Comorbid depression and glycemic instability in adolescent type 1 diabetes: Clinical insights into suicide risk

Table 2 Differential diagnosis of diabetes stress and clinical depression

Feature	DD	MDD
Core trigger	Directly related to diabetes management, fear of complications, doctor-patient relationship	No specific trigger or related to broad life stress events or genetic susceptibility
Symptom scope	Confined to diabetes-related contexts; patient may function well in non-diabetes areas	Pervasive; affects all areas of life (academics, social, hobbies, sleep, appetite)
Core experience	Feeling overwhelmed by disease, powerlessness, anxiety/avoidance of glucose data, and treatment burnout	Anhedonia, low self-worth, pervasive sadness, guilt, and thoughts of death
Diagnostic tools	PAID-T, T1-DDS	PHQ-9, Children’s Depression Inventory, and Beck Depression Inventory
Relation to HbA1c	Strong independent correlation; higher DD usually correlates with worse HbA1c	Weaker correlation; often affects HbA1c indirectly via DD as a mediator or appetite changes
First-line intervention	Diabetes education, self-efficacy-enhancing behavioral intervention, peer support, and resolving specific management barriers	Psychotherapy (CBT/IPT), psychopharmacology (SSRIs)

The content is based on the American Diabetes Association Position Statement[8] and the International Society for Pediatric and Adolescent Diabetes Psychological Care Guidelines[26]. DD: Diabetes stress; MDD: Major depressive disorder; PAID-T: Problem Areas in Diabetes-Teen; T1-DDS: T1 Diabetes Distress Scale; PHQ-9: Patient Health Questionnaire 9; HbA1c: Glycated hemoglobin; CBT: Cognitive behavioural therapy; IPT: Interpersonal therapy; NSSI: Non-suicidal self-injury.