Few Pediatric Diabetes Patients Access Outpatient Psychotherapy following Screening and Referral

Introduction: Adolescents and young adults (AYAs) with diabetes are at risk for suboptimal psychological functioning. This study aims to describe the prevalence of elevated depression scores, outpatient psychotherapy referrals, and individuals receiving follow-up care in a clinic with an integrated psychologist. Further, we examine whether having an integrated psychologist leads to better access to mental health services for AYA. Methods: Participants were seen in a multidisciplinary diabetes clinic from September 2016 to 2017. Assessment included a semi-structured interview and depression screener (PHQ). Families with concerns related to diabetes management were offered on-site outpatient psychotherapy, others given community referrals. Follow-up with referrals was assessed at next diabetes visit. Results: Participants included 100 ethnically diverse AYAs, 11-21 years (M=16.06±2.42; 56% female), diagnosed with type 1 (79%), type 2 (19%), or MODY (2%), with a range of glycemic control (HbA1c 5.5 to >14%). PHQ scores were: no/minimal (58%), mild (26%), moderate (11%), moderately severe (3%), and severe (2%). 59% of patients were referred for outpatient psychotherapy. Referral reasons included depression, anxiety, behavioral difficulties, family conflict, and diabetes management challenges. At follow-up, only 9% were receiving services. Barriers included transportation, organization (e.g., losing referral), and stigma. Conclusions: Pediatric psychologists within integrated diabetes teams offer effective mental health screening and referrals. Almost half (42%) of AYA in our cohort had ≥5 depressive symptoms, and while 59% were referred for outpatient therapy, only 9% received these services. Despite patient access to a pediatric psychologist in clinic, a large discrepancy between referral and follow-up rates remains. This disparity highlights the importance of identifying and reducing barriers to follow-up care for AYAs with diabetes.