Discrimination and material-need insecurities intersect in association with poor mental health among youth and young adults with type 1 diabetes.

OBJECTIVE

Little is known about how perceived discrimination and material-need insecurities jointly contribute to poor mental health among youth and young adults (YYA) with diabetes. We examined how these factors intersect to influence mental health among YYA with type 1 diabetes.

METHOD: Analyses included 829 YYA with type 1 diabetes from the SEARCH Food Security Cohort study. Classification tree analysis identified patterns among perceived discrimination, material-need insecurities, demographic, and socioeconomic characteristics that distinguish between moderate-to-severe and minimal-to-mild depressive and anxiety symptoms assessed using the Center for Epidemiological Studies-Depression and the 7-item Generalized Anxiety Disorder scales. Material-need insecurities included household food insecurity, housing, and transportation insecurity.

RESULTS

Overall, 35.6% of participants reported moderate-to-severe depressive symptoms and 27.6% reported moderate-to-severe anxiety symptoms. Discrimination intersected with food insecurity among YYA with type 1 diabetes such that 86% of those experiencing greater discrimination and food insecurity reported moderate-to-severe depressive symptoms compared to 47% among the food secure group. In those reporting less discrimination, 56% of those with food insecurity reported moderate to severe depressive symptoms compared to 17% among the food secure group. For anxiety, 56% of those with food insecurity reported moderate-to-severe symptoms among those who were food secure, 40.4% of those with greater discrimination and 16.8% of those with less discrimination reported moderate-to-severe anxiety symptoms. Adding discrimination to models which included food insecurity and demographic measures improved prediction accuracy (AUC=0.71 versus AUC=0.64 for depressive and AUC=0.68 versus AUC=0.64 for anxiety symptoms).

CONCLUSIONS

Addressing household food insecurity and discrimination may help to decrease mental health problems among YYA with type 1 diabetes.