Addressing Diabetes and Depression in the School Setting The Role of School Nurses

Diabetes is one of the most common chronic diseases among children and adolescents in the United States, with about 215,000 people 20 years of age or younger having this disease (Centers for Disease Control and Prevention [CDC], 2010). Each year, more than 13,000 young people are diagnosed with type 1 diabetes, and between 8% and 43% of new cases of childhood diabetes are classified as type 2 diabetes (CDC, 2010). While diabetes can be a challenging disease for anyone, having diabetes as an adolescent can bring additional concerns beyond the typical challenges that can impede self-management behaviors (Jaser, 2010; Owens, Shea, & Lewis, 2010). Having a chronic illness like diabetes often requires that adolescents juggle their pursuit of independence with the need to rely on others— teachers, parents, and school nurses— to successfully manage their illness on a daily basis. If managing diabetes becomes stressful or overwhelming for the adolescent and these feelings persist, the teenager may become depressed (Davis, 2005; Hood et al., 2006; Jaser, 2010). Although depression is often not recognized as a common comorbidity in diabetes, depression affects 14% to 20% of adolescents with diabetes and is more common in girls (CDC, 2012c; Davis, 2005; Hood et al., 2006; Jaser, 2010; Lawrence et al., 2006). Depressive symptoms, such as persistent sadness, difficulty concentrating, and feeling tired all the time, can impact a teen’s ability to follow through on daily self-management behaviors (e.g., monitoring blood glucose levels on a consistent basis) and to problem-solve when urgent issues with diabetes care arise (e.g., low blood sugar levels; Antal & Wysocki, 2008). Depression that occurs with diabetes also can increase a teen’s risk for acute and chronic diabetes-related complications, such as retinopathy, diabetic ketoacidosis, and hospitalization (Herpertz et al., 2001; Hood et al., 2006; Jaser, 2010). Additionally, depression can impact school performance, peer relations, and risk-taking behaviors (Antal & Wysocki, 2008; Jaser, 2010; Shrier, Harris, Sternberg, & Beardslee, 2001). Please see Figure 1 to learn more about recognizing the signs of depression.