Our research was approved by the Regional Institutional Research Ethics Committee, Clinical Center, University of Debrecen (ID: 4528A-2016) following the ethical principles of the WMA Declaration of Helsinki. Written informed consent was obtained from all participants.
Our sample consisted of 115 T1DM children and adolescents. 60 girls (52.17%), 55 boys (47.83 %) participated, and their mean age was 14.13 years (min.: 8 yrs; max.: 18 yrs; SD = 2.47). The mean duration of diabetes was 6.72 years (SD=3.78). The mean value of HbA1C was 8.32 (SD=1.53). 27.68% of the sample was of optimal HbA1C level, while 45.53% of sub-optimal, and 26.79% of high-risk HbA1C-level. Regarding the type of the applied intensive insulin therapy, we divided the children into two groups. 44.6 % of the sample was treated with Multiple Daily Insulin Injections (MDI), while 55.4 % was treated with insulin pump therapy (Continuous Subcutaneous Insulin Infusion, CSII) (Table 1). Data collection was carried out between September 2016 and December 2017 at the Endocrinology Outpatient Clinic Department of Pediatrics, University of Debrecen, Faculty of Medicine, Debrecen, Hungary.
PRISM-D, Drawing version of Pictorial Representation of Illness Self-Measure; Büchi, Sensky, 1999, Havancsák, 2013
The PRISM-D test is the drawing test version of PRISM test  developed by Hungarian researchers . Participants have to present their disease on a white A/4 sheet by means of drawing a circle with a red marker. The white sheet symbolises the subject’s current life and the yellow pre-printed circle (7 cms in diameter) in the bottom-right corner represents the Self. First, according to the instruction, participants have to draw their disease on the test sheet without restriction as regards size and position . Then, with optional colour markers, they may display significant factors that can currently be found in their lives. The distance between the centres of the Self-circle and the circle representing the disease (Self–Illness Separation, SIS)  implies the extent of the subjective distress caused by the disease. The size of the Illness-circle (Illness Perception Measure, IPM)  refers to the disease perception. This test can provide us with a picture of the complexity of the person’s life as well as the factors affecting recovery . During data analysis, we analyzed SIS, IPM, the area and cumulated area, and the number of circles. We also categorised the circles on the basis of their primary meaning. The circles which the children had labelled were examined by three independent reviewers and rated into the following four main content categories: „Significant others”; „Free-time activities, hobbies”; „Future-related content, goals”; „School”. The framework created by Hungarian researchers served as the basis of categorization . Since it is a system of categories developed on the adult sample, we have exchanged the category „Work” with category „School”. We analyzed the frequency of content categories and the connection between illness representations and individual resources.
The Cantril Self-Anchoring Striving Scale , Life Evaluation Index, 
We used the Life Evaluation Index  to measure SWL. The index was developed based on the 11 steps of the Cantril ladder . The Cantril-ladder is a visual analogue scale, which means that the marked step indicates where the responders position themselves between the two endpoints of the scale. Children had to assess their satisfaction with life on an 11-step ladder both now and in five years. Step 10 of the ladder presents the highest, and step 0 presents the lowest level of satisfaction with life in both currently and in the future. The Cronbach-alpha is 0.91. Gallup  created the following three independent groups based on the points achieved on the scale:
1) „Thriving”: they are characterized by strong and consistent well-being. They view their current life situation as well as the next five years positively. They report significantly fewer health issues, less anxiety, stress, sadness and anger, and more happiness and enjoyment. In their case, the assessment as regards the present scores ≥ 7 points, and regarding the future ≥ 8 points.
2) „Struggling”: their well-being is inconsistent. They are moderately satisfied with their
present and future life situations. Compared to the „Thriving” group, they report a higher level of daily stress and anxiety and become ill twice as frequently.
3) „Suffering”: a high-risk group in respect of the development of mental disorders. They are slightly satisfied with their present life and their assessment for the next five years is rather low. They report more somatic symptoms, more severe disease burden, stress, anger, sadness. The assessment of the present and the future is ≤ 4 points.
Self-rated health, SRH 
We examined the self-rated health with the following question: „How would you assess your health compared to your peers?”, which children had to assess on a 4-point Likert-scale where 1 = ’poor or bad’, 2 = ’fair’, 3 = ’good’, 4 = ’excellent’. The question proved reliable both with adult and adolescent populations .
Child Depression Inventory, CDI, [31, 32, 33]
CDI is a screening tool of 27 questions applied to measure the level of depression among children of 7 to 18 years of age, with three answer options (0,1,2) per question. Of the answers, „0” stands for the absence of symptoms, „1” for mild symptom manifestation, and „2” for clinical level manifestation of symptoms for the previous two weeks. The maximum score is 54 points. In this study, we worked with two cut-off points; we separated subclinical depressive symptoms (13 – 15 points) and clinical depressive symptoms (≥ 16 points). The Cronbach-alpha is 0.92 .
The haemoglobin A1C (HbA1C) is an important diabetes-specific indicator. The HbA1c values for blood glucose control were collected from medical reports. The HbA1c test is the most commonly used measure of glycemic control and diagnostic test for T1DM . We determined the severity of illness by the HbA1c indicator, which is recommended by the ISPAD. HbA1C <7.5 mmol represents optimal metabolic control, between 7.5 – 9.0 mmol suboptimal, while above 9.0 mmol means high-risk metabolic control.
We used IBM SPSS Statistics v22 for the statistical analysis of the data. The normality of the variables was assessed by Chi-square test and Kolmogorov-Smirnov test. As most of our variables did not display normal distribution, we used nonparametric statistical analysis. Descriptive statistics were used to analyse the variables of children’s mental health. We analyzed the associations between dependent and independent variables using Spearman rank correlation test, Kruskal-Wallis test
and Mann Whitney U test.