The relationship between parenting stress and parent-child interaction with health outcomes in the youngest patients with type 1 diabetes (0-7 years)

State of the Science: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders

Before the development of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), evidence-based treatment options for commonly co-occurring anxiety, mood, and related disorders consisted of numerous single-disorder protocols that shared many similarities, reflecting the overlap among these disorders themselves. The UP distilled common elements of cognitive behavioral protocols into a unified intervention directly targeting core temperamental features underlying these disorders of emotion, namely neuroticism and associated emotion dysregulation. The UP has since become a leading "transdiagnostic" treatment for emotional disorders, which is now available in several formats (e.g., individual, group, digital) and has accumulated a strong evidence base, leading to international implementation. There is now also research evidence that the UP can be flexibly applied to a range of clinical presentations, including borderline personality disorder, trauma- and stressor-related disorders, eating disorders, alcohol use disorder, and comorbid chronic physical health conditions. Yet additional research is needed to evaluate the UP in routine clinical settings, with more heterogeneous patient populations, and under circumstances that mirror actual clinical practice. Thus, we must also continue to explore the benefits of large-scale UP training initiatives and implementation in major healthcare systems.

Coaching for parents of children with type 1 diabetes: A randomized controlled trial

OBJECTIVE

To assess the effectiveness of a standardized bi-weekly six-month telephone coaching intervention for parents of children with type 1 diabetes.

METHODS

This single-blind randomized controlled trial followed participants for 12 months. The primary outcome was children's health-related quality of life. Secondary outcomes included treatment adherence, diabetes-related family conflict, and hemoglobin A1c. Data was collected using validated questionnaires and health records. We compared groups using a linear mixed effects model.

RESULTS

102 families were randomized (control: n = 49; intervention: n = 53). Coaching had no impact on children's overall health-related quality of life or overall secondary outcomes; however, there were patterns in subsections that suggest the possible impact of coaching. Coaching was perceived as a positive addition to routine care by 80% of families and 82% would recommend working with a coach to another family. 58% of participants would continue coaching beyond the study.

CONCLUSION

Coaching did not impact overall quality of life or secondary outcomes; however, coaching was well received by families who perceived significant benefits. Patterns in subsections warrant further study.

PRACTICE IMPLICATIONS

Adding a health coach into diabetes multidisciplinary care supports families in a way that is unique from their routine clinical care.

The Role of Systemic Family Psychotherapy in Glycemic Control for Children with Type 1 Diabetes

(1) Background: Family factors play an important role in the management of diabetes, establishing a relationship between conflicts and non-adherence to therapy. High values of HbA1c are involved in specific complications of the disease (retinopathy, nephropathy, neuropathy, ketoacidosis). This study aimed to determine the role of systemic family psychotherapeutic interventions in increasing the quality of parent-child/adolescent relationships and in optimizing the child's glycemic control. (2) Methods: In this prospective observational study, 64 parents of children and adolescents with type 1 diabetes were evaluated regarding their relationship with their children, using the Child-Parent Relationship Scale-Short Form (CPRS-short form). The children were divided into three groups: one participated for 6 months in systemic family psychotherapy with children and their parents (FT), the second group participated in individual psychotherapy (IT), and the control group (CG) received no intervention. HbA1c values were recorded before and after the interventions. (3) Results: HbA1c means decreased significantly after the family psychotherapy program. The scores on closeness in the family therapy group increased significantly, and the scores on conflict decreased significantly after the intervention, compared with IT and CG. (4) Conclusions: Systemic family psychotherapy produces better results in disease management and in strengthening parent-child relationships.

Overburden in Caregivers of Chronically Ill Adolescents: A Comparative Study between Pulmonological and Endocrinological Diseases

Chronic pediatric disease has a major impact on the life of a child and his or her family. In this sense, the figure of the main caregiver is relevant, who may present adjustment difficulties before the disease, accompanied by high levels of stress and emotional discomfort, which interfere with the adolescent's adjustment before the new situation. The aim of this research was to carry out a comparative study among caregivers of adolescents with various diseases, analyzing the risk and protective factors for the stress presented by this population. For this purpose, a sample of 406 main caregivers of adolescents with an endocrinological or pneumological disease from different hospitals in Valencia was used, where characteristics related to the disease, attachment, type of family, and emotional distress of these caregivers were considered. In general, the results show higher levels of stress in caregivers of adolescents with an endocrinological disease, specifically DM1, and found significant predictors of anxiety-depressive symptomatology, the need for approval, and several variables related to the disease. These data reveal the importance of providing comprehensive care to the family system, offering health skills to overcome diseases, and reinforcing the protective factors offered by the family system.

Burden of care and a sense of loneliness in caregivers of children with type 1 diabetes. a cross-sectional study

BACKGROUND

Treatment of type 1 diabetes is a process involving not only sick children, but also their caregivers.

AIM

To assess the burden of care and sense of loneliness in caregivers of children with type 1 diabetes. Also, an analysis was conducted of the connection between sociodemographic factors characterizing caregivers and the clinical factors characterizing sick children and between the burden of care and the sense of loneliness.

MATERIALS AND METHODS

The study included 125 caregivers of children with type 1 diabetes. In order to collect the research data, the Caregiver Burden Scale and the Revised UCLA Loneliness Scale were used.

RESULTS

In the research group, the total result in the caregiving burden scale was 2.14, which remains within the average burden level. Caregivers showed the highest burden level in the General Strain Subscale. The analysis showed that mothers experience a greater burden of care than fathers in the General Strain Subscale and that caregivers of younger children are more burdened with care within the Isolation and Disappointment Subscales. Moderate high degree of loneliness was shown in 4.8% of caregivers. A higher burden of care for caregivers of children with type 1 diabetes is accompanied by a higher sense of loneliness.

CONCLUSIONS

The results of this study may help healthcare professionals plan a holistic, family-centered care program that will take into account factors that increase the burden of care: younger age of the affected child, motherhood, caregiver unemployment, feelings of loneliness, lower education, caregiver unemployment, blood glucose meter measurements, and frequent night-time blood glucose measurements.

The burdens faced by parents of preschoolers with type 1 diabetes mellitus: an integrative review

PURPOSE

This study examined the literature concerning the burdens of parents of preschool-aged children diagnosed with type 1 diabetes mellitus.

METHODS

We employed an integrative review methodology based on Whittemore and Knafl's framework. The literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across four electronic databases: PubMed, Web of Science, the Cumulative Index to Nursing Allied Health Literature (CINAHL), and PsycINFO. Ultimately, 18 articles were included in the review.

RESULTS

The review yielded four themes: (1) parental burdens, (2) factors related to the burdens, (3) coping strategies, and (4) implications for clinical practice. Parents experienced psychological, physical, and social burdens due to the diabetes care of their children. Several factors influenced burdens, including child-related characteristics such as age, severity of diabetes, and hospitalization experience, as well as parental factors like family income, race, and residential area. Parents initially felt burdened when their child was diagnosed with type 1 diabetes, but over time, they often adapted to the situation through support and sharing of responsibilities. Parents desired education and interventions reflecting the unique characteristics of preschoolers.

CONCLUSION

This integrative literature review revealed that parents experience numerous burdens when their child is diagnosed with diabetes. Future research should focus on developing interventions to address parents' psychological difficulties, including tracking parental psychological changes over time. Tailored nursing interventions should also be provided to parents of preschool-aged children, as opposed to the more generic nursing interventions traditionally applied across all age groups of children in clinical settings.

Young Children with Type 1 Diabetes: Recent Advances in Behavioral Research

PURPOSE OF REVIEW

This review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions.

RECENT FINDINGS

Rates of type 1 diabetes (T1D) in young children (ages 1-7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child's diabetes management. T1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.

Caregiver burden, and parents' perception of disease severity determine health-related quality of life in paediatric patients with intoxication-type inborn errors of metabolism

Background

Living with a non-acute (phenylketonuria) or acute (e.g. urea cycle disorders, organic acidurias) intoxication-type inborn error of metabolism (IT-IEM) can have a substantial impact on health-related quality of life (HrQoL) of paediatric patients and their families. Parents take primary responsibility for treatment monitoring and experience worry and fear about their child's health status. Quantitative evidence on parental psychological factors which may influence the HrQoL of patients with IT-IEM are sparse to non-existent.

Methods

In this multicenter survey study 50 parents of IT-IEM patients (ages 5–19) assessed the severity of their child's disease, reported on caregiver burden, and proxy-rated their child's HrQoL. Additionally, 35 patient self-reports on HrQoL were obtained (n = 16 female patients, n = 19 male patients). Multiple linear regressions were conducted to examine the predictive power of child age, sex, medical diagnosis type (acute / non-acute), parental perceived disease severity and caregiver burden on patients' HrQoL. Mediation analyses were used to investigate the relation of caregiver burden and parental ratings of disease severity with patients' HrQoL.

Results

Significant regression models for self-reported [F(5,34) = 10.752, p < .001, R² adj.^. = 0.59] and parent proxy reported HrQoL [F(5,49) = 20.513, p < .001, R² adj.^. = 0.67] emerged. High caregiver burden and perceived disease severity predicted significantly lower patient self- and proxy-reported HrQoL while type of diagnosis (acute versus non-acute) did not. Female sex predicted significantly lower self-reported HrQoL. High caregiver burden was the mediating factor between high perceived severity of the child's disease and lower proxy- by parent rated HrQoL.

Conclusion

Detecting elevated burden of care and providing support for parents seems crucial to prevent adverse consequences for their children's HrQoL. Intervention studies are needed, to assess which support programs are most efficient.

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Caregiver burden enforced by high parent-perceived disease severity is a considerable risk factor for low HrQoL in paediatric patients with IT-IEM.

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The parent perspective was a better estimator for the impact of disease than the mere medical type of diagnosis.

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Female sex predicted lower self-reported HrQoL

Health-related quality of life of preschool-aged children with type 1 diabetes in the context of family and maternal functioning

In this study, generic health-related quality of life (HRQoL) of young children with type 1 diabetes (T1D) was compared to healthy peers taken in consideration of family functioning and psychological well-being of mothers. A total of 113 mothers provided data (28 mothers had a preschool-aged child with T1D). There were no significant differences in background parameters of two investigated groups. No significant differences between children with and without T1D were detected either in HRQoL or in family functioning. Moreover, mothers of children with diabetes reported lower levels of resilience and more depressive symptoms than mothers of healthy peers. In the regression analysis, mothers' depressive symptoms and the family functioning significantly affected children's HRQoL regardless of the presence of diabetes. These results suggest that parents of children with T1D handle the burden of diabetes well and integrate into the daily activities of the families. Mothers experience distress, presumably because diabetes management is burdensome; however, the family can function well and the young children can live in a similar way to their healthy peers.

Determinants of Quality of Life in Children with Inborn Errors of Metabolism Receiving a Restricted Diet

OBJECTIVE

To investigate the determinants of quality of life (QoL) in children with inborn errors of metabolism with restricted diet (IEMRDs) using a single theory-based multidimensional model.

STUDY DESIGN

In this multicenter cross-sectional study, data from children aged 8-17 years with IEMRDs (except phenylketonuria) and their parents were collected from January 2015 to December 2017. Measurements included a child's self-reported QoL, self-rated behavioral problems and anxiety, and parental anxiety. Based on hypotheses from a literature-built theoretical model linking demographic, clinical, family environment, and psychosocial characteristics to QoL either directly or indirectly, associations of these factors with a child's self-rated QoL were examined using a structural equation modeling approach.

RESULTS

A total of 312 children (mean [SD] age, 12.2 [2.6] years; 51% boys [n = 160]) were included. Higher levels of trait anxiety and behavioral problems in children were the most important factors associated with poorer QoL (standardized path coefficients, -0.71 and -0.23, respectively). In addition, higher parent trait anxiety, younger age at diagnosis, and a disease requiring an emergency diet were associated with poorer QoL in these children. The final model fit the data closely according to conventional goodness-of-fit statistics and explained 86% of the QoL variance.

CONCLUSIONS

Psychosocial factors appear to be major determinants of QoL impairment in children with IEMRDs. These factors should be addressed in clinical practice as part of the global treatment plan for a child with IEMRD. Future studies based on a longitudinal design should consider coping strategies when exploring potential predictive factors of QoL.

Understanding Daily, Emotional, and Physical Burdens and Needs of Parents Caring for Children with Type 1 Diabetes

AIMS

To investigate (1) daily, emotional, and physical caregiving burdens in parents of children with type 1 diabetes, (2) the sociodemographic and clinical predictors of three burdens, and (3) support measures that parents wish to receive.

METHODS

The study was a multicenter cross-sectional survey conducted in nine German pediatric diabetes centers. A questionnaire assessing three types of burdens and wishes for support was distributed to parents with a child with type 1 diabetes visiting one of the pediatric centers for a routine check-up.

RESULTS

Data from 1,107 parents (83% mothers) were analyzed. Parents reported significantly higher emotional burdens compared to daily and physical burdens (p < 0.0001). Mothers felt more burdened than fathers did. Parents of younger children reported higher daily and physical burdens compared to the parents of older children, and similarly, parents of technology users reported higher daily and physical burdens compared to the parents of nontechnology users. However, emotional burdens did not differ in both comparisons. Other demographic factors (i.e., parent's age, migration status, and single-parent family status) predicted high levels of daily or physical burdens, but only HbA1c level and the parent's gender (mother) predicted a high emotional burden. Independent of the level of burden, 78% of parents wanted additional diabetes training.

CONCLUSION

Despite parents reporting high emotional burdens in connection with diabetes care, HbA1c and the gender of the reporting parent were the only risk factors. As the child gets older, parents' daily and physical distress decrease but not the emotional burden. Diabetes training including regularly offered booster sessions as well as low-threshold interventions for mental health issues and practical self-care skills is recommended to provide continuous support for parents.

Problematic Child Mealtime Behavior and Caregiver Mobile Phone Use

OBJECTIVE

To evaluate the associations of caregiver mobile phone problematic use and child problematic mealtime behaviors (PMBs) to improve understanding of the possible implications of caregiver mobile phone problematic use.

METHODS

Surveys were administered to caregivers of children aged 3 to 8 years. The survey included demographics, a validated measure for caregiver mobile phone problematic use (Mobile Phone Problematic Use Scale-10 [MPPUS-10]), and a validated measure for the perception of child PMB (Meals in our Household [MIOH]). The bivariate associations between child and caregiver characteristics, mobile phone problematic use, and PMBs of children were analyzed. Partial correlations examined these relations while controlling for significant (p ≤ 0.05) covariates.

RESULTS

Eighty-four caregivers (mean age 32.6 years, 63% white, 21% ≤ high school completion) participated. The correlation of MIOH problematic behavior total with MPPUS-10 was significant (r = 0.33, p ≤ 0.01). Significantly correlated caregiver variables with MPPUS-10 included age (r = -0.25, p = 0.02) and female sex (p = 0.01). No significant caregiver variables were noted for PMB. Child's age was significantly correlated with PMB (r = -0.27, p = 0.01). MPPUS-10 and PMB correlation remained significant when controlling for significant covariates.

CONCLUSION

A positive correlation existed between MPPUS-10 and PMB. Understanding the potential association between caregiver mobile phone problematic use and child PMB strengthens the pediatricians' ability to counsel about the implications of caregiver mobile phone problematic use when discussing child PMB.

Caregiver burden and parenting stress among left-behind elderly individuals in rural China: a cross-sectional study

Background

One public health problem that cannot be ignored is the mental health of left-behind elderly individuals in rural areas. However, the burden of care and parenting stress among left-behind elderly individuals has never been analyzed. The purpose of this study was to explore the level of caregiver burden and parenting stress and their relationship among left-behind elderly individuals.

Methods

A total of 261 left-behind elderly people responded to the study. The 22-item Zarit Burden Interview and the 36-item Parenting Stress Index-Short Form were used.

Results

We sent out 300 questionnaires in total. The effective rate was 87% (n = 261). Among the left-behind elderly individuals, most respondents were female (n = 171; 65.5%). The results showed that older age (OR:3.04; 95%CI: 1.307–7.048), an annual income of ¥5000–¥9900 (OR:3.25; 95%CI: 1.192–8.852) and higher parenting stress (OR:1.17; 95%CI: 1.103–1.242) were the risk factors related to higher caregiver burden in the left-behind elderly individuals. The influencing factor for lower caregiver burden in the left-behind elderly was gender (being male) (OR:0.08; 95%CI:0.036–0.178). Age (r = − 0.789; P < 0.001) and gender (r = 0.325; P < 0.001) were significant positively correlated with parenting stress, and annual income (r = − 0.717; P < 0.001) was negatively correlated with parenting stress.

Conclusion

Parenting stress is a risk factor affecting caregiver burden of left-behind elderly individuals. Healthcare professionals should pay close attention to the caregiver burden and parenting stress of left-behind elderly individuals, especially those who are older, female and have lower income.

Assessment of Quality of Life and Functional Outcomes of Operated Cases of Hirschsprung Disease in a Developing Country

PURPOSE

Children treated for Hirschsprung disease (HD) are adversely affected by fecal incontinence and soiling. This can be detrimental to their physical, psychosocial quality of life (QoL) and impacts the normal functioning of their family. QoL studies in HD are predominantly from developed countries. We measured general quality of life, impact on family and functional bowel status using validated questionnaires in HD children in a developing country.

METHODS

Patients with HD, treated in a tertiary paediatric institution in India between 2010 and 2017, were identified. Patients and/or their proxy completed the Pediatric Quality of Life and Family Impact Module questionnaires. Functional outcomes were assessed using Rintala's score.

RESULTS

A 86 children and their parents participated in the study. Majority had rectosigmoid disease (67.4%) and underwent Soave's endoanal pull through (74.4%). A 21% of patients had low Rintala score indicating poor functional bowel outcomes. Only 11% of children had poor QoL scores. Family functioning outcomes were also severely affected in the same subgroup of patients. There was statistically significant correlation between Rintala score and QoL scores (p-value<0.001). Disease severity, type of surgery, and duration of follow-up did not have a statistically significant impact on the QoL.

CONCLUSION

QoL in children with HD was comparable to the general population. Bowel dysfunction affects a notable number of children and was the most significant determinant of poor QoL.

Coping self-efficacy and parenting stress in mothers of children with congenital heart disease

BACKGROUND

Mothers of children with congenital heart disease (CHD) experience high parenting stress that affects both mothers and children.

OBJECTIVES

The purpose was to examine the relationship between coping self-efficacy and parenting stress in mothers of children with CHD and to identify the factors related to parenting stress.

METHODS

Data were collected using a self-reporting questionnaire from 100 mothers whose children, aged 0 to 12, had been diagnosed with CHD. The Coping Self-Efficacy scale was used to measure coping self-efficacy, and Pediatric Inventory for Parents was used to measure the parenting stress. Multiple linear regression analysis was conducted to investigate the factors related to parenting stress.

RESULTS

Higher parenting stress was related to lower coping self-efficacy to obtain social support and having any other children.

CONCLUSION

Interventions that consider factors related to parenting stress and to enhance coping self-efficacy is required. Effective practice could be delivered by paying more attention to mothers with less supporters and those who have other dependent children.

Barriers to and Facilitators of School Health Care for Students with Chronic Disease as Perceived by Their Parents: A Mixed Systematic Review

Understanding parental perspectives through mixed systematic reviews is imperative for developing effective school health care for children and adolescents with chronic disease. A mixed systematic review was conducted to explore barriers to and facilitators of school health care for students with chronic disease as perceived by their parents. Four databases (2010-2020) were searched, following which critical appraisals were conducted to determine the validity of the selected studies using the Mixed Method Appraisal Tool, version 2018. Twenty articles were synthesized using the convergent integrated approach from the Joanna Briggs Institute's mixed method systematic review methodology. We examined 20 articles regarding parents' perceived barriers and facilitators and found views across four levels: intrapersonal, interpersonal, institutional, and public and policy. Parents perceived more barriers than facilitators. Barriers on the institutional level were the most frequently reported of all levels of barriers. These results suggest that multi-level school health interventions could be a valuable resource to facilitate effective school guidelines and public policies for students with chronic diseases.

Impact of Caregiver's Psychological Aspects towards Quality of Life of Children with Acute Lymphoblastic Leukemia (ALL)

BACKGROUND

Families who have children with Acute Lymphoblastic Leukemia (ALL) are at high risk of experiencing stress. Stress on the family can cause the formation of negative communication in children so that families tend to spend more time in dealing with negative emotions through negative actions. This study aimed to analyze the correlation between stress, anxiety, and depression in caregiver with pediatric ALL outcome.

METHODS

A cross sectional study was conducted on children with ALL and their caregivers at the Pediatric Ward, Dr. Soetomo Hospital, Surabaya. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) questionnaire were used to measure anxiety and depression in caregivers. Previous stressful experiences in children and caregivers were assessed by The Perceived Stress Scale (PSS), Children quality of life was assessed by pediatric quality of life inventory (PedsQL™) questionnaire. Pearson and Spearman correlation strength test was performed for the statistical analysis.

RESULTS

There is no significant correlation between stress level of caregivers with the quality of life of children with ALL (P > 0.05). There is negative correlation between the level of anxiety and depression in caregivers with the quality of life of children (P < 0.05). There is negative correlation between children stress level with the quality of life of children (P < 0.05).

CONCLUSION

The psychological condition of the caregiver affects the quality of life of children. The higher the level of anxiety and depression in caregivers, the lower the quality of life of children.<br />.

Long-term outcomes and quality of life of patients with Hirschsprung disease: a systematic review and meta-analysis

BACKGROUND

Advances in surgical techniques and perioperative care have improved the short- and mid-term postoperative outcomes of patients with Hirschsprung disease (HD). However, the long-term outcomes of these patients (older than 10 years) have not been fully investigated. The aim of this systematic review is to clarify the prevalence of long-term outcomes and the quality of life of these patients.

METHODS

PubMed, AMED, Cochrane Library, CINAHL and PsycINFO databases were searched from inception to October 2018, following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. Original studies reporting the outcomes of patients older than ten years with HD were selected and reviewed. The overall prevalence of fecal incontinence, constipation, bowel function score, bladder dysfunction symptoms, and patients' quality of life were extracted from the included studies and pooled through the random-effects meta-analysis model. The heterogeneity and variation in the pooled estimations were evaluated by Cochrane's Q test and the I2 test. The sensitivity analysis was conducted by the sequential omission of individual studies. Publication bias was evaluated by Egger's linear regression test. The whole procedure was conducted with Stata (version 14).

RESULTS

In total, 3406 articles were identified from the literature search, among which twelve studies, including 625 patients, were included for analysis. The pooled prevalences of fecal incontinence, constipation, and bladder dysfunction symptoms and good to excellent bowel function scores were 0.20 (95% CI 0.13-0.28), 0.14 (95% CI 0.06-0.25), 0.07 (95% CI 0.04-0.12), and 0.95 (95% CI: 0.91-0.97), respectively; the pooled mean score of gastrointestinal-related quality of life was 118 (95% CI: 112.56-123.44).

CONCLUSIONS

HD patients older than ten years old have an overall high prevalence of fecal incontinence and a low quality of life. Targeted and evidence-based follow-up procedures and transitional care are essential to meet these patients' long-term care needs. Prospective and multicenter research that focuses on the attributes and predictors of the long-term prognosis of patients with HD are necessary.

Parental stress, anxiety and trait mindfulness: associations with parent-child mealtime interactions in children with type 1 diabetes

Introduction This study examined how maternal and paternal stress, anxiety, and trait mindfulness, and child glycemic control are related to real-life parent-child interactions in families confronted with type 1 diabetes (T1D). Methods Parents reported on trait mindfulness, illness-related parenting stress, general stress, and state anxiety. Parent-child mealtime interactions were videotaped and scored in 33 families (31 mothers and 20 fathers) of children with T1D (5-12y., mean HbA1c = 7.22%). Results Parental stress and anxiety were related to more maladaptive and less adaptive parent-child interactions. For mothers, mindfulness was related to less observed discomfort of the child during injection. For fathers, more emotional involvement was related to better child glycemic control. Discussion Results indicate that parental stress and anxiety may be risk factors for maladaptive parent-child interactions.

Living with type 1 diabetes mellitus: How does the condition affect children's and adolescents' quality of life?

OBJECTIVE

Our study aimed to measure the health-related quality of life (QoL) of Tunisian children and adolescents with type 1 diabetes mellitus (T1MD).

METHODS

This cross-sectional study included 48 patients aged 3-18 years with T1MD, diagnosed for at least 6 months, and their parents, who underwent outpatient examinations from September to December 2018. The children's QoL was assessed using the PedQL 3.0 Diabetes Module exploring five dimensions: diabetes symptoms, treatment barriers, treatment adherence, worry, and communication problems. Parents shared their perception of their children's QoL through the PedQL 4.0 parents' report (general health and emotional, social, and scholar functioning). Glycemic control was assessed using the last glycated haemoglobin (HbA_1c) values.

RESULTS

The patients' average QoL score was 80.52 (±13.61) without significant differences between gender and age. The longer the duration of the disease, the worse the glycemic control. Girls and adolescents seemed to have poorer glycemic control. Boys and adolescents had more difficulties in all aspects of QoL. Parents perceived a worse QoL than that reported by their sons/daughters (72.34±16.42; P=0.006).

CONCLUSION

These findings emphasize the importance of an interdisciplinary, biopsychosocial, and family-centered care approach to patients with T1MD.

Testing the Theory of Resilience and Relational Load (TRRL) in Families with Type I Diabetes

The theory of resilience and relational load was tested with 60 couples and their adolescent children (ages 11-18) with type I diabetes (T1D). The couples participated in a stress-inducing conversation task in their home, followed by a random assignment to a two-week intervention designed to increase their relationship maintenance. Before the intervention, stronger communal orientation predicted greater maintenance for husbands and wives, but maintenance only reduced T1D stress for wives. The wives' and adolescents' T1D stress were also correlated, but the husbands' T1D stress was not significantly associated with either of them. Better maintenance was associated with less conflict during couples' conversations. Maintenance was also directly associated with less perceived and physiological stress (cortisol) from the conversation. Finally, wives in the intervention reported the most thriving, communal orientation and the least loneliness. The intervention also reduced adolescents' general life stress, but it did not influence their T1D stress or thriving.

Mental health and parenting stress in mothers of children with diabetes treated in a patient-centred medical home

BACKGROUND

Mothers of children with diabetes are at-risk for experiencing parenting stress and diminished mental/emotional health. To the best of our knowledge, no studies to date have examined whether there are differences in these outcomes between mothers whose diabetic child is managed in a patient-centred medical home or not.

OBJECTIVE

The objective of the present study was to assess whether there were differences in mental health and parenting stress among mothers whose diabetic child was managed in a patient-centred medical home or not.

METHODS

Two hundred fifty-three mothers of children with diabetes (mean age = 12.50 years; SD = 3.90) from the 2011-2012 National Survey of Children's Health were included in this study. Hierarchical multiple regression was conducted to determine the amount of variance that having a patient-centred medical home contributed to maternal emotional/mental health and parenting stress.

RESULTS

After controlling for child sex, age, race/ethnicity and family poverty level, patient-centred medical home status was associated with better mental health for mothers and less parenting stress. Effective care coordination was the only subcomponent of the patient-centred medical home that significantly contributed to the variance in mother's mental/emotional health and parenting stress.

CONCLUSIONS

Receiving care in a patient-centred medical home, particularly the care coordination component, may mitigate some of the negative maternal effects of managing a child's diabetes.

Communication and the Appraisal of Uncertainty: Exploring Parents' Communication with Credible Authorities in the Context of Chronic Childhood Illness

Individuals with chronic illnesses must manage long-term uncertainty as they cope with the ways the illness influences their lives. In the context of pediatric illnesses, parents must manage uncertainty during the diagnosis and treatment of their child's illness. It is common for children with complex chronic illnesses to see multiple specialists for the treatment of their condition. While previous research has explored parents' uncertainty during a child's diagnosis and during end-of-life care, less is known about these experiences when the child is referred to a team of specialists for treatment. The aim of the current study was to explore how specialists, as credible authorities, influence parents' uncertainty during parents' first visit to a multidisciplinary clinic for the care of their child's complex chronic illness. Data were collected through semi-structured interviews with 29 parents after their child's first visit to a vascular anomaly clinic at a large Midwestern children's hospital. The results suggest parents' communication with credible authorities facilitates effective uncertainty management primarily through the mechanism of uncertainty reappraisal. The results also suggest that specialists, as credible authorities, are a key mechanism in the appraisal of uncertainty for conditions that are often misdiagnosed and mismanaged.

Medical-Legal Partnership Impact on Parents' Perceived Stress: A Pilot Study

Stress has adverse effects on health, and prolonged stress exposure is a risk factor for several mental and physical illnesses. ¹ Families living in poverty face many stressors created and maintained by economic hardship and unaddressed legal and social needs. Medical-Legal Partnerships (MLPs) aim to improve health and well-being by addressing health-harming legal and social needs of patients. This pilot study examined whether MLP-involved parents perceived themselves as stressed; to what they attributed their stress; and whether they reported a reduction in stress when their MLP cases were closed. The study shows improvements in perceived stress following receipt of MLP interventions.

The relationship of Type 1 diabetes self-management barriers to child and parent quality of life: a US cross-sectional study

AIM

Families of children and adolescents with Type 1 diabetes experience self-management challenges that negatively impact diabetes control. This study assesses whether self-management challenges are also associated with quality of life (QOL) for children and adolescents with Type 1 diabetes and their parents.

METHODS

Children aged 8-12 years (n = 135), adolescents aged 13-16 years (n = 132) and their parents completed QOL assessments (diabetes-specific QOL from the PedsQL Diabetes Module or the Family Impact Module, both scaled 0-100) and a validated survey of up to six self-management barriers [PRISM; scaled 1 (low) to 5 (high)]. Regression coefficients were calculated to assess the association of self-management barriers with child and adolescent diabetes-specific QOL or parent QOL, including interaction effects to assess the stability of the associations.

RESULTS

Mean duration of diabetes was 4.7 years for children and 6.1 years for adolescents. The majority of children and adolescents did not meet target values for glycaemic control. All barriers but one (Healthcare Team Interactions) were associated with lower diabetes-specific QOL for children and adolescents, as well as lower QOL for parents (all P < 0.05). Barrier scores that were 1 unit higher were associated with diabetes-specific QOL that was 3.7-5.1 points lower for children and 5.8-8.8 points lower for adolescents, as well as QOL that was 6.0-12.6 points lower for parents. Diabetes-specific QOL was most strongly associated with 'Denial of Disease and Its Consequences' for children and with 'Regimen Pain and Bother' for adolescents. Parent QOL was most strongly associated with 'Understanding and Organizing Care'. Associations were stable across numerous demographic and disease factors.

CONCLUSIONS

Single-unit differences in self-management barrier scores are associated with clinically meaningful differences in QOL for children and parents. Interventions specifically tailored to address individual self-management barriers may improve both diabetes control and QOL.

A brief version of the Pediatric Inventory for Parents (PIP) in Spanish population: Stress of main family carers of chronic paediatric patients

A chronic illness in childhood has a negative impact on the paediatric patient and on family functioning. Psychological stress in parents influences the level of adjustment to the illness of their children. The Pediatric Inventory for Parents (PIP) was designed to measure stress in parents whose child has a chronic illness or requires prolonged medical monitoring. The main objective of this study is to provide a brief version of the Spanish translation of the PIP, across a sample consisting of 465 main familial caregivers (85.2% female, n = 396) between 27 and 67 years old (X¯ = 44.13; SD = 5.35) of paediatric patients between 9 and 18 years old (X¯ = 12.10, SD = 2.20; 56.8% men, n = 264) diagnosed with diabetes mellitus type I (20.9% of the sample; n = 97), short stature (32.5% of the sample; n = 151), or a chronic respiratory disease (asthma, cystic fibrosis, bronchiolitis obliterans and bronchiectasis) (46.6% of the sample; n = 217). After performing several EFAs (Exploratory Factor Analyses) and CFAs (Confirmatory Factorial Analyses), it was decided that 30 items need to be removed. Reliability and validity results suggest that the new 12-item version possesses appropriate psychometric properties. Cronbach’s alpha value ranging between α = .42 and α = .81 and fit values obtained indicate a good fit: χ²/df (88.393/48) = 1.84 (α < .01); S-B χ²(df) = 88.393 (48); CFI = .95; IFI = .95; RMSEA = .05 (.033 - .074) for the frequency scales and χ²/df (72.002/48) = 1.5 (α < .01); S-Bχ²(df) = 72.002 (48); CFI = .97; IFI = .97; RMSEA = .04 (.011 - .063) for the difficulty scales. The PIP also showed predictive ability in regards to anxiety and depression, a positive relationship between the instrument's own scales and a negative relationship with the caregiver's age. Finally, depending on the paediatric patient's diagnosis, differences in stress levels were found.

Maternal distress in the context of their child's type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8-15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.

Paediatric parenting stress in fathers and mothers of young children with Type 1 diabetes: a longitudinal study

AIM

To compare levels of paediatric parenting stress in the fathers and mothers of young children with Type 1 diabetes and study the variation in this stress over time.

METHODS

One hundred and twelve parents (56 mothers and 56 fathers) of young children (0-7 years) with Type 1 diabetes participated in this study. They completed the Pediatric Inventory for Parents to assess paediatric parenting stress (frequency and difficulty scores on the Communication, Emotional Distress, Medical Care and Role Functioning subscales and Total Score); 44 mothers (79%) and 31 fathers (55%) completed the questionnaire again, 1 year later. Independent and paired sample t-tests were used to examine the differences between fathers and mothers and the changes over time. Cohen's d effect sizes were also calculated.

RESULTS

Mothers scored significantly higher than fathers on the stress subscales for Communication frequency and difficulty, Emotional Distress frequency and difficulty, Medical Care frequency and Total Score frequency and difficulty (d ranged from -0.44 to -0.56). Furthermore, fathers reported a decrease in Medical Care frequency (d = 0.10) and an increase in Emotional Distress difficulty (d = -0.32) and Total Score difficulty (d = -0.29), whereas mothers reported a decrease in Emotional Distress frequency, Medical Care frequency and Total Score frequency (d ranged from 0.31 to 0.66) over a 1-year period.

CONCLUSIONS

These results show that within families with a young child with Type 1 diabetes, the burden of care increases in fathers and decreases in mothers, suggesting that fathers assume more responsibility for care of their child with Type 1 diabetes as the child grows.