A pilot study of observed parenting and adjustment in adolescents with type 1 diabetes and their mothers

Parent-adolescent relationship in youths with a chronic condition

BACKGROUND

Suffering from a chronic disease or disability (CDD) during adolescence can be a burden for both the adolescents and their parents. The aim of the present study is to assess how living with a CDD during adolescence, the quality of parent-adolescent relationship (PAR) and the adolescent's psychosocial development interact with each other.

METHODS

Using the Swiss Multicenter Adolescent Survey on Health 2002 (SMASH02) database, we compared adolescents aged 16-20 years with a CDD (n = 760) with their healthy peers (n = 6493) on sociodemographics, adolescents' general and psychosocial health, interparental relationship and PAR.

RESULTS

Bivariate analyses showed that adolescents with a CDD had a poorer psychosocial health and a more difficult relationship with their parents. The log-linear model indirectly linked CDD and poor PAR through four variables: two of the adolescents' psychosocial health variables (suicide attempt and sensation seeking), the need for help regarding difficulties with parents and a highly educated mother that acted as a protective factor, allowing for a better parent-adolescent with a CDD relationship.

CONCLUSION

It is essential for health professionals taking care of adolescents with a CDD to distinguish between issues in relation with the CDD from other psychosocial difficulties, in order to help these adolescents and their parents deal with them appropriately and thus maintain a healthy PAR.

Maternal Coping and Depressive Symptoms as Predictors of Mother-Child Communication About a Child's Cancer

OBJECTIVE

This study sought to identify possible associations between maternal coping and depression and subsequent mother-child communication about cancer following the child's diagnosis. 

METHOD

Mothers (N = 100) reported on coping and depressive symptoms shortly after the child's diagnosis (M = 1.9 months). Subsequently, we observed children (age 5-17 years; M = 10.2 years; 48% female; 81% White) and mothers discussing cancer and coded maternal communication. 

RESULTS

Higher primary and secondary control coping, and lower depressive symptoms, were generally correlated with more positive, and less harsh and withdrawn communication. In regression models, higher primary control coping (i.e., coping efforts to change the stressor or one's emotional reaction to the stressor) independently predicted less withdrawn communication, and depressive symptoms mediated relations between coping and harsh communication. 

CONCLUSIONS

Maternal primary control coping and depressive symptoms predict mothers' subsequent harsh and withdrawn communication about cancer.

Death concerns and psychological well-being in mothers of children with autism spectrum disorder

PURPOSE

Utilizing a terror management theory perspective, the present research examined whether having a child with autism spectrum disorder (ASD) is associated with underlying cognitions and explicit worries about death, and their roles in psychological well-being.

METHOD

147 mothers of children with ASD (n=74) and typically developing children (n=73) completed a fear of death scale, as well as measures of death-thought accessibility, positive and negative affect, depression, and anxiety.

RESULTS

Following previous research, mothers of children with ASD reported worse psychological health. Additionally, they evidenced greater death-thought accessibility compared to mothers of typically developing children, but did not differ in explicit worries about mortality. Greater death-thought accessibility, in turn, mediated the influence of ASD diagnosis on negative affect, depression, and anxiety.

CONCLUSION

The current study offers an initial understanding of the association between mortality concerns and psychological health for mothers of children with ASD. Further, it underscores the importance of health care providers' efforts to attend to, and educate parents about, their thoughts of mortality, even if the parent does not acknowledge such concerns.

WHAT THIS PAPER ADDS

The present study examined the impact of both implicit and explicit worries about death in parents of children with Autism Spectrum Disorder (ASD). Specifically, we were able to demonstrate that increased death-thought accessibility among mothers of children with ASD was associated with worse psychological health. While it is possible for parents of children with ASD to report conscious worries about death, there were no observed differences on this measure. As far as we know, this work is the first to empirically examine the prevalence of mortality-related concerns in this population and the subsequent effects of death-thought accessibility on psychological health. This is an important avenue of research as parents of children with ASD may experience greater worries about leaving their children upon death with no one to care for them, or to leave their children in the care of individuals who may not understand their son or daughter's unique needs. Additionally, the current findings highlight the importance of addressing mortality-related concerns, even when they may not be explicitly recognized, among parents of children with ASD. Given the effectiveness of parent education programs for children with ASD, a primary avenue for intervention may be education. Training care providers in ways to better discuss thoughts of death may help to alleviate stress and foster greater psychological well-being.

Health-related quality of life and social support in adolescents with type 1 diabetes

This study investigated the correlations between health-related quality of life and social support in adolescents with type 1 diabetes (T1DM). Participants were 102 adolescents between 12 and 17 years old, who were patients of a healthcare program in the city of Porto Alegre, south of Brazil. Two questionnaires, the KIDSCREEN-52 and the Brazilian version of Social Support Appraisals, were used to evaluate health-related quality of life and social support. Results showed good quality of life and social support levels. Strong correlations were verified between social support and three of the KIDSCREEN-52 dimensions: psychological well-being (r = .63; p < .01); peers and social support (r = .67; p < .01) and school environment (r = .64; p < .01). Analysis of linear regression showed that gender, age and social support are variables associated with health-related quality of life, explaining 52.6% of variance. Results revealed the impact of the disease to young people, and can help to find strategies to improve care in these cases.

Effect of race and marital status on mothers' observed parenting and adolescent adjustment in youth with type 1 diabetes

OBJECTIVE

To examine demographic differences in parenting behaviors and adjustment in youth with type 1 diabetes. 

METHODS

Adolescents' psychosocial adjustment was assessed via self-reports and parent reports, and clinical data were obtained from adolescents' medical records. Mother-adolescent dyads (N = 93) engaged in a videotaped discussion task, which was coded for observed parenting behaviors.

RESULTS

Single and non-White mothers exhibited significantly more overinvolved and less collaborative parenting behaviors. Higher levels of overinvolved parenting and lower levels of collaborative parenting were associated with poorer adolescent adjustment (i.e., higher levels of externalizing problems). Observed parenting was not significantly associated with glycemic control. There was an indirect effect of marital status and race/ethnicity on externalizing behaviors through parenting.

CONCLUSIONS

The current study highlights parenting as a potential target for interventions, especially in single and minority mothers, to improve adjustment in this population.

A 3-year prospective study of parent-child communication in early adolescents with type 1 diabetes: relationship to adherence and glycemic control

OBJECTIVE

To examine changes in parent-child communication patterns and their relation to glycemic control and treatment adherence using observational data in a 3-year prospective multisite study of youth with type 1 diabetes aged 9-11 years at baseline and their families (n = 217).

METHODS

Adolescents and caregivers participated in a diabetes problem-solving discussion. Families were rated on negative and positive communication and interactions using the Interaction Behavior Code.

RESULTS

Maternal and paternal negative communication decreased over time, whereas adolescent and maternal positive communication and positive reciprocity increased. Baseline preadolescent youth and maternal positive communication predicted adherence 3 years later. Changes in family communication did not predict changes in glycemic control or adherence.

CONCLUSIONS

During the transition to adolescence, family communication changed in unexpected and positive ways. Additionally, the relationship of baseline family communication to subsequent adherence suggests the need to assess family communication concerning diabetes-related management during preadolescence.

Maternal depressive symptoms and disease care status in youth with type 1 diabetes

OBJECTIVE

The current study assessed relations among maternal depressive symptoms, poorer youth diabetes adherence, and glycemic control. Specifically, hypothesized mediating links of lowered expectations of parental involvement, less parental monitoring, and more conflict were examined.

METHOD

Participants included 225 mothers and their young adolescents, aged 11-14 years (M = 12.73 years, SD = 1.2) diagnosed with T1D. Maternal depressive symptoms and outcome expectancies for maternal involvement were evaluated with self-report questionnaires. Multisource, parent/youth, and multimethod assessment of adherence, parental monitoring, and conflict were evaluated during a baseline assessment from a larger randomized clinical trial.

RESULTS

The first hypothesized structural equation model demonstrated a good fit and indicated that more maternal depressive symptoms were directly associated with less parental monitoring and more conflict, which in turn each were associated with poorer adherence and glycemic control. Although higher involvement expectancies were associated with more monitoring and less conflict, they were not associated with other model variables. A second alternative model also fit the data well; poorer youth adherence was associated with more conflict that in turn related to maternal depressive symptoms.

CONCLUSIONS

Two models were tested by which maternal depressive symptoms and poorer youth adherence were interrelated via less monitoring and more conflict. Follow-up longitudinal evaluation can best characterize the full extent of these relations.

Good cop, bad cop: quality of parental involvement in type 1 diabetes management in youth

Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers-primarily mothers and fathers-of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D.

Mother-child communication and maternal depressive symptoms in families of children with cancer: integrating macro and micro levels of analysis

OBJECTIVES

This study examines associations between maternal depressive symptoms and macro- and micro-level aspects of mothers' communication about their children's cancer.

METHODS

Mothers reported depressive symptoms after diagnosis or relapse (child mean age = 10.4 years; 53% male). Mother-child dyads (N = 94) were subsequently observed discussing the child's cancer and maternal communication was coded.

RESULTS

Macro-level indicators (positive and negative communication) were associated with certain micro-level indicators of communication (topic maintenance, reflections, reframes, and imperatives). Higher depressive symptoms predicted lower positive communication and higher negative communication. Maternal reflections and imperatives predicted positive communication, and topic maintenance and reframes predicted negative communication, beyond child age, family income, and depressive symptoms.

CONCLUSIONS

Findings suggest concrete targets for improving communication in families after diagnosis or relapse.

Longitudinal trajectories of parental involvement in Type 1 diabetes and adolescents' adherence

OBJECTIVE

The purpose of this study was to examine longitudinal trajectories of parental involvement and adolescent adherence to the Type 1 diabetes regimen, to determine whether changes in multiple facets of parental involvement over time predicted subsequent changes in adolescents' adherence, and to examine whether adolescent self-efficacy mediated the effect of parental involvement on adherence.

METHOD

Two hundred fifty-two adolescents (M age = 12.49 years, SD = 1.53; 53.6% females) diagnosed with Type 1 diabetes mellitus, their mothers, and 188 fathers were enrolled in a 2.5-year longitudinal study. Across 5 time points, up to 252 adolescents and their parents completed measures of adherence, parental involvement (diabetes monitoring, behavioral involvement in diabetes management, and acceptance), and adolescent diabetes self-efficacy.

RESULTS

Using multilevel modeling, analyses indicated significant average declines over time in adherence and most indicators of parental involvement. Lagged multilevel models indicated that declines in mothers' and fathers' acceptance and diabetes monitoring predicted subsequent declines in adolescents' adherence. Additional analyses revealed that longitudinal associations between both maternal acceptance and diabetes monitoring and subsequent adolescent adherence were mediated by adolescents' self-efficacy.

CONCLUSIONS

Results of this study, which were largely consistent across reporters, highlight the importance of maintaining parental involvement in diabetes across adolescence and suggest that parental involvement is beneficial for adolescents' adherence, in part, because it contributes to higher self-efficacy for diabetes management among adolescents.

Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes: Systematic review

OBJECTIVE

To investigate the way that family stress influences glycemic control among patients with diabetes who are younger than 18 years of age.

DATA SOURCES

PubMed and Scopus were searched for relevant studies published since 1990 using the following key words: diabetes type 1, glycemic control, family stress, family conflict, and family function.

STUDY SELECTION

In total, 1478 papers were identified in the initial search. The final review included 6 cohort studies, 3 cross-sectional studies, and 1 qualitative review in which family stress was assessed using specific diabetes-related conflict measurement instruments, and glycemic control was evaluated by glycosylated hemoglobin measurement.

SYNTHESIS

In most studies family stress was negatively correlated with patients' glycemic control. Family function was strongly related to patients' glycemic control, while family conflict was adversely associated with glycemic control. Families of low socioeconomic status, those of adolescents with diabetes, and those of single parents were more prone to diabetes-related stress and thus more susceptible to worse glycemic control.

CONCLUSION

Therapeutic psychological interventions and educational programs can help alleviate family diabetes-related stress and will likely improve glycemic control.

Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review

PURPOSE

The purpose of this review is to describe the prevalence of psychological distress in parents of children with type 1 diabetes (T1DM), the relationship between parental psychological distress and health outcomes, and parents' psychological experience of having a child with T1DM. Clinical and research implications are presented.

METHOD

A systematic mixed-studies review was undertaken to review the quantitative and qualitative research on the parental experience of having a child with T1DM. A total of 34 articles met the inclusion criteria and were included in the review.

RESULTS

The prevalence of parental psychological distress across all studies ranged from 10% to 74%, with an average of 33.5% of parents reporting distress at diagnosis and 19% of parents reporting distress 1 to 4 years after diagnosis. Parental psychological distress in parents of children with T1DM, regardless of how it was defined, was associated with higher child self-report of stress and depressive symptoms, more problematic child behavior, and lower child self-report of quality of life. Parental psychological distress also had negative effects on diabetes management. Themes of the qualitative synthesis indicated that parents perceived T1DM as a difficult diagnosis that contributed to significant family disruption. Adjustment occurred over time; however, ongoing stress was experienced.

CONCLUSIONS

Screening for psychological distress in parents of children with T1DM is indicated, and preventive interventions are needed.

Affective responses of the parents after diagnosis of type 1 diabetes in children

BACKGROUND

These days, diabetes is deemed as one of the most important health and social-economic problems of the world. Since parents play a major role in treatment of diabetes, the most important part of managing diabetes is in the hands of the parents of children affected by diabetes. This special responsibility will increase the stress and family challenges and impacts parents' emotional responses. The affective reactions or responses of the parents can also be conveyed to the child himself and reduce self-care, increase glucose levels, increase the possibility of complications and reduce the quality of life. Thus, it is highly important to recognize the affective reactions of parents during various stages of the disease for the purpose of intervention.

MATERIALS AND METHODS

All parents of children diagnosed with insulin-dependent diabetes who referred to Sedigheh-ye-Tahereh Endocrinology and Metabolism Research Center, Isfahan, Iran, were selected and the Symptom Checklist-90 (SCL-90) was filled in five stages (immediately, one month, three months, six months and twelve months after diagnosis). Convenient sampling was used to select 45 consecutive subjects out of whom 10 dropped out during the study.

FINDINGS

The major problems of the study subjects at the beginning of diagnosis were depression, anxiety and physical problems, respectively. Three, six and twelve months later, they were depression, obsession and physical problems. Over time, the mean score of parents' affective reactions declined which indicated the acceptance of the disease by parents over time.

CONCLUSIONS

In view of the fact that both mother and father of children with diabetes suffer from affective problems and since fathers refer to diabetes centers less than mothers, some decisions should be made to mentally support both fathers and mothers.

Families with children with diabetes: implications of parent stress for parent and child health

OBJECTIVE

To examine the relation of parent stress to parent mental health and child mental and physical health.

METHODS

We interviewed children with type 1 diabetes (n = 132; mean age 12 years) annually for 5 years and had one parent complete a questionnaire at each assessment. Parents completed measures of general life stress, stress related to caring for a child with diabetes, benefit finding, and mental health. Child outcomes were depressive symptoms, self-care behavior, and glycemic control. Multilevel modeling was used to examine concurrent and longitudinal relations.

RESULTS

Greater parent general stress and greater parent diabetes-specific stress were associated with poorer parent mental health. Overall, greater parent general stress was associated with poorer child outcomes, whereas greater parent diabetes-specific stress was associated with better child outcomes.

CONCLUSIONS

Families with high levels of general life stress should be identified as they are at risk for both poor parent and child health outcomes.

Family interaction in pediatric diabetes

Adaptation to type 1 diabetes is optimized in the presence of ongoing family support and supervision. Therefore, it is particularly important to understand how family interactions influence adaptation to the illness. The purpose of this paper is to review the current literature on family interaction in youth with type 1 diabetes. Recent advancements in the literature include greater specificity of types of parental involvement, attention to the role of fathers, acknowledgment of the impact of parental distress, increased use of observational methods, and awareness of the impact of culture. Continued parental involvement-particularly monitoring-in the management of diabetes care is important as children transition into adolescence, and the best outcomes are evident when this involvement occurs in a warm, collaborative manner. Parents need support in managing their own distress to maintain this type of involvement.

Depleted parental psychological resources as mediators of the association of income with adherence and metabolic control

For adolescents with Type 1 diabetes, lower family income may be associated with poorer diabetes management through depleted parental psychological resources (i.e., higher parental depressive symptoms, lower parental acceptance). Adolescents (N = 252; 46% male) aged 10-14 years with Type 1 diabetes assessed the acceptance of their mother and father (e.g., "gives me the feeling that she likes me as I am"; "she doesn't feel she has to make me over into someone else"). Mothers provided information on family income and demographics. Both mothers and fathers reported their depressive symptoms. HbA1c scores were indexed via medical records. Lower family income was associated with higher (i.e., worse) HbA1c, more mother and father depressive symptoms, and less acceptance from both parents. Mediation analyses revealed that the relationship of lower family income with metabolic control occurred indirectly through lower maternal and paternal acceptance and lower adherence. Lower family income may impair the quality of parent--adolescent relationships that are beneficial for good diabetes management.

Parenting behavior, child functioning, and health behaviors in preadolescents with type 1 diabetes

OBJECTIVE

To examine the association of critical parenting behaviors with preadolescent reported depressive symptoms, self-efficacy, and self-care behaviors in youth with type 1 diabetes (T1D).

METHOD

A total of 84 youth with T1D, ages 9-11 years, completed the Diabetes Family Behavior Checklist, Child Depression Inventory, Self-Efficacy for Diabetes scale, and Self-Care Inventory during a baseline assessment for a randomized controlled trial of an intervention to promote adherence.

RESULTS

Preadolescents who reported more critical parenting behaviors reported more depressive symptoms and lower self-efficacy. The relationship between critical parenting and self-efficacy was partially mediated by depressive symptoms. In a second model, depressive symptoms were associated with lower self-efficacy and fewer self-care behaviors. The relationship between depressive symptoms and self-care was fully mediated by self-efficacy.

CONCLUSIONS

Critical parenting behaviors are associated with preadolescents' psychological well-being, which has implications for self-care. Clinical implications include decreasing critical parenting behaviors and monitoring preadolescents with T1D for depressive symptoms.

Coping and resilience in adolescents with type 1 diabetes

BACKGROUND

Adolescents with type 1 diabetes (T1D) must cope with the ongoing stress of treatment management, so it is important to identify the most adaptive coping strategies. Previous studies, however, have typically measured broad categories of coping (e.g. approach/avoidance) and few used instruments specifically designed for this population.

OBJECTIVE

This article aimed to use a developmentally sensitive coping measure to explore how the use of specific coping strategies impacts resilience (i.e. quality of life, competence and metabolic control) in adolescents with T1D.

METHODS

Thirty adolescents with T1D between the ages of 10 and 16 and their mothers completed questionnaires on adolescents' coping strategy use, competence and quality of life. Clinical data (i.e. HbA1c) were obtained from adolescents' medical records.

RESULTS

Greater use of primary control coping strategies (e.g. problem solving, emotional expression) was associated with higher competence scores, better quality of life and better metabolic control. Secondary control coping strategies (e.g. acceptance, distraction) were related to higher social competence, better quality of life and better metabolic control. Finally, the use of disengagement coping strategies (e.g. withdrawal or denial) was linked with lower competence and poorer metabolic control.

CONCLUSIONS

The results of this study support the use of developmentally sensitive coping measures by researchers and clinicians to determine the most effective coping strategies for adolescents with T1D.

Longitudinal associations of maternal depressive symptoms, maternal involvement, and diabetes management across adolescence

OBJECTIVE

To examine whether maternal depressive symptoms: (a) predicted the level of maternal involvement in diabetes management tasks across adolescence; and (b) moderated associations of involvement with adolescent adherence, metabolic control, and depression.

METHODS

Eighty-two youth aged 10-15 years with type 1 diabetes and their mothers completed measures at baseline and 16 months later. Participants rated maternal involvement in diabetes tasks, adherence, and depressive symptoms; metabolic control was indexed from medical records.

RESULTS

Maternal depressive symptoms were associated with higher involvement at baseline, and slower declines in involvement across time. At baseline, involvement was associated with lower adolescent depression and better metabolic control, but this association was stronger when mothers reported fewer depressive symptoms. Interactions of maternal depression with involvement across time suggested maternal involvement was associated with better subsequent adherence primarily when mothers reported fewer depressive symptoms.

CONCLUSIONS

Mothers' depressive symptoms may undermine her care-giving effectiveness during adolescence.