Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease, according to a recent study that shines a harsh light on the psychological toll the disease can take on this group.

For every 1,000 young adults aged 19 through 25 who had diabetes, 37 were hospitalized for mental health/substance use, compared to nine young adults without diabetes. The study by researchers at the Health Care Cost Institute also found the incidence of such hospitalizations is on the rise for these patients. The 2014 rate was 68 percent higher than two years earlier, when the rate of mental health/substance use hospitalizations per 1,000 for that group was 22.

“It was definitely not something that we were expecting,” said Amanda Frost, a senior researcher at HCCI, who worked on the recently published study. HCCI researchers will examine the trend more closely in future work, she said.

The study analyzed the insurance claims of more than 40 million people younger than age 65 from 2012 through 2014  with work-place provided coverage from three major health insurers. No other age group showed such high rates of hospitalization for mental health or substance use, according to the study. The rate for children up to age 18 with diabetes was second highest, at 21 per 1,000 in 2014.

One possible contributor to the rise in hospitalizations may be the health law, which permitted young people to stay on their parents’ health insurance until they turn 26, said Frost.

In 2014, “we saw a big jump in employer-sponsored insurance coverage for those young folks,” she said. In addition, “we could see an increase in young adults’ mental health hospital admissions at that time.”

Depression is two to three times more common among young people with diabetes than those that don’t have the disease, said Tina Drossos, a clinical psychologist at the University of Chicago Medicine Kovler Diabetes Center.

Managing the disease is tough at any age, but young people may find it particularly challenging. “It’s a 24/7 disease,” she said, requiring kids to continually test their blood, monitor their carbohydrates, and take more insulin if their blood sugar gets too high. In contrast, some other chronic conditions require someone to take a pill once a day, nothing more.

Young people may feel their condition sets them apart. “Everybody wants to fit in, and this is something that doesn’t fit in,” she said, noting that young people with diabetes can be subject to bullying and teasing.

But that doesn’t explain the increase in hospitalizations for mental health issues, she said. Typically, young people would be hospitalized if they tried to commit suicide or had seriously entertained the idea of suicide and formed a plan to carry it out.

“Most people who are depressed don’t commit suicide,” she noted.

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