(DCP062) SUICIDAL IDEATION, SUICIDE ATTEMPTS AND SUICIDE DEATHS IN ADOLESCENTS AND YOUNG ADULTS WITH TYPE 1 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Suicide is the second leading cause of death among adolescents and young adults in North America. Depression and suicidal ideation are more prevalent in adolescents with chronic conditions and may have negative effects on adherence and health outcomes. Type 1 diabetes (T1D) is a chronic condition of childhood requiring intense self-management, which becomes even more challenging during adolescence and the transition to young adulthood. Therefore, adolescents and young adults with T1D may be at increased risk of suicide-related behaviours (i.e., suicidal ideation, suicide attempt and suicide death); in turn, such behaviours may affect their diabetes self-management. The aims of this systematic review were: 1) to determine the prevalence of suicidal ideation, suicide attempts and suicide deaths in adolescents and young adults with T1D ages 10 to 25; 2) to compare the prevalence of suicide-related behaviours in youth with T1D versus without T1D; 3) to identify factors associated with suicide-related behaviours.

METHODS AND RESULTS: A systematic search was conducted on MEDLINE, EMBASE, and PsycINFO for studies published from inception to November 9, 2022. Methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Two independent reviewers conducted all stages of the review, with disagreements resolved through discussion. We included 32 studies. Suicidal ideation was ascertained with the Patient Health Questionnaire (PHQ-9) in most studies. Using a random effects model with a Freeman-Tukey double arcsine transformation, the pooled prevalence of suicidal ideation at any point in patients’ lifetime was 15.4% (95% confidence interval [CI] 10.4-21.1%; n=17 studies). It was higher than the pooled prevalence of suicidal ideation reported in control groups of youth without T1D i.e., 8.7% (95% CI 0.0-41.0%; n=3). The prevalence of lifetime suicide attempts ranged from 0.5 to 11.1% (n=9). The designs of studies reporting suicide deaths in patients with T1D did not allow for the calculation of a pooled prevalence. Female sex was associated with increased prevalence of suicidal ideation and suicide attempts in most studies. Yet, suicide deaths tended to be more frequent in male individuals. Findings on the association between suicidal ideation and hemoglobin A1c (HbA1c) were inconsistent.

Conclusion: This systematic review suggests a high prevalence of suicidal ideation and suicide attempts in adolescents and young adults with T1D, especially when compared to those without T1D. Clinical interventions may also need to be individualized to address the higher prevalence of suicidal ideation and attempts in females as well as suicide deaths in males.