Diabetes
Associations Between Mental Health and Type 2 Diabetes Among Adolescents and Young Adults: The PAPAYA Study Cindy J Huang* Cindy Huang Huang Huang Huang Huang Huang Huang Huang Huang Huang Kaiser Permanente Northern California Division of Research
Introduction: Adolescents and young adults (AYAs) with type 2 diabetes (T2D) face elevated mental health risks, but existing studies lack statistical power for subgroup analyses. We examined associations between T2D diagnosis and mental health outcomes among diverse AYAs within an integrated healthcare system and tested for effect modification by age, sex, and race/ethnicity.
Methods: This cross-sectional study used data from the Predictors of Adverse Cardiometabolic Problems in Adolescents and Young Adults (PAPAYA) cohort at Kaiser Permanente Northern California (KPNC) and included AYAs (adolescents: ages 10-19, young adults: ages 20-30), identified as of 1/1/2022. T2D was defined using a validated algorithm. Depression and anxiety were defined using ICD-10 diagnosis codes and screening tools (depression: PHQ-2 ≥ 3 and PHQ-9 ≥ 10; anxiety: GAD-7 ≥ 10). Logistic regression models estimated prevalence odds ratios (PORs) for associations between T2D diagnosis and each mental health outcome, adjusting for and testing effect measure modification (EMM) by age, sex, and race/ethnicity.
Results: Among 789,363 AYAs (50.3% female; race/ethnicity: 31.9% White, 25.7% Hispanic, 20.5% Asian, 7.2% multiracial, 6.9% Black, 7.8% other/unknown), 3,392 (0.43%) had a T2D diagnosis. AYAs with T2D had higher odds of depression (POR = 1.81, 95% CI: 1.68-1.95) and anxiety (POR = 1.60, 95% CI: 1.49-1.73), compared to AYAs without diabetes. EMM by age demonstrated that adolescents with T2D had higher odds of depression (POR = 2.73, 95% CI: 2.26-3.29) and anxiety (POR = 2.16, 95% CI: 1.78-2.62), with stronger associations compared with young adults (depression: p_int < 0.0001; anxiety: p_int = 0.003). EMM by race/ethnicity showed significant associations between all major racial/ethnic groups and depression (POR range: 1.62-2.53, p_int = 0.02). There was no evidence of effect modification by sex.
Conclusion: AYAs with T2D are at higher risk for depression and anxiety than their peers without diabetes. Adolescents with T2D experience particularly high mental health burden, underscoring the need for targeted interventions to support this high-risk subgroup.