Managing a chronic condition like Type 1 Diabetes (T1D) is never easy, especially for children and adolescents. It requires constant attention to blood sugar levels, insulin administration, and carbohydrate intake, among many other factors. But there is a lesser known obstacle to this condition that often goes overlooked: mental health struggles, specifically, depression. Alexandra Monzon, PhD, a clinical pediatric psychologist with Nemours Children’s Hospital, Florida, is working to provide targeted mental health interventions for children with T1D.
Why Depression is More Common in Kids with Type 1 Diabetes
Dr. Monzon explained that T1D is stressful for young patients due to its demanding and constant nature — it requires patients to “be their own pancreas.” The continuous effort to regulate blood sugar through diet and insulin shots can lead to patients being overwhelmed, anxious, and depressed.
Dr. Monzon noted that symptoms can overlap and intensify in patients with Type 1 diabetes and depression. For instance, T1D already has a major impact on sleep; children often wake up to use the bathroom or drink water, or sleep may be disrupted due to changing blood sugar levels. Depression also takes a toll on sleep; insomnia, oversleeping, and other sleep disturbances are common. Together, these sleep disruptions become magnified, which can lead to issues with concentration, mood, and other day-to-day functions.
The challenges that both depression and T1D present for children are the driving factor in Dr. Monzon’s current work. Her goal is to “identify which mental health treatments for pediatric T1D are not just helpful, but feasible, scaled to real-world settings.”
Given the barriers that patients and their families face when accessing traditional mental health care, such as financial and schedule limitations, it is often unrealistic for patients to be able to attend multiple therapy sessions. Monzon proposed a solution: Single Session Interventions (SSI).
A New Approach to Supporting Mental Health in T1D
Through the proposed SSI solution, physicians use a combination of therapy techniques to target a specific issue. In Dr. Monzon’s work, the intervention may include psychoeducation about the relationship between diabetes and mental health, a values assessment to identify areas of joy and meaning in the patient’s life, activity planning to engage patients in behaviors that improve mood, and cognitive strategies to challenge negative thinking patterns that contribute to depression.
The goal is to foster a “growth mindset,” allowing patients to realize that their thoughts, moods, and feelings can change. These components are aimed at helping the patients gain better control over their emotional responses and develop healthier coping mechanisms.
How the Therapy Works
Dr. Monzon is running a pilot study designed to determine the effectiveness of SSI in treating pediatric T1D patients with depression. The study uses a randomized controlled trial (RCT) design, where participants are randomly assigned to either an intervention group, which will receive the SSI, or a control group that will not receive therapy. The study targets adolescents aged 12 to 18 years diagnosed with T1D.
Participants will complete Ecological Momentary Assessments (EMA), which are daily self-report surveys that measure mood. Additionally, participants will complete standardized self-report questionnaires assessing depression and anxiety. In addition, A1C levels, the estimated average blood sugar over the past three months, will also be recorded. Since A1C levels are a key indicator of how well a child is managing their T1D, the study will measure these levels before and after the intervention to assess whether improvements in mental health are associated with better diabetes management.
Follow-up assessments will be conducted three months and six months after the intervention to evaluate the long-term effects of the SSI. The study will examine how easily the intervention can be incorporated into routine care and whether it can be successfully replicated in clinical settings.
Dr. Monzon’s hope is that SSI will provide a quick, accessible solution for youth struggling with depression and help improve their diabetes management. The findings from this pilot study will help determine whether the intervention should be expanded to a larger, nationally representative sample.
What This Means for Kids With Chronic Conditions
Dr. Monzon envisions that SSI could be adapted for use in other chronic medical conditions, offering an accessible mental health intervention for pediatric patients. This approach could pave the way for a culture where mental health treatment is no longer pushed aside, but an essential component of living with chronic illnesses like T1D. Dr. Monzon’s work is supported by a K23 Mentored Patient-Oriented Research Career Development Award from the National Institutes of Health.
Alexandra Monzon, Ph.D., is a Research Scientist at Nemours Children’s Health, Florida
