Interrelationship between mental health and changes in stress-regulating systems in children and adolescents with type 1 diabetes mellitus during the war in Ukraine
DOI:
https://doi.org/10.15574/SP.2026.1(153).119127Keywords:
adolescents, type 1 diabetes mellitus, mental health, stress-realizing and stress-limiting systemsAbstract
Aim - to investigate the relationships between indicators of stress-regulating systems depending on the mental state of children and adolescents with type 1 diabetes mellitus (T1DM) during the period of military actions in Ukraine.
Materials and methods. A total of 93 patients with T1DM (44 boys, 49 girls) aged 9-18 years were examined. Patients were stratified into three groups: 1 - normal mental health, 2 - non-pathological stress reactions, and 3 - mental disorders. Serum levels of cortisol (C), malondialdehyde (MDA), carbonylated proteins (CP), and superoxide dismutase activity (SODs) were measured. In whole blood, serotonin (S), glutathione peroxidase activity (GPx), and cellular superoxide dismutase activity (SODc) were assessed.
Results. Mental health status in adolescents with T1DM was associated with changes in stress-regulating systems, with sex-specific features. In patients with normal mental health, increased levels of C, S, MDA, SODs, and SODc were observed. Non-pathological stress reactions were characterized by elevated CP and reduced SODc and GPx activity. In adolescents with mental disorders, increased CP, decreased S, and reduced SODs and SODc activity were found. In girls, correlations in the first two groups reflected compensatory-adaptive mechanisms, whereas in those with mental disorders an imbalance between stress-regulating indicators was evident. In boys, even with normal mental health, findings suggested tension within the stress-limiting systems, progressing to exhaustion in groups with impaired mental state, alongside the accumulation of stress-realizing markers.
Conclusions. Stress-regulating systems are closely associated with mental health status in children and adolescents with T1DM during wartime. The imbalance between stress-limiting and stress-realizing systems is most pronounced in those with mental disorders, particularly in boys.
The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee. Informed consent was obtained.
No conflict of interest was declared by the authors.
References
Al-Kufaishi AMA, Al-Musawi NJT. (2024). Hypothalamus-pituitary-adrenal axis in patients with post-traumatic stress disorders and related to oxidative stress. Hormone Molecular Biology and Clinical Investigation. 45(4): 157-164. https://doi.org/10.1515/hmbci-2024-0017; PMid:39140180
Bandelow B, Baldwin D, Abelli M, Bolea-Alamanac B, Bourin M et al. (2016). Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. World J. Biol. Psychiatry. 15: 1-53. https://doi.org/10.1080/15622975.2016.1190867; PMid:27419272 PMCid:PMC5341771
Belenichev IF, Nagornaya EA, Chernyi VI, Pavlov SV et al. (2014). Neuroprotection and neuroplasticity. K.: Polyhraf plius: 512. https://doi.org/10.31612/9789661718998
Buccellato KH, Peterson AL. (2024). The role of cortisol in development and treatment of PTSD among service members: A narrative review. Psychoneuroendocrinology. 169: 107152. https://doi.org/10.1016/j.psyneuen.2024.107152; PMid:39094515
Buuse M, Hale MW. (2019). Stress: Physiology, Biochemistry, and Pathology. Handbook of Stress Series. 3: 115-123.
Can Yilmaz G, Karadag M. (2025). Chronotype, sleep, and glycemic control in children and adolescents with type 1 diabetes: a case-control study. Journal of Pediatric Endocrinology and Metabolism. 38(5): 442-449. https://doi.org/10.1515/jpem-2024-0492; PMid:40110970
Chaban OS, Frankova IA. (2015). Sovremennie tendentsii v diagnostike i lechenii posttravmaticheskogo stressovogo rasstroistva. NeuroNEWS. 2(66): 8-18.
Chainy GBN, Sahoo DK. (2019). Hormones and oxidative stress: an overview. Free Radical Research. 54(1): 1-26. https://doi.org/10.1080/10715762.2019.1702656; PMid:31868060
Correia AS, Cardoso A, Vale N. (2023). Oxidative Stress in Depression: The Link with the Stress Response, Neuroinflammation, Serotonin, Neurogenesis and Synaptic Plasticity. Antioxidants. 12(2): 470. https://doi.org/10.3390/antiox12020470; PMid:36830028 PMCid:PMC9951986
Davyidov VV, Kashkalda DA, Goloborodko AV. (2008). Normyi soderzhaniya biologicheski aktivnyih veschestv u detey i podrostkov. Spravochnik. Kharkov: Fedorko: 119-121.
Dubinina EE, Morozova MG, Leonova NV, Gamper NL, Soliternova IB, Nuller JuL et al. (2000). Oxidative modification blood plasma proteins in patients with mental disorders (depression and depersonalization). Voprosy meditsinskoi khimii. 46(4): 398-409.
El-Din Elshalkami NMM, Salem NA-B, ElShabrawy WO, Abou-Elhassan SM. (2022). Oxidative status and its relationship with glycemic state in children with type 1 diabetes mellitus. Alexandria Journal of Pediatrics. 35(3): 201-207. https://doi.org/10.4103/ajop.ajop_39_22
Grabia M, Socha K, Soroczyńska J, Bossowski A, Markiewicz-Żukowska R. (2023). Determinants Related to Oxidative Stress Parameters in Pediatric Patients with Type 1 Diabetes Mellitus. Nutrients. 15: 2084. https://doi.org/10.3390/nu15092084; PMid:37432230 PMCid:PMC10180949
Itani T, Jacobsen KH, Kraemer A. (2017). Suicidal ideation and planning among Palestinian middle school students living in Gaza Strip, West Bank, and United Nations Relief and Works Agency (UNRWA) camps. International Journal of Pediatrics and Adolescent Medicine. 4(2): 54-60. https://doi.org/10.1016/j.ijpam.2017.03.003; PMid:30805502 PMCid:PMC6372497
Jurcăua R-N, Honceriub C, Jurcăuc I-M, Drosescu P. (2020). Relationship between post-traumatic stress disorder (PTSD) and oxidative stress, a pubmed approach. Sport аnd Society Interdisciplinary Journal of Physical Education and Sports. 20(2). https://doi.org/10.36836/2020/2/10; PMid:32874689
Kandemir N, Vuralli D, Ozon A, Gonc N, Ardicli D, Jalilova L et al. (2024). Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50‐year, single‐center experience. Journal of Diabetes. 16(5): e13562. https://doi.org/10.1111/1753-0407.13562; PMid:38664892 PMCid:PMC11045915
Kashkalda DA, Volkova YuV, Turchyna SI, Sukhova LL. (2025). Comparative characteristics of the state of stress-¬regulatory systems in children with type 1 diabetes mellitus, who have experienced traumatic events of the war in Ukraine. Ukrainian journal of pediatric endocrinology. 1: 4-9. https://doi.org/10.30978/UJPE2025-1-4
Korobeinikov EN. (1989). Modifikatsiya opredeleniya produktov perekisnogo okisleniya lipidov v reaktsii s tiobarbiturovoi kislotoi. Lab. delo. 7: 8-10.
Kostiuk VA, Potapovich AI, Kovaleva ZhV. (1990). A simple and sensitive method of determination of superoxide dismutase activity based on the reaction of quercetin oxidation. Voprosy Meditsinskoi Khimii. 36(2): 28-35.
Lankin VZ, Tikhaze AK, Kovalevskaya AL et al. (1981). Vozrastnie izmeneniya glutation-S-transferaznoi i glutationperoksidaznoi aktivnosti pecheni kris. Dokl. 261(6): 1461-1470.
Maidannyk VG, Shevchenko T. (2018). The state of lipid peroxidation and antioxidant system in children with type 1 diabetes depending on the presence of chronic complications. Problems of clinical pediatrics. 4(42): 6-13.
Mitelov DA. (2022). Current problems in pediatric neurodiabetology. Actual issues of physiology, pathology and the organization of medical support for school-aged children and adolescents: materials of the conference with international participation. Kharkiv. Children and Adolescents Health Care. 2: 60. https://doi.org/10.53457/2022.2.6
Mykhailova IA. (2013). Psykhycheskye rasstroistva u detei pry sakharnom dyabete 1 typa. Ukrainian journal of pediatric endocrinology. 1: 30-34.
Mykhailova IA. (2023). Sered zhakhiv viiny. U 75% ditei Ukrainy travmovana psykhika. Kharkiv. URL: https://gromada.group/news/statti/23944-sered-zhahiv-vijni-u-75-ditej-ukrayini-travmovana-psihika.
Ogłodek EA. (2022). Changes in the Serum Concentration Levels of Serotonin, Tryptophan and Cortisol among Stress-Resilient and Stress-Susceptible Individuals after Experiencing Traumatic Stress. Int J Environ Res Public Health. 19(24): 16517. https://doi.org/10.3390/ijerph192416517; PMid:36554398 PMCid:PMC9779530
Propp MA, Paz D, Makhkamov S, Payton ME, Choudhury Q et al. (2024). A Prospective Cohort Study on the Effects of Repeated Acute Stress on Cortisol Awakening Response and Immune Function in Military Medical Students. Biomedicines. 12(11): 2519. https://doi.org/10.3390/biomedicines12112519; PMid:39595087 PMCid:PMC11592205
Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V et al. (2017). Oxidative Stress: Harms and Benefits for Human Health. Oxidative Med. Cell. Longev. 2017: 8416763. https://doi.org/10.1155/2017/8416763; PMid:28819546 PMCid:PMC5551541
Ribaudo G, Bortoli M, Witt CE, Parke B, Mena S, OselladoreE et al. (2022). ROS-Scavenging Selenofluoxetine Derivatives Inhibit in Vivo Serotonin Reuptake. ACS Omega. 7: 8314-8322. https://doi.org/10.1021/acsomega.1c05567; PMid:35309454 PMCid:PMC8928538
Smeeth D, McEwen FS, Popham CM, Karam EG, Fayyad J, Saab D et al. (2023). War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children Mol Psychiatry. 28(2): 647-656. https://doi.org/10.1038/s41380-022-01859-2; PMid:36385169 PMCid:PMC9908541
Sobhi W, Derguine R, Boucheffa S, Khenchouche A, Boutrid N et al. (2021). Type 1 diabetes and oxidative stress markers. American Heart Journal. 242: 174. https://doi.org/10.1016/j.ahj.2021.10.070
Sokhor N, Yasniy O, Smashna O, Hashimova N. (2024). The impact of war and forced displacementon the mental health of children andadolescents (literature review). Psychosomatic Medicine and General Practice. PMGP [internet]. 9(1). https://uk.e-medjournal.com/index.php/psp/article/view/471. https://doi.org/10.26766/pmgp.v9i1.471
Steinberg АL, Rubin-Falcone H, Galfalvy H, Kaufman J. (2019). Cortisol Stress Response and in Vivo PET Imaging of Human Brain Serotonin 1A Receptor Binding. Int. J. Neuropsychopharmacology. 22(5): 329-338. https://doi.org/10.1093/ijnp/pyz009; PMid:30927011 PMCid:PMC6499240
Tereshchenko L, Tolkunova I. (2023). Psychological features of enhancing stress resistance levels in adolescent children during times of war. Psychological Journal. 9; 3(71): 28-38. https://doi.org/10.31108/1.2023.9.3.3
Trifunovic S, Stevanovic I, Milosevic A, Ristic N, Janjic M, Bjelobaba I et al. (2021). The Function of the Hypothalamic-Pituitary-Adrenal Axis During Experimental Autoimmune Encephalomyelitis: Involvement of Oxidative Stress Mediators. Front. Neurosci. 15: 649485. https://doi.org/10.3389/fnins.2021.649485; PMid:34220419 PMCid:PMC8248369
Vašíček O, Lojek A, Číž M. (2020). Serotonin and its metabolites reduce oxidative stress in murine RAW264.7 macrophages and prevent inflammation. J. Physiol. Biochem. 76: 49-60. https://doi.org/10.1007/s13105-019-00714-3; PMid:31900806
Wazir Z. (2021). Contributor In Gaza, Childhoods Lost to the Trauma of War Israel's May siege leaves the majority of children in Gaza with deep emotional scars, a new study shows. U.S.News. URL: https://www.usnews.com/news/best-countries/articles/2021-08-05/palestinian-children-face-constant-and-unique-trauma-in-gaza-experts-say.
Zelinska NB, Rudenko NG, Globa EV, Rudenko OV. (2022). Diseases of the endocrine system in children in Ukraine and specialized care to pediatric patients in 2021. Ukrainian journal of pediatric endocrinology. 1-2(41-42): 6-16. https://doi.org/10.30978/UJPE2022-1-2-6
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
