Psychoneuroimmunological factors in type 1 diabetes: characteristics and consequences

Type 1 diabetes is a serious chronic autoimmune disease that pervasively imposes itself into sufferers' lives without respite. While insulin is a treatment that aids to sustain life for those with the disease, it is not a cure, indeed presently, there is no cure. The direct and indirect physiological impact of type 1 diabetes is significant, degenerative, and ultimately for the vast majority of sufferers, life shortening. These include both acute and chronic complications that require a substantial and unceasing investment in self-care energies in order to prevent, monitor, and manage the multitude of ramifications they proffer. Additionally, the disease confers a significantly increased risk for psychopathology and neuropsychopathology. Anxiety, depression, and cognitive impairment across multiple domains, all have an increased prevalence in individuals with type 1 diabetes. There are a number of hypotheses as to why increased mind and brain disorders prevail that include factors relating to environmental, psychosocial and neurophysiological pathogenic mechanisms. While the specifics remain unclear, there is consensus that the biopsychosocial complexity of type 1 diabetes means that the pathogenic mechanisms underlying increased mind and brain comorbidities in the disease are likely to be heterogeneous and evanescent. This thesis presents a series of eleven studies that evaluate and describe the interrelationships between type 1 diabetes and a number of biopsychosocial characteristics, and their consequences. Psychosocial, psychological, cognitive, and immunoregulatory phenomena are explored throughout the thesis. A number of findings are presented across the eleven studies however, perhaps the most significant finding is that affective disorders (anxiety, depression, and comorbid anxiety-depression) are pervasively prevalent in children and adults with type 1 diabetes, and that the relationship between disordered affect and other psychosocial factors long considered ubiquitous such as increased stress and poor coping skills, differ in the disease compared to those without the condition. Moreover, the influence of affective disorders was shown to be pervasive, impacting cognitive function and inflammatory characteristics in type 1 diabetes to a far greater extent than no-type 1 diabetes controls. The influence of affective disorders was also shown to mediate the risk of diabetes-specific clinical factors such as metabolic control and complications. Ultimately, this thesis illustrates that psychopathological phenomena are a serious issue in type 1 diabetes that present a tangible impediment to general and diabetes-specific health and wellbeing. A far greater clinical investment is required to address this issue, and more research is needed to better understand the pathogenic mechanisms involved, and the consequences they produce