Comparative study of psychiatric disorders in diabetic children and their parents

Abstract

1. The literature on the rate of psychiatric disorders among children with chronic physical illness in general and diabetes as a chronic illness in particular is reviewed.

2. A comparative study of the rate of psychiatric disorders among 50 diabetic children and their parents, and of 50 control children matched for age, sex and social class by occupation of father is described.

3. The three hypotheses tested are:- i) that diabetic children will show a higher rate of psychiatric disorders than the controls. ii) that the parents of diabetic children will show more psychiatric disturbances than parents of controls. iii) that the marriage of the parents of diabetic children will be more poorly integrated than the marriage of the controls.

4. Apart from testing these hypotheses, the aim was also to find out how a British group of diabetic children compares with those reported in Sweden and the U.S.A.

5. The instruments used included a children's behaviour inventory, a teacher questionnaire and the symptom sign inventory, all of proven reliability. Mothers were the main informants.

6. No significant differences were found between the rates of psychiatric disorders observed among the diabetic children and the controls both at home and at school. The differences between the present finding and those described in the were thought to he due to various factors including the age range of children studied by different workers, the instruments employed and the different therapeutic regimes of the various centres.

7. The mothers of the diabetic children were found to oe significantly different from the mothers of controls in the amount of self-reporting of nervousness, the demands they have made on their general practitioners for psychiatric complaints and on psychiatric hospitals. The mothers of the diabetic children also impressed the present author as being more anxious and reactively depressed than the mothers of controls. The differences on the personal disturbance scale of the symptom sign inventory between the two groups of mothers did not reach significant levels. The latter finding was thought to be due to the fact that the personal disturbance scale was not sensitive enough in identifying psychiatric morbidity in subjects not acutely disturbed.

The marriages of the parents of diabetic children were not more poorly integrated than those of the controls. Fathers did not appear to be as deeply affected by the child's illness. The first and the third hypotheses are thus unproven but the second one is partially proven.

8. Of all the factors likely to be associated with psychiatric disturbance in diabetic children, only the sex of the child was found to be of some importance in that there was a suggestive evidence of an association. Although there was a preponderance of girls among the disturbed diabetic children, when the diabetic girls and boys were compared with control girls and boys separately on three measures (mother's general concern, total behaviour score, and teacher's rating of behaviour) no significant differences were found. The evidence was thus inconclusive.

Other factors which were not significantly associated with psychiatric disturbance in diabetic children but which showed a trend towards a positive correlation included lower socio-economic status, prolonged hospitalisations and increased psychiatric morbidity in mothers. The lack of significant relationships with these factors was thought to be due to the small number of disturbed children in the present sample.

9. It is concluded that firstly, mothers need more opportunities to discuss their anxieties about the future outlook of their children with the attending physicians. Secondly, the traditional case work of the social worker may not be adequate in this situation. Social workers attached to the families need to know about diabetes and its management in children. Thirdly, it is recommended that group ventures similar to those already started by parents of autistic children, of mentally handicapped children and of children with other chronic handicaps, be launched by the British Diabetic Association for the parents of diabetic children.