# Depressive Symptoms and Glycemic Control Among Children and Adolescents With Diabetes: The Mediation Effect of Self-Care Behaviors

## TL;DR

Depressive symptoms in children and adolescents with diabetes are linked to poor glycemic control, partly because they affect self-care behaviors.

## Contribution

This study identifies self-care behaviors as a partial mediator between depressive symptoms and glycemic control in diabetic youth.

## Key findings

- Depressive symptoms and poor self-care behaviors are associated with higher HbA1c levels in diabetic children and adolescents.
- Self-care behaviors mediate 30.65% of the effect of depressive symptoms on glycemic control.
- Improving self-care behaviors could help mitigate the impact of depression on diabetes management.

## Abstract

This study aimed to assess the association between depressive symptoms and glycemic control among children and adolescents with diabetes and to determine if their self-care behaviors mediate this association.

A total of 207 patients of children and adolescents with diabetes were included in a cross-sectional survey study. The Chinese version of the Children's Depression Inventory (CDI) was used to evaluate the depressive symptoms of the patients. The Chinese version of the Summary of Diabetes of Self-Care Activities (SDSCA) was used to evaluate the level of diabetes self-care behaviors. The values of HbA1c of children and adolescents with diabetes were obtained from patients' medical history cases or self-reporting. Structural equation modeling (SEM) was used to examine the mediation effect of self-care behaviors between depressive symptoms and glycemic control.

In 207 children and adolescents with diabetes, the total score of depressive symptoms was 12.71 ± 6.73 and the total score of self-care behaviors was 42.31 ± 14.09. The HbA1c of the patients was 9.14 ± 2.55%. High depressive symptoms and low self-care behaviors are related to high levels of HbA1c (all p  < 0.001). The results revealed that the effect of depressive symptoms on glycemic control was partly mediated by self-care behaviors and the mediation effect accounts for 30.65% of the total effect.

Depressive symptoms show a significant association with glycemic control among children and adolescents with diabetes, with self-care behaviors serving as a partial mediator in this relationship. Depressive severity may influence glycemic control partly by affecting self-care behaviors.