Childhood-onset type 1 diabetes (T1D) is associated with substantial psychiatric morbidity in later life, but it remains unknown whether these associations are due to common underlying biological mechanisms or the impacts of living with the condition and its treatment. Here, using Czech national register data, we identified children with T1D aged ≤14 years between 1994 and 2007 and estimated the risk of psychiatric disorders up to 24 years later. We found that children diagnosed with T1D had an elevated risk of developing substance use, mood, anxiety and personality disorders, and behavioral syndromes. Conversely, we found that children with T1D had a lower risk of developing psychotic disorders. In Mendelian randomization analysis, we found an association with schizophrenia, which, however, did not persist following multiple testing adjustment. The combined observational and Mendelian randomization evidence suggests that T1D diagnosis in childhood predisposes to far-reaching, extensive psychiatric morbidity, which is unlikely to be explicable by common underlying biological mechanisms. The findings of this study highlight that monitoring and addressing the mental health needs of children with T1D is imperative, whereas glucose dysregulation and/or inflammation implicated in schizophrenia pathogenesis warrants future research.

Cambridgeshire and Peterborough NHS Foundation Trust Cambridge UK

Department of Clinical Epidemiology Aarhus University Aarhus Denmark

Department of Pediatrics Motol University Hospital and 2nd Faculty of Medicine Charles University Prague Czechia

Department of Psychiatry Faculty of Medicine in Pilsen Charles University Pilsen Czechia

Department of Psychiatry University of Cambridge Cambridge UK

Department of Public Mental Health National Institute of Mental Health Klecany Czechia

MRC Biostatistics Unit University of Cambridge Cambridge UK

MRC Epidemiology Unit University of Cambridge Cambridge UK

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