Psychosocial issues in pediatric diabetes.

Although the majority of diabetic patients exhibit mild depression, anxiety, and somatic complaints at the time of diagnosis, these symptoms are usually temporary and resolve within 6 to 9 months. However, in some patients, depressive symptoms may increase with the duration of diabetes. Anxiety seems to increase and to be more prevalent in girls than in boys. Depression and self-esteem problems have a negative impact on the adaptation to diabetes and metabolic control. Patients' adjustment to diabetes shortly after diagnosis seems to predict adjustment later on. Family characteristics have major implications in the patient's adjustment to diabetes, self-management, and quality of life. Children and adolescents living in families with a high degree of conflict or that are less caring appear to have poorer metabolic control. Thus, the goal of achieving metabolic and psychological stability requires a diabetes team equipped to provide social and psychological support in addition to the development of technical skills. This includes very early assessment of family dynamics and psychological intervention.