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- Authors
- Cooper, M. N., Lin, A., Alvares, G. A., de Klerk, N. H., Jones, T. W., & Davis, E. A.
- Affiliations
- The Kids Research Institute Australia (AU)
- Telethon Kids Institute; The University of Western Australia; Perth Australia
- Corresponding author
- Davis, E. A.
- Venue
- Pediatric Diabetes
- Publisher
- Hindawi Limited
- Published
- 2016-11-23
- Volume
- 18
- Issue
- 7
- Pages
- 599-606
- ISSN
- 1399-543X (ISSN-L)
- OpenAlex
- W2556137199
- Cited by
- 75
- References
- 36
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 12 · 2023: 10 · 2022: 11 · 2021: 8 · 2020: 6 · 2019: 4 · 2018: 9 · 2017: 3
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- NHMRC Early Career Fellowship (#1072593)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, childhood-onset diabetes, mental illness, early adulthood, anxiety disorders, mood disorders, eating disorders, personality disorders, comorbidities, glycemic control, HbA1c, mental health service utilization, risk factors, young adults
- MeSH terms
- Adolescent, Anxiety, Feeding and Eating Disorders, Mental Disorders, Child, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Humans, Hyperglycemia, Hypoglycemia, Male, Mortality, Registries, Retrospective Studies, Risk Factors, Western Australia, Comorbidity, Incidence, Proportional Hazards Models, Mood Disorders, Electronic Health Records
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