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Evans M, Ellis DA, Vesco AT, Feldman MA, Weissberg-Benchell J, Carcone AI, Miller J, Boucher-Berry C, Buggs-Saxton C, Degnan B, Dekelbab B, Drossos T. Diabetes distress in urban Black youth with type 1 diabetes and their caregivers: associations with glycemic control, depression, and health behaviors. J Pediatr Psychol 2024; 49:394-404. [PMID: 38216126 DOI: 10.1093/jpepsy/jsad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative samples, and (3) determine how DD relates to glycemic outcomes, diabetes self-management, parental monitoring of diabetes, and youth depressive symptoms. METHODS Baseline data from a multicenter clinical trial were used. Participants (N = 155) were recruited from 7 Midwestern pediatric diabetes clinics. Hemoglobin A1c (HbA1c) and measures of DD, parental monitoring of diabetes care, youth depression and diabetes management behaviors were obtained. The sample was split into (1) adolescents (ages 13-14; N = 95) and (2) preadolescents (ages 10-12; N = 60). Analyses utilized Cohen's d effect sizes, Pearson correlations, t-tests, and multiple regression. RESULTS DD levels in youth and caregivers were high, with 45%-58% exceeding either clinical cutoff scores or validation study sample means. Higher DD in youth and caregivers was associated with higher HbA1c, lower diabetes self-management, and elevated depressive symptoms, but not with parental monitoring of diabetes management. CONCLUSIONS Screening for DD in Black youth with T1D and caregivers is recommended, as are culturally informed interventions that can reduce distress levels and lead to improved health outcomes. More research is needed on how systemic inequities contribute to higher DD in Black youth and the strategies/policy changes needed to reduce these inequities.
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Affiliation(s)
- Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Deborah A Ellis
- School of Medicine, Wayne State University, Detroit, MI, United States
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Marissa A Feldman
- Division of Psychology, Johns Hopkins, All Children's Hospital, St Petersburg, FL, United States
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | | | - Jennifer Miller
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Claudia Boucher-Berry
- Division of Pediatric Endocrinology, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Bernard Degnan
- Pediatric Endocrinology, Ascension St John Children's Hospital, Detroit, MI, United States
| | - Bassem Dekelbab
- Pediatric Endocrinology, Beaumont Health Care, Royal Oak, MI, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
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Abadula F, Garretson S, Okonkwo N, LeStourgeon LM, Jaser SS. Detangling Associations Between Maternal Depressive Symptoms and Diabetes Relationship Distress With Adolescents' HbA1c. J Pediatr Psychol 2024; 49:89-94. [PMID: 37794836 PMCID: PMC10874213 DOI: 10.1093/jpepsy/jsad070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Previous research in families of children with type 1 diabetes demonstrates that maternal depressive symptoms are a known risk factor for poor diabetes outcomes. We sought to examine whether maternal diabetes relationship distress or maternal depressive symptoms were more strongly associated with adolescent glycemic outcomes. METHODS Analyses were conducted using data from mothers who consented to screen for a behavioral intervention. The screener included the Patient Health Questionnaire and the Parent Diabetes Distress Scale, Parent/Teen Relationship Distress subscale. Hemoglobin A1c (HbA1c) was extracted from adolescents' medical records. RESULTS Our sample consisted of 390 maternal caregivers of adolescents with type 1 diabetes aged 11-17. Screening data revealed that 35% of mothers reported clinically significant diabetes distress related to their relationship with their adolescents, and 14% of mothers reported clinically significant depressive symptoms. The adolescents of mothers who reported diabetes relationship distress had significantly higher mean HbA1c levels (9.7 ± 2.2%) compared to those whose mothers were not distressed (8.2 ± 1.8%, d = .72). Similarly, adolescents whose mothers reported clinically significant depressive symptoms had higher mean HbA1c levels (9.6 ± 2.4%) than those whose mothers were not depressed (8.6 ± 2.0%, d = .48). After adjusting for clinical and demographic factors, mothers' reports of diabetes relationship distress were more strongly associated with adolescents' HbA1c than maternal depressive symptoms. CONCLUSIONS Our findings suggest that screening for maternal distress-particularly distress related to the caregiver-adolescent relationship-could match families with psychosocial support or other resources to improve both psychosocial and glycemic outcomes.
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Affiliation(s)
- Fayo Abadula
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Sydney Garretson
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Nkemjika Okonkwo
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | | | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, USA
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Klemenčič S, Lipovšek JK, Turin A, Dovč K, Bratina N, Shmueli-Goetz Y, Trebušak Podkrajšek K, Repič Lampret B, Jenko Bizjan B, Karakatič S, Battelino T, Drobnič Radobuljac M. Attachment in close relationships and glycemic outcomes in children with type 1 diabetes. Child Adolesc Psychiatry Ment Health 2023; 17:121. [PMID: 37848951 PMCID: PMC10583356 DOI: 10.1186/s13034-023-00672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Our aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin (HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS 101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes. RESULTS More girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = -0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = -8.543, p = 0.002). CONCLUSIONS Attachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D.
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Affiliation(s)
- Simona Klemenčič
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia.
| | - Jasna Klara Lipovšek
- Centre for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Anja Turin
- Centre for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovč
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Yael Shmueli-Goetz
- Anna Freud National Centre for Children and Families and Psychoanalysis Unit, University College London, London, UK
| | - Katarina Trebušak Podkrajšek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute of Special Laboratory Diagnostics, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Barbka Repič Lampret
- Clinical Institute of Special Laboratory Diagnostics, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Barbara Jenko Bizjan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute of Special Laboratory Diagnostics, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sašo Karakatič
- Institute of Informatics, Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Bohoričeva Ulica 20, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Drobnič Radobuljac
- Centre for Mental Health, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Chen Z, Wang J, Carru C, Coradduzza D, Li Z. The prevalence of depression among parents of children/adolescents with type 1 diabetes: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1095729. [PMID: 36936139 PMCID: PMC10014558 DOI: 10.3389/fendo.2023.1095729] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Emerging research indicates that depression among parents of children/adolescents with type 1 diabetes mellitus (T1DM) has increased significantly. However, the prevalence rates reported by different studies vary substantially. METHODS Seven databases were systematically searched (Pubmed, Embase, MEDLINE, Scopus, Web of Science, Cochrane Library, PsycInfo) from the inception to 15th October 2022. We pooled prevalence rates from each study with a random-effect model. We conducted a stratified meta-analysis to identify the potential sources of heterogeneity among studies. The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was utilized to evaluate the quality of evidence. RESULTS Twenty-two studies were included, with a total of 4639 parents living with type 1 diabetic children. Overall, the pooled prevalence rate of depression or depressive symptoms was 22.4% (95%CI 17.2% to 28.7%; I 2 = 96.8%). The prevalence was higher among mothers (31.5%) than fathers (16.3%) as well as parents of children (aged < 12 years) with T1DM (32.3%) than those with adolescents (aged ≥ 12 years) (16.0%). CONCLUSION Our research suggests that more than 1 in 5 parents of type 1 diabetic children/adolescents worldwide suffer from depression or depressive symptom. Depression screening and interventions are required for parents of children with T1DM. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier (CRD42022368702).
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Affiliation(s)
- Zhichao Chen
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jing Wang
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Zhi Li
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- *Correspondence: Zhi Li,
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Cervera-Torres S, Núñez-Benjumea FJ, de Arriba Muñoz A, Chicchi Giglioli IA, Fernández-Luque L. Digital health for emotional and self-management support of caregivers of children receiving growth hormone treatment: a feasibility study protocol. BMC Med Inform Decis Mak 2022; 22:215. [PMID: 35964116 PMCID: PMC9375279 DOI: 10.1186/s12911-022-01935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Caregivers of children undergoing growth hormone treatment often face stress and stigma. In this regard, family-centered approaches are increasingly considered, wherein caregivers’ mental wellbeing is taken into account to optimize children’s health-related outcomes and behaviors (e.g., treatment adherence). Here, mindfulness and parenting-based programs have been developed to support the mental wellbeing of caregivers and, in turn, promote richer interactions with the children. Nevertheless, this type of program can face drawbacks, such as the scheduling and availability of family members. Recent digital health (DH) solutions (e.g., mobile apps) are showing promising advantages as self-management support tools for improving wellbeing and behaviors related to the treatments. Although, further evidence is necessary in the field of Growth Hormone Treatment (GHt). Accordingly, this study aims to examine the usability of a mobile DH solution and the feasibility of a DH intervention designed to promote emotional and mental wellbeing of caregivers of children undergoing GHt. Methods This is a prospective mixed-methods (qualitative-quantitative) exploratory study composed of two sub-studies, including caregivers of children undergoing GHt. Sub-study one (SS1; n = 10) focuses on the usability of the DH solution (detecting potential barriers and facilitators) and an ad hoc semi-structured interview will be administered to the caregivers after using the DH solution for one month. Sub-study two (SS2; n = 55) aims to evaluate the feasibility of the DH intervention on caregivers’ perceived distress, positive affectivity, mental wellbeing, self-efficacy, together with the children’s quality of life and treatment adherence. All these parameters will be assessed via quantitative methods before and after 3-months of the DH intervention. Usability and engagement will also be assessed during and at the end of the study. Results It is expected that significant amounts of data will be captured with regards of the feasibility of the DH solution. Discussion The manuscript provides a complete protocol for a study that will include qualitative and quantitative information about, on one hand, the user-friendliness of the DH solution, and on the other, the effects on caregivers’ emotional, as well as, behavioral parameters in terms of the usability and engagement to the DH solution. The findings will contribute to the evidence planning process for the future adoption of digital health solutions for caregiver support and better health-related outcomes. Trial registration ClinicalTrials.gov, ID: NCT04812665. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01935-1.
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Ye B, Zhao S, Zeng Y, Chen C, Zhang Y. Perceived parental support and college students' depressive symptoms during the COVID-19 pandemic: The mediating roles of emotion regulation strategies and resilience. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 35400981 PMCID: PMC8980203 DOI: 10.1007/s12144-022-03049-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 01/14/2023]
Abstract
The current study examined the mediating roles of emotion regulation strategies (i.e., cognitive reappraisal and expressive suppression) and resilience in the relationship between perceived parental support and depressive symptoms among college students during the first wave of the COVID-19 pandemic in China. A large sample of Chinese college students (N = 2, 423) participated in this investigation. Results indicated that perceived parental support was negatively related to depressive symptoms. The two emotion regulation strategies and resilience partially and serially mediated the relation between perceived parental support and depressive symptoms. Theoretical and practical implications of these results are discussed.
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Affiliation(s)
- Baojuan Ye
- Center of Preschool Education, Center of Mental Health Education and Research, School of Psychology, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022 China
| | - Shunying Zhao
- Center of Preschool Education, Center of Mental Health Education and Research, School of Psychology, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022 China
| | - Yadi Zeng
- Center of Preschool Education, Center of Mental Health Education and Research, School of Psychology, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022 China
| | - Chuansheng Chen
- Department of Psychology and Social Behavior, University of California, Irvine, CA 92697 USA
| | - Yanzhen Zhang
- Department of Psychology, University of California, 900 University Ave, Riverside, CA 92521 USA
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Majmudar D, East P, Martinez S, Blanco E, Lozoff B, Burrows R, Gahagan S. Associations between adverse home environments and appetite hormones, adipokines, and adiposity among Chilean adolescents. Clin Obes 2022; 12:e12488. [PMID: 34569164 DOI: 10.1111/cob.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
Little is known regarding the relationship between adverse home environments and hormones important in regulation of appetite and their impact on obesity in children and adolescents. In this study, we examined the impact of socioeconomic economic status, family stress and maternal depressive symptoms on appetite hormones, adipokines and adiposity. To determine whether adverse home environments in childhood and adolescence relate to adiposity in adolescence and disruptions in appetite hormones and adipokines, specifically lower levels of adiponectin and ghrelin and elevated levels of leptin and orexin. Adversity in the home (maternal depressive symptoms, family stress, socioeconomic disadvantage) was measured in the households of 593 Chilean youth at age 10 years (52.3% male) and in 606 youth at 16 years. At 16 years, participants provided fasting blood samples for assessment of adipokines and appetite hormones. Waist-to-height ratio was used to assess central adiposity. Correlational analyses examined associations between continuous levels of adversity in childhood and adolescence and appetite hormones and adiposity in adolescence. Multinomial logistic regressions compared hormone levels by tertiles of adversity. Participants were 52% male, with average age at the 16 years hormone assessment being 16.8 (n = 606, SD = 0.26). Those with highest maternal depression at age 10 had lower adiponectin OR = 0.95 [95% CI: 0.91, 0.99], p = 0.005) and ghrelin levels (OR = 0.98 [95% CI: 0.98, 1.00), p = 0.022) than those in the lowest maternal depression group at age 16. Those with the highest family stress at 16 years had lower adiponectin levels (OR = 0.93 [95% CI: 0.89, 0.98), p = 0.004) and higher central adiposity (OR = 1.05 [1.01, 1.08], p = 0.009) than the lowest family stress group. There were no significant associations found between socioeconomic status at either 10 or 16 years and appetite hormones. Results add new evidence regarding the relationship between household adversity to appetite hormones and adipokines, with the most consistent results for adiponectin. Current findings suggest that the relationship between home environment and adipokines and appetite hormones may play a role in altered adiposity in children and adolescents.
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Affiliation(s)
- Deshna Majmudar
- Frank H Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Patricia East
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Suzanna Martinez
- School of Public Health, University of California, San Francisco, California, USA
| | - Estela Blanco
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Betsy Lozoff
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Raquel Burrows
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
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Nguyen LA, Pouwer F, Lodder P, Hartman E, Winterdijk P, Aanstoot HJ, Nefs G. Depression and anxiety in adolescents with type 1 diabetes and their parents. Pediatr Res 2022; 91:188-196. [PMID: 33664478 DOI: 10.1038/s41390-021-01392-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Longitudinal studies including parental distress when examining adverse health outcomes in adolescents with type 1 diabetes are lacking. This study examined whether parental depression and anxiety predict adolescent emotional distress and glycated hemoglobin A1c (HbA1c) 1 year later and whether a relation between parental distress and HbA1c is mediated by the level of parental involvement in diabetes care and by treatment behaviors. METHODS Longitudinal path modeling was applied to data from 154 adolescents and parents from diabetes centers participating in the Longitudinal study of Emotional problems in Adolescents with type 1 diabetes and their Parents/caregivers (Diabetes LEAP). At baseline and 1-year follow-up, participants completed measures of depression and anxiety. HbA1c was extracted from medical charts. Responsibility and treatment behavior questionnaires were completed by adolescents at baseline. RESULTS Baseline parental depressive and anxiety symptoms were not associated with 1-year adolescent depressive symptoms, anxiety symptoms, and HbA1c. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. CONCLUSIONS Parental depressive and anxiety symptoms did not predict adolescent health outcomes 1 year later. Future studies may determine whether the link is present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress. IMPACT Adolescents with T1D are a vulnerable group in terms of psychological and health outcomes. Whether parental emotional distress (i.e., depressive and anxiety symptoms) is prospectively associated with adolescent emotional distress and/or HbA1c has been understudied. Our results show that parental distress was not related to adolescent distress or HbA1c 1 year later. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. Future studies could determine whether these links are present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress.
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Affiliation(s)
- Linh A Nguyen
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,STENO Diabetes Center Odense, Odense, Denmark.,School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Esther Hartman
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Per Winterdijk
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Henk-Jan Aanstoot
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands. .,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. .,National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands.
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Mbamognoua N, Osseni RA, Ongoth FEM, Ohouna RLM, Bouenizabila E, Moko AO, Monabeka HG. Psychosocial Experience of Parents of Children, Adolescents and Young Adults with Type 1 Diabetes in Brazzaville. Health (London) 2022. [DOI: 10.4236/health.2022.146045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nguyen LA, Pouwer F, Winterdijk P, Hartman E, Nuboer R, Sas T, de Kruijff I, Bakker‐Van Waarde W, Aanstoot H, Nefs G. Prevalence and course of mood and anxiety disorders, and correlates of symptom severity in adolescents with type 1 diabetes: Results from diabetes LEAP. Pediatr Diabetes 2021; 22:638-648. [PMID: 33331108 PMCID: PMC8251968 DOI: 10.1111/pedi.13174] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/15/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES We aim to determine the prevalence and the course of anxiety and mood disorders in Dutch adolescents (12-18 years old) with type 1 diabetes, and to examine correlates of symptom severity, including parental emotional distress. METHODS Participants were 171 adolescents and 149 parents. The Diagnostic Interview Schedule for Children-IV was used to assess current, past year and lifetime anxiety and mood disorders in adolescents. Symptom severity and diabetes distress were measured with validated questionnaires. Correlates of these symptoms were examined using hierarchical regression analyses and included demographics (adolescent sex and age), clinical factors (diabetes duration, treatment modality, most recent glycated hemoglobin A1c ; all extracted from medical charts), adolescent diabetes distress, and parent emotional distress. RESULTS Twenty-four (14%) adolescents met the criteria for ≥1 disorder(s) in the previous 12 months. Anxiety disorders were more prevalent than mood disorders (13% vs. 4%). Lifetime prevalence of anxiety and mood disorders was 29% (n = 49). The presence of any of these disorders earlier in life (from 5 years old up to 12 months prior to assessment) was associated with disorders in the past 12 months (OR = 4.88, p = 0.001). Higher adolescent diabetes distress was related to higher symptoms of anxiety (b = 0.07, p = 0.001) and depression (b = 0.13, p = 0.001), while demographics, clinical characteristics, and parental emotional distress were not related. CONCLUSIONS Anxiety and mood disorders are common among adolescents and related to earlier disorders. Higher diabetes distress was related to higher symptom severity. Clinicians are advised to address past psychological problems and remain vigilant of these problems.
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Affiliation(s)
- Linh Anh Nguyen
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic disorders (CoRPS), Tilburg UniversityTilburgThe Netherlands,Department of Medical PsychologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark,School of PsychologyDeakin UniversityGeelongVictoriaAustralia,STENO Diabetes Center OdenseOdenseDenmark
| | | | - Esther Hartman
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic disorders (CoRPS), Tilburg UniversityTilburgThe Netherlands
| | - Roos Nuboer
- Department of PediatricsMeander Medical CentreAmersfoortThe Netherlands
| | - Theo Sas
- DIABETER, Diabetes CenterRotterdamThe Netherlands,Department of PediatricsAlbert Schweitzer HospitalDordrechtThe Netherlands,Department of Pediatric EndocrinologyErasmus Medical Center – Sophia Children's HospitalRotterdamThe Netherlands
| | - Ineke de Kruijff
- Department of PediatricsDiabetes Central, St. Antonius HospitalNieuwegeinThe Netherlands
| | | | | | - Giesje Nefs
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic disorders (CoRPS), Tilburg UniversityTilburgThe Netherlands,Department of Medical PsychologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,DIABETER, Diabetes CenterRotterdamThe Netherlands
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12
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Hannonen R, Vuorimaa H, Rantanen K, Alho I, Luukkaala T, Heikkilä A, Lappalainen R. Finnish diabetes-related quality of life questionnaire for children and adolescents: Reliability and validity. Acta Paediatr 2021; 110:1516-1525. [PMID: 33289955 DOI: 10.1111/apa.15707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/01/2020] [Accepted: 12/04/2020] [Indexed: 01/09/2023]
Abstract
AIM To study the psychometric properties, reliability and validity of the FinDiab quality-of-life questionnaire (FDQL), a strength-oriented quality-of-life (QOL) questionnaire for children and adolescents with type 1 diabetes (T1D). METHODS Participants were 215 youths with T1D (aged 10-17 years). They completed FDQL and comparison questionnaires (KINDL-R and SDQ). Demographic and disease measures were collected from the participants' medical records. The questionnaire's psychometric properties were investigated. Construct validity was studied through principal component analysis using Promax rotation, reliability with alphas, and criterion and convergent validity with correlations between sum scale, subscales, demographic and disease factors, and comparison measures. RESULTS FDQL demonstrated an adequate range of measurement and feasibility. The four-factor solution was found to be optimal, resulting in the subscales of flexibility with diabetes, well-being, social relations and health behaviour. The sum scale correlated significantly with glycaemic control and the psychosocial and QOL comparison measures. Construct, criterion and convergent validity of the subscales was also good. Children under 14 years of age reported better QOL than older adolescents. CONCLUSION FDQL is a practical QOL assessment method focusing on strengths. The questionnaire has good validity and reliability and is easy to use as a clinical tool.
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Affiliation(s)
- Riitta Hannonen
- Department of Psychology Kymenlaakso Social and Health Care Kotka Finland
| | - Hanna Vuorimaa
- Department of Pediatrics Päijät‐Häme Central Hospital Lahti Finland
| | - Kati Rantanen
- Faculty of Social Sciences, Psychology, Tampere University Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Iina Alho
- Department of Psychology, University of Jyväskylä Department of Pediatrics Central Finland Health Care District Jyväskylä Finland
| | - Tiina Luukkaala
- Faculty of Social Sciences, Tampere University Research, Development and Innovation Centre Tampere University Hospital Tampere Finland
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13
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Douma M, Maurice-Stam H, Gorter B, Krol Y, Verkleij M, Wiltink L, Scholten L, Grootenhuis MA. Online psychosocial group intervention for parents: Positive effects on anxiety and depression. J Pediatr Psychol 2021; 46:123-134. [PMID: 33230541 PMCID: PMC7896276 DOI: 10.1093/jpepsy/jsaa102] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the efficacy of an online psychosocial group intervention for parents of children with a chronic illness, in terms of anxiety and depression, and disease-related coping skills. Methods Parents (N = 73) participated in a parallel multicenter randomized controlled trial comparing an intervention group to a waitlist control group. In the group intervention Op Koers Online (English: On Track Online) parents learned how to use adaptive coping strategies taught with cognitive behavioral therapy and acceptance and commitment therapy techniques. Assessments (online questionnaires) took place at baseline (T0), 6-months (T1), and 12-months (T2) follow-up. Mixed-model analyses were performed to test the difference in change in outcomes between intervention (N = 34) and waitlist control group (N = 33). Results When compared with the waitlist control group, the intervention had a significant positive effect (p < .05) on changes in anxiety, depression, and total score T1 versus T0 (β = −.47 to −.51) and T2 versus T0 (β = −.39 to −.46), the coping skills open communication, relaxation, social support, acceptance, predictive control (β = .42–.88) and helplessness (β = −.47) T1 versus T0 and relaxation and positive thinking T2 versus T0 (β = .42–.53). Conclusions Parental anxiety and depression decreased, and use of adaptive coping skills improved after the intervention. The online character, the focus on parents themselves instead of on their child and the possibility for parents of children with rare illnesses to participate, are innovative and unique aspects of Op Koers Online for parents. The next step is to implement the intervention in clinical practice.
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Affiliation(s)
- Miriam Douma
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam
| | - Heleen Maurice-Stam
- Department of Psychosocial Research and Care Innovation, Psychosocial Research and Care Innovation, Princess Máxima Center for Pediatric Oncology
| | - Bianca Gorter
- Department of Medical Psychology, DeKinderKliniek, DeKinderGGZ
| | - Yvette Krol
- Department of Medical Psychology, Deventer Hospital
| | - Marieke Verkleij
- Department of Medical Psychology, Amsterdam University Medical Centers, location VUmc
| | - Lianne Wiltink
- Department of Medical Psychology, Canisius Wilhelmina Hospital
| | - Linde Scholten
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam
| | - Martha A Grootenhuis
- Department of Psychosocial Research and Care Innovation, Psychosocial Research and Care Innovation, Princess Máxima Center for Pediatric Oncology
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14
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Alessi J, de Oliveira GB, Feiden G, Schaan BD, Telo GH. Caring for caregivers: the impact of the COVID-19 pandemic on those responsible for children and adolescents with type 1 diabetes. Sci Rep 2021; 11:6812. [PMID: 33762633 PMCID: PMC7991637 DOI: 10.1038/s41598-021-85874-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
This study aimed to assess the psychological impact of the COVID-19 pandemic on guardians of children and adolescents with type 1 diabetes. An online survey was performed to assess the prevalence of pandemic-related emotional burden, mental health disorders and diabetes-specific emotional burden related to diabetes care during the COVID-19 pandemic. Caregivers of children and adolescents with diabetes under the age of 18 and caregivers of youth without diabetes for the non-diabetes group were invited to participate. For the primary outcome, mental health disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20), while pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care were evaluated in different domains with specific questions. For analyses, a hierarchical testing strategy was performed. A total of 764 participants were included in the study. Regarding the pandemic period, caregivers of youth with type 1 diabetes endorsed significantly more pandemic-related emotional burden for both themselves (OR 1.67; 95% CI, 1.10 to 2.53) and for their child (OR 2.28; 95% CI, 1.54 to 3.38) when compared to the non-diabetes group. The emotional burden evaluation on different age ranges showed that the two groups were similar when the dependent youth was younger than 6 years. Moreover, a positive screening for mental health disorders during social distancing was higher in the diabetes group compared to the non-diabetes group (OR 2.43; 95% CI, 1.70 to 3.47), particularly in those aged under 12 years old. There was no difference between groups in mental health disorders among caregivers of adolescents older than 12 years. Our results allow to conclude that concern, burden and mental health disorders can be present in caregivers of youth with diabetes, and behavioral changes during the COVID-19 pandemic may enhance this situation.
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Affiliation(s)
- Janine Alessi
- Postgraduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil. .,Internal Medicine Department, Hospital São Lucas - Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil.
| | - Giovana Berger de Oliveira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS, 90160-092, Brazil
| | - Gabriela Feiden
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil.,Associação de Apoio aos Diabéticos do Rio Grande do Sul (AADIRS), Porto Alegre, Brazil
| | - Beatriz D Schaan
- Postgraduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil.,Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Internal Medicine Department, Hospital São Lucas - Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil.,School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS, 90160-092, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Porto Alegre, Brazil.,Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina da PUCRS, Av. Ipiranga, 6681 - Partenon, 90160-092, Porto Alegre, RS, Brasil
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15
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Žilinskienė J, Šumskas L, Antinienė D. Paediatric Type1 Diabetes Management and Mothers' Emotional Intelligence Interactions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3117. [PMID: 33803528 PMCID: PMC8002982 DOI: 10.3390/ijerph18063117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 11/16/2022]
Abstract
The functioning of the parents' emotional sphere is very important to a child's mental and physical health. This study focused on investigating the association between mothers' emotional intelligence (EI) and paediatric type I diabetes (T1DM) disease management in their children. We hypothesized that mothers' EI is associated with T1DM outcomes. Mothers of children with T1DM aged 6-12 years were surveyed. One hundred and thirty-four mothers, the main caregivers of their diabetic children, provided measures of EI and completed a demographic questionnaire. The primary indicator of diabetes management was haemoglobin A1c (HbA1c; the main form of glycosylated haemoglobin). EI scales and subscales were associated with glycaemic management indices. Logistic regression analysis was applied for the assessment of the association between parents' EI and their paediatric with T1DM disease management. The analysis demonstrated a statistically significant correlation between T1DM management and mothers' ability to understand and control own emotions, to transform their own negative emotions into positive and to control own negative emotions. Mothers' EI scales and subscales of understanding and regulating their own emotions, subscales of transforming their own negative emotions into positive ones and controlling their own negative emotions were statistically reliable predictors of glycaemic control in children with T1DM.
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Affiliation(s)
- Jolanta Žilinskienė
- Department of Health Psychology, Faculty of Public Health, Lithuanian University of Health Sciences, A. Mickevičiaus Street 9, LT-44307 Kaunas, Lithuania;
| | - Linas Šumskas
- Department of Preventive Medicine and Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, A. Mickevičiaus Street 9, LT-44307 Kaunas, Lithuania;
| | - Dalia Antinienė
- Department of Health Psychology, Faculty of Public Health, Lithuanian University of Health Sciences, A. Mickevičiaus Street 9, LT-44307 Kaunas, Lithuania;
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16
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Butler AM, Hilliard ME, Titus C, Rodriguez E, Al-Gadi I, Cole-Lewis Y, Thompson D. Barriers and Facilitators to Involvement in Children's Diabetes Management Among Minority Parents. J Pediatr Psychol 2021; 45:946-956. [PMID: 31995219 DOI: 10.1093/jpepsy/jsz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study aimed to describe parents' perceptions of the factors that facilitate or are barriers to their involvement in children's type 1 diabetes (T1D) management among African American and Latino parents. METHODS African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability-Opportunity-Motivation-Behavior (COM-B) framework. RESULTS Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents' desire for their child to have a "normal" life was described as both a Motivation-based facilitator and barrier. CONCLUSIONS African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families' unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children's diabetes management.
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Affiliation(s)
| | | | | | | | - Iman Al-Gadi
- Baylor College of Medicine/Texas Children's Hospital
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17
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Parental Stress, Anxiety and Depression Symptoms Associated with Self-Efficacy in Paediatric Type 1 Diabetes: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010152. [PMID: 33379307 PMCID: PMC7795592 DOI: 10.3390/ijerph18010152] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 01/12/2023]
Abstract
Background: Parents play a significant role in the management and monitoring of their children’s Type 1 diabetes mellitus (T1DM), being considered a family disease. The current review intends to investigate parental stress, depression and anxiety symptoms associated with self-efficacy referred to paediatric diabetes management. Method: A literature review was carried out using PsycINFO, Web of Science and PubMed where the following terms were considered: diabetes mellitus, paediatric, parent-child relationship, self-efficacy, parenting stress, perceived stress, stress, depression, anxiety. Standing a defined list of inclusion and exclusion criteria, a total of 33 papers were finally included. Results: Findings have shown that parents experience relatively high levels of anxiety, depression and stress symptoms related to managing a child with T1DM and are associated with parental self-efficacy. Parental stress predicts a worsening in the control of HbA1c levels, while parental diabetes-specific distress predicts an increase in children depression symptoms. High parental self-efficacy associates with better monitoring, allowing better adherence and more balanced HbA1c levels in the children. Conclusions: Interventions aimed at fostering social support, improving diabetes management, and decreasing perceived stress, might alleviate parents’ psychological symptoms by focusing on increasing their self-efficacy. Digital interventions might also represent valuable solutions to support parents in the management of paediatric diabetes not presented and substantiated in the main text and should not exaggerate the main conclusions.
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18
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Bishop M, Cohen LL, Robbertz AS. Illness-Related Parenting Stress and Maladjustment in Congenital Heart Disease: Mindfulness as a Moderator. J Pediatr Psychol 2020; 45:1208-1215. [PMID: 33051657 DOI: 10.1093/jpepsy/jsaa081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Congenital heart disease (CHD) is characterized by structural defects to the heart or the coronary blood vessels and often requires surgical repair. Raising an infant or toddler with CHD can be challenging and lead to high parenting stress and maladjustment. The parenting literature suggests that mindfulness may buffer parenting stress. The purpose of this study was to examine whether mindfulness might moderate the relationship between illness-related parenting stress and maladjustment in parents of infants and toddlers with CHD. METHODS Parents of infants and toddlers with CHD attending an outpatient clinic provided background information and completed measures of illness-related parenting stress, mindfulness, and maladjustment. RESULTS Results indicated that illness-related parenting stress was associated with maladjustment, and mindfulness moderated this relationship. Specifically, illness-related parenting stress was related to maladjustment at low and average levels of mindfulness; at high mindfulness, there was no association between illness-related parenting stress and maladjustment. CONCLUSIONS Consistent with the broader literatures, our sample of parents of infants and toddlers with CHD reported high illness-related parenting stress and maladjustment. Building on other studies demonstrating the benefits of mindful parenting, our results suggest that engaging in mindfulness might thwart the association between illness-related parenting stress and maladjustment in parents of infants and toddlers with CHD.
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19
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Di Riso D, Bassi G, Mancinelli E, Zaffani S, Salcuni S, Maffeis C. Mothers and Fathers Parenting Stress and Their Perception of Children's Psychosocial Functioning in Paediatric Diabetes: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134734. [PMID: 32630232 PMCID: PMC7369791 DOI: 10.3390/ijerph17134734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
Abstract
(1) Background: In the context of a child with Type 1 Diabetes Mellitus (T1DM), the rearrangement of the family’s lifestyle can account for an increased risk of experiencing psychosocial problems for both child and parents. Those few studies on pediatric diabetes, which focused on parents’ perception of children’s psychological strengths and weaknesses, reported significantly higher rates of children’s emotional and conduct problems associated with an imbalance in the Hemoglobin A1c (HbA1c). The main aim of this paper was to assess the role of parental perception of children’s psychosocial symptoms as a mediator of the perceived parenting stress, considering mother and father separately. (2) Methods: The study involved 12 parent couples (Mothers Mage = 40.25, SD = 6.58; Fathers Mage = 42.5, SD = 6.38) of children with T1DM aged between 7 and 11 years (Mage = 8.8, SD = 0.996). Parents completed questionnaires such as the Strengths and Difficulties Questionnaire for parents and their perspective of their child, and the Parenting Stress Index–Short Form. (3) Results: Mothers and fathers had significant differences in the perception of their child’s internalizing symptoms. Specifically, mothers present a greater perception of the mentioned symptoms compared to fathers. Mediation models showed that only for fathers’ perception of the child conduct problems has a significant role between the fathers’ perception of dysfunctional interaction with the child and the HbA1c. (4) Conclusions: The current study provides useful evidence also for clinical settings, suggesting that an interesting interplay between parenting stress, perception of children’s symptoms and glucometabolic control should be taken into consideration.
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Affiliation(s)
- Daniela Di Riso
- Department of Developmental Psychology and Socialization, University of Padova, 35122 Padova, Italy; (D.D.R.); (S.S.)
| | - Giulia Bassi
- Department of Developmental Psychology and Socialization, University of Padova, 35122 Padova, Italy; (D.D.R.); (S.S.)
- Fondazione Bruno Kessler, 38123 Trento, Italy
- Correspondence:
| | - Elisa Mancinelli
- Department of General Psychology, University of Padova, 35131 Padova, Italy;
| | - Silvana Zaffani
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Surgery, Dentistry, Pediatrics and Gynaecology, University-Hospital of Verona, 37126 Verona, Italy; (S.Z.); (C.M.)
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, 35122 Padova, Italy; (D.D.R.); (S.S.)
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Surgery, Dentistry, Pediatrics and Gynaecology, University-Hospital of Verona, 37126 Verona, Italy; (S.Z.); (C.M.)
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20
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Oser TK, Oser SM, Parascando JA, Grisolano LA, Krishna KB, Hale DE, Litchman M, Majidi S, Haidet P. Challenges and Successes in Raising a Child With Type 1 Diabetes and Autism Spectrum Disorder: Mixed Methods Study. J Med Internet Res 2020; 22:e17184. [PMID: 32217508 PMCID: PMC7301267 DOI: 10.2196/17184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Self-management of type 1 diabetes (T1D) requires numerous decisions and actions by people with T1D and their caregivers and poses many daily challenges. For those with T1D and a developmental disorder such as autism spectrum disorder (ASD), more complex challenges arise, though these remain largely unstudied. OBJECTIVE This study aimed to better understand the barriers and facilitators of raising a child with T1D and ASD. Secondary analysis of web-based content (phase 1) and telephone interviews (phase 2) were conducted to further expand the existing knowledge on the challenges and successes faced by these families. METHODS Phase 1 involved a qualitative analysis of publicly available online forums and blog posts by caregivers of children with both T1D and ASD. Themes from phase 1 were used to create an interview guide for further in-depth exploration via interviews. In phase 2, caregivers of children with both T1D and ASD were recruited from Penn State Health endocrinology clinics and through the web from social media posts to T1D-focused groups and sites. Interested respondents were directed to a secure web-based eligibility assessment. Information related to T1D and ASD diagnosis, contact information, and demographics were collected. On the basis of survey responses, participants were selected for a follow-up telephone interview and were asked to complete the adaptive behavior assessment system, third edition parent form to assess autism severity and upload a copy of their child's most recent hemoglobin A1c (HbA1c) result. Interviews were transcribed, imported into NVivo qualitative data management software, and analyzed to determine common themes related to barriers and facilitators of raising a child with both ASD and T1D. RESULTS For phase 1, 398 forum posts and blog posts between 2009 and 2016 were analyzed. Common themes related to a lack of understanding by the separate ASD and T1D caregiver communities, advice on coping techniques, rules and routines, and descriptions of the health care experience. For phase 2, 12 eligible respondents were interviewed. For interviewees, the average age of the child at diagnosis with T1D and ASD was 7.92 years and 5.55 years, respectively. Average self-reported and documented HbA1c levels for children with T1D and ASD were 8.6% (70 mmol/mol) and 8.7% (72 mmol/mol), respectively. Common themes from the interviews related to increased emotional burden, frustration surrounding the amount of information they are expected to learn, and challenges in the school setting. CONCLUSIONS Caregivers of children with both T1D and ASD face unique challenges, distinct from those faced by caregivers of individuals who have either disorder alone. Understanding these challenges may help health care providers in caring for this unique population. Referral to the diabetes online community may be a potential resource to supplement the care received by the medical community.
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Affiliation(s)
- Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sean M Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Lee Ann Grisolano
- Department of Psychiatry, Penn State College of Medicine, Herhsey, PA, United States
| | - Kanthi Bangalore Krishna
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State of College of Medicine, Hershey, PA, United States
| | - Daniel E Hale
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State of College of Medicine, Hershey, PA, United States
| | - Michelle Litchman
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Shideh Majidi
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, CO, United States
| | - Paul Haidet
- Departments of Medicine, Public Health Sciences, and Humanities, Penn State College of Medicine, Hershey, PA, United States
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21
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Cushman GK, Rich KL, Rea KE, Quast LF, Stolz MG, Gutierrez-Colina AM, Eaton CK, Lee JL, Mee LL, George R, Blount RL. Caregivers' Barriers to Facilitating Medication Adherence in Adolescents/Young Adults With Solid Organ Transplants: Measure Development and Validation. J Pediatr Psychol 2020; 45:498-508. [PMID: 32374379 DOI: 10.1093/jpepsy/jsaa023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the factor structure, validity, and reliability of the Caregiver Medication Barriers to Adherence Scale (CMBAS), which assesses caregivers' barriers to facilitating medication adherence in adolescent and young adults (AYAs) with solid organ transplants. METHODS The sample included 93 caregivers of AYAs ages 12-22 years who received a liver, kidney, or heart transplant. Caregivers completed the CMBAS and surveys to assess its validity, including internalizing symptoms, personality traits (i.e., neuroticism, conscientiousness), and AYAs' nonadherence to immunosuppressant medications. AYA nonadherence to tacrolimus was objectively assessed via the Medication Level Variability Index (MLVI). RESULTS Confirmatory factor analyses of the CMBAS revealed a two-factor model: Caregiver Emotional Distress and Caregiver Cognitive Burden/Responsibility. Higher CMBAS scores were related to higher levels of caregiver internalizing symptoms (rs = .28 to .30), neuroticism (r = .27), and caregiver proxy-reported immunosuppressant nonadherence (r = .27), as well as lower levels of caregiver conscientiousness (rs = -.25 to -.26). The CMBAS was not associated with the MLVI (rs = -.13 to -.16). CONCLUSIONS The CMBAS demonstrated reliability and validity for caregivers of AYAs with solid organ transplants. Findings support the use of the CMBAS as a brief clinical screening tool to identify caregivers' barriers to facilitating AYA medication adherence.
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Affiliation(s)
| | - Kristin Loiselle Rich
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati School of Medicine
| | | | | | | | - Ana M Gutierrez-Colina
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | - Jennifer L Lee
- Emory University School of Medicine.,Children's Healthcare of Atlanta
| | - Laura L Mee
- Emory University School of Medicine.,Children's Healthcare of Atlanta
| | - Roshan George
- Emory University School of Medicine.,Children's Healthcare of Atlanta
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22
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Pinquart M. Featured Article: Depressive Symptoms in Parents of Children With Chronic Health Conditions: A Meta-Analysis. J Pediatr Psychol 2020; 44:139-149. [PMID: 30346613 DOI: 10.1093/jpepsy/jsy075] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/25/2018] [Indexed: 11/12/2022] Open
Abstract
Objective Caring for children with chronic health conditions is associated with stressors that may impair mental health. The goal of our meta-analysis was to analyze depressive symptoms among parents who care for a child or adolescent with chronic physical disease and/or sensory disability and/or physical disability compared with parents of healthy children or test norms. Methods A systematic search through electronic databases identified 460 relevant studies that were included in a random-effects meta-analysis. Results Parents of children with chronic conditions showed small to moderate elevations of depressive symptoms compared with parents of healthy/nondisabled children and test norms (g = .46 SD units). Twelve studies using structured clinical interviews provided a weighted mean depression rate of 20.9%. The highest elevations were found among parents of young people with neuromuscular disorders, cancer, and cerebral palsy. Elevations of depressive symptoms were greater in cases with shorter durations of the chronic condition, in mothers compared with fathers, and in parents from economically less developed countries rather than developed countries. Conclusions Parents of children with chronic conditions, particularly parents of children with neuromuscular disorders, cancer, and cerebral palsy, should be screened for depression and receive psychosocial services aimed at reducing these symptoms, if needed.
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Enlow PT, Wasserman R, Aroian K, Lee J, Wysocki T, Pierce J. Development and Validation of the Parent-Preschoolers Diabetes Adjustment Scale (PP-DAS). J Pediatr Psychol 2020; 45:170-180. [PMID: 31710685 DOI: 10.1093/jpepsy/jsz093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This article extends work on a social-ecological model of caregiver adjustment and describes the: (a) development and (b) validation of the Parent-Preschoolers Diabetes Adjustment Scale (PP-DAS), a broad measure of caregiver adjustment. METHODS Participants were caregivers (nstudy1 = 51; nstudy2 = 177) of very young children (<6 years old) with Type 1 diabetes (T1D). In study 1, researchers and stakeholders collaborated to develop 92 items using the 5 domains of a social-ecological model of caregiver adjustment to the challenges of raising a very young child with T1D, and parents and researchers provided feedback on these items. In study 2, confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to examine the factor structure of the PP-DAS. Reliability and validity were also examined. RESULTS After review by parents and researchers, 52 items were removed resulting in the 40-item version used in study 2. The CFA demonstrated poor fit with the five proposed domains of the social-ecological model, so an EFA was conducted and supported a different five-factor solution. Twenty items were removed due to low factor loadings or communalities, resulting in a final 20-item measure. The PP-DAS demonstrated adequate internal consistency (α's = .73-.84), convergent validity with parent psychological functioning and self-efficacy in T1D management, and criterion validity with hemoglobin A1c and adherence. CONCLUSIONS The PP-DAS is a valid and reliable measure of adjustment in caregivers of very young children with T1D. The PP-DAS may help identify caregivers who are having adjustment difficulties and would benefit from additional support.
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Affiliation(s)
- Paul T Enlow
- Center for Healthcare Delivery Science, Nemours/A.I. duPont Hospital for Children
| | - Rachel Wasserman
- Center for Healthcare Delivery Science, Nemours Children's Hospital
| | - Karen Aroian
- College of Nursing, University of Central Florida
| | - Joyce Lee
- Division of Pediatric Endocrinology, University of Michigan
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Health System
| | - Jessica Pierce
- Center for Healthcare Delivery Science, Nemours Children's Hospital
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Annunziato RA, Stuber ML, Supelana CJ, Dunphy C, Anand R, Erinjeri J, Alonso EM, Mazariegos GV, Venick RS, Bucuvalas J, Shemesh E. The impact of caregiver post-traumatic stress and depressive symptoms on pediatric transplant outcomes. Pediatr Transplant 2020; 24:e13642. [PMID: 31880384 DOI: 10.1111/petr.13642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
PTSS as well as symptoms of depression have been reported in children who experience a serious medical adversity as well as their caretakers. The adverse effects of PTSS, when experienced by the patients, on medical outcomes have been clearly documented. However, the impact of those symptoms, if any, when experienced by the caretakers on child outcomes has not been investigated prospectively. We evaluated whether caregiver PTSS and depression symptoms predict adherence to medications and medical outcomes in a prospective multisite study. Four hundred children participated in MALT. Caretaker PTSS were assessed by the IES and depressive symptoms by CES-D. During 2 years of follow-up, the MLVI was used to determine adherence. Centrally read, biopsy-confirmed organ rejection was the primary medical outcome. IES scores were not associated with either adherence or rejection outcomes. In contrast, there were significant correlations between CES-D (depression) scores and lower adherence, r = .13, P < .001, and a trend toward higher scores on the CES-D among those whose children had experienced rejection, 12.4 (SD = 10.9) versus 9.1 (SD = 8.6), P = .077. Caregivers' PTSS were not a risk factor for poor child outcomes in this cohort, whereas depression symptoms were associated with non-adherence and possibly increased rates of rejection. Further study can validate if caregivers' depression as opposed to PTSS confers greater risk and should be a focus during the clinical care of medically ill children.
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Affiliation(s)
- Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | - Christina J Supelana
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | - Claire Dunphy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | | | - Estella M Alonso
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | - John Bucuvalas
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, New York
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Derakhshanpour F, Mohammadian S, Zaeri2 H, Sanei Y, Leila K. Relationship between Psychosocial Factors and Glycemic Control in 7-16 Years Old Children with Type 1 Diabetes. JOURNAL OF CLINICAL AND BASIC RESEARCH 2020. [DOI: 10.29252/jcbr.4.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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26
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27
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The Social Context and Illness Identity in Youth with Type 1 Diabetes: A Three-Wave Longitudinal Study. J Youth Adolesc 2019; 49:449-466. [DOI: 10.1007/s10964-019-01180-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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Whittemore R, Coleman J, Delvy R, Zincavage R, Ambrosoli JA, Shi L, Kato B, Marceau L. An eHealth Program for Parents of Adolescents With T1DM Improves Parenting Stress: A Randomized Control Trial. DIABETES EDUCATOR 2019; 46:62-72. [PMID: 31808376 DOI: 10.1177/0145721719890372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the short-term effects of the Type 1 Teamwork program for parents of adolescents with type 1 diabetes mellitus (T1DM) on the primary outcome of psychosocial stress. METHODS The study was a randomized wait-list control trial evaluating an eHealth program to reduce parenting stress around T1DM management during adolescence through interactive sessions on the safe transfer of responsibility, positive communication, and stress management. The primary outcome was psychosocial stress (parenting stress specific to child illness and general stress). Secondary outcomes included depressive and anxiety symptoms, parent support for adolescent autonomy, family conflict, and adolescent metabolic control (A1C). Data were collected at baseline, 3 months, and 6 months online. Mixed-model analyses were conducted, using intent-to-treat procedures. RESULTS Parents (n = 162) had a mean age of 45.6 (±5.3) years, were 98% female, 91% white, 91% married/partnered, 51% of high income, and geographically dispersed around the United States. Parents reported that adolescents had a mean A1C of 7.9% (±1.2%) and T1DM duration of 5.08 (±3.62) years. At 6 months, parents in the Type 1 Teamwork group demonstrated less parenting stress compared with the control group. There were no differences between groups on general stress or secondary outcomes. Attrition at 6 months was 32% in the treatment group and 11% in the control group. CONCLUSIONS An eHealth program for parents of adolescents with T1DM improves parenting stress in a sample of parents from across the United States.
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Affiliation(s)
| | | | | | | | | | - Ling Shi
- HealthCore, Inc, Watertown, Massachusetts
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29
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Shomaker LB, Cox S, Lehman DP, Kelly NR, Thompson KA, Mehari RM, Brady SM, Galescu OA, Demidowich AP, Chen KY, Tanofsky-Kraff M, Yanovski JA. Depressive symptoms in adolescent girls at-risk for type 2 diabetes and their parents. PSYCHOL HEALTH MED 2019; 25:530-540. [PMID: 31684760 DOI: 10.1080/13548506.2019.1687914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Few studies have characterized the relation between parent's depression symptoms and adolescent's depression symptoms in adolescents at-risk for type 2 diabetes (T2D). We evaluated the associations of parental depression symptoms with the depression symptoms and metabolic functioning of adolescent offspring at-risk for T2D. One-hundred sixteen parents and adolescent girls with a family history of diabetes completed surveys of depression symptoms. Adolescents' degree of metabolic risk for T2D was estimated from body mass index (BMI; kg/m2) standard score, percent adiposity from dual-energy x-ray absorptiometry scan, and whole body insulin sensitivity index determined from glucose/insulin concentrations during a two-hour oral glucose tolerance test. Parents' and adolescents' depression symptoms were significantly associated, even after accounting for race/ethnicity, age, puberty, body composition, and parental diabetes/BMI. Adjusting for similar covariates, parent depression symptoms also were positively related to adolescents' BMI standard score and had a trend-level association with adiposity. There was an inverse relation between parental depression symptoms and adolescent insulin sensitivity, which was entirely accounted for by adolescent body composition. The associations of parental depression symptoms with more elevated depression symptoms and higher BMI in adolescents at-risk for T2D has potential implications for interventions addressing these co-morbid health conditions.
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Affiliation(s)
- Lauren B Shomaker
- Department of Human Development and Family Studies and Colorado School of Public Health, Colorado State University, Fort Collins, USA.,Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA.,Department of Medical and Clinical Psychology, Department of Defense (DOD), Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA
| | - Shelby Cox
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, USA
| | - Devon P Lehman
- Department of Human Development and Family Studies and Colorado School of Public Health, Colorado State University, Fort Collins, USA
| | - Nichole R Kelly
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA.,Department of Medical and Clinical Psychology, Department of Defense (DOD), Uniformed Services University of the Health Sciences (USUHS), Bethesda, USA.,Department of Counseling Psychology and Human Services and the Prevention Science Institute, University of Oregon, Eugene, USA
| | - Katherine A Thompson
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Rim M Mehari
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Sheila M Brady
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Ovidiu A Galescu
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Andrew P Demidowich
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
| | - Kong Y Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, DHHS, Bethesda, USA
| | - Marian Tanofsky-Kraff
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA.,Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, USA
| | - Jack A Yanovski
- Department of Health and Human Services (DHHS), Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, USA
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Capistrant BD, Friedemann-Sánchez G, Pendsey S. Diabetes stigma, parent depressive symptoms and Type-1 diabetes glycemic control in India. SOCIAL WORK IN HEALTH CARE 2019; 58:919-935. [PMID: 31675285 DOI: 10.1080/00981389.2019.1679321] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 05/27/2023]
Abstract
Diabetes distress and stigma have been associated with worse patient outcomes in developed countries. However, diabetes stigma has not been studied in low and middle-income countries where clinical practices differ, diabetes awareness is lower, and families face different challenges for supporting children with Type 1 Diabetes (T1D). This study assessed the relationship between parental depression and diabetes stigma with a child's glycemic control in a clinic-based survey in Nagpur, India. The association between self-reported T1D stigma, depressive symptoms, and child's measured glycemic control (HbA1C) was assessed with data from 165 of the parents of school-aged (aged 5+) children receiving clinical T1D care at an urban nonprofit organization that provides free clinical care to children with Type-1 Diabetes (T1D) in India. Parents with moderate/severe depressive symptoms who experience stigma associated with their child's diabetes had children with significantly worse glycemic control than parents with no/mild depressive symptoms who experience the same amount of stigma. Higher reports of stigma were associated with an average of 0.65 points higher HbA1C (β = 0.65, 95% Confidence Interval (CI): 0.18, 1.13) for parents with moderate/severe than parents with mild/no depressive symptoms. Indian parents with depressive symptoms who face social stigma associated with their child's diabetes have children with worse T1D outcomes.
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Affiliation(s)
| | | | - Sharad Pendsey
- Diabetes Research, Education And Management (DREAM) Trust, Nagpur, India
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Nefs G, Nguyen L, Winterdijk P, Hartman E, Sas T, Nuboer R, De Kruijff I, Bakker-van Waarde W, Aanstoot HJ, Pouwer F. Study protocol of Diabetes LEAP: a longitudinal study examining emotional problems in adolescents with type 1 diabetes and their parents/caregivers. BMC Pediatr 2019; 19:377. [PMID: 31651275 PMCID: PMC6813041 DOI: 10.1186/s12887-019-1743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a chronic metabolic condition requiring intensive daily self-care to avoid both high and low blood glucose levels. Self-care and glycemic outcomes are particularly problematic in adolescence, a period known for its increased risk of emotional problems. However, the true scope of mood and anxiety disorders in adolescents with T1D is unknown. Earlier studies are limited by a small sample size, lack of diagnostic interview data, a focus on depression only, non-adolescent specific estimates, lack of information about parental emotional problems and/or a cross-sectional design. Diabetes LEAP is a two-year prospective observational cohort study examining (a) the prevalence and course of depression and anxiety in adolescents with T1D and their parents/caregivers, (b) the risk factors predicting the presence of these emotional problems, (c) their longitudinal relation with diabetes outcomes, and (d) the psychosocial care currently in place. METHODS Adolescents (12-18 years) from 8 Dutch pediatric diabetes clinics are interviewed using the DISC-IV to establish the presence of mood and anxiety disorders in the previous 4 weeks, the previous 12 months, and lifetime. They also complete questionnaires, including CDI-2, GAD-7, and PAID-T. Parents/caregivers complete PHQ-9, GAD-7, and PAID-PR. Follow-up assessments take place after 1 and 2 years. DISCUSSION This longitudinal study with diagnostic interviews in a large cohort of adolescents with T1D in the Netherlands will provide much needed information regarding the prevalence and course of depression and anxiety in this group, thereby opening avenues for proper recognition, prevention and timely treatment.
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Affiliation(s)
- Giesje Nefs
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands. .,Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Huispost 840, Postbus 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Linh Nguyen
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Per Winterdijk
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands
| | - Esther Hartman
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Theo Sas
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands.,Department of Pediatrics, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318, AT, Dordrecht, The Netherlands.,Department of Pediatric Endocrinology, Erasmus Medical Center - Sophia Childrens' Hospital, Rotterdam, The Netherlands
| | - Roos Nuboer
- Department of Pediatrics, Meander Medical Center, Maatweg 3, 3813, Amersfoort, TZ, Netherlands
| | - Ineke De Kruijff
- Department of Pediatrics, Diabetes Centraal, St. Antonius Hospital, Soestwetering 1, 3543, AZ, Utrecht, The Netherlands
| | - Willie Bakker-van Waarde
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,School of Psychology, Deakin University, Locked Bag 20001, Geelong, VIC, 3220, Australia.,STENO Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Parenting Styles and Internalizing Symptoms in Adolescence: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173192. [PMID: 31480548 PMCID: PMC6747480 DOI: 10.3390/ijerph16173192] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/29/2019] [Accepted: 08/31/2019] [Indexed: 12/24/2022]
Abstract
A growing body of recent research has identified associations between various parenting practices and styles and internalizing problems among adolescents. However, the reported findings are inconsistent and the studies in question have been conducted from different theoretical backgrounds. The aim of this systematic review was to synthesize the literature on the association of parental socialization styles with depression, anxiety, and suicidal ideation. To this end, we conducted a systematic search of the PsycInfo, Scopus, Pubmed, and Web of Science databases, covering literature published from 2010 to 2019. The search was restricted to peer-reviewed studies in English or Spanish. The results show that parental warmth, behavioural control, and autonomy granting are inversely related to internalizing symptoms in adolescents. Conversely, psychological control and harsh control by parents are positively associated with adolescent anxiety, depression, and suicidal ideation. Although the associated effect sizes are only small or moderate, the results suggest that these variables should be taken into account when designing programmes aimed at promoting parenting styles conducive to the wellbeing of adolescents.
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Bishop MN, Gise JE, Donati MR, Shneider CE, Aylward BS, Cohen LL. Parenting Stress, Sleep, and Psychological Adjustment in Parents of Infants and Toddlers With Congenital Heart Disease. J Pediatr Psychol 2019; 44:980-987. [DOI: 10.1093/jpepsy/jsz026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Objective
Parents of children with chronic medical needs report increased parenting challenges, poor sleep, and maladjustment. The impact of parenting stress on both sleep and adjustment has yet to be evaluated for parents of infants and young children with congenital heart disease (CHD). We studied the relations among parenting stress, sleep, and adjustment in parents of infants and toddlers with CHD. We expected that sleep quality would mediate the relationship between parenting stress and adjustment.
Methods
Sixty-nine parents of infants and toddlers with CHD were evaluated on self-report measures of illness-related parenting stress (Pediatric Inventory for Parents), sleep (Pittsburgh Sleep Quality Index), and psychological adjustment (Brief Symptom Index-18).
Results
The parents of infants and toddlers with CHD reported elevated levels of parenting stress, sleep problems, and maladjustment. The positive relationship between parenting stress and parent maladjustment was mediated by sleep quality.
Conclusions
Findings suggest that parents of infants and toddlers with CHD report high parenting stress, poor sleep, and maladjustment. Analyses indicate the stress-adjustment relationship is mediated by quality of sleep. Given the multiple demands on parents of infants and children with CHD, it is important to attend to parents’ overall functioning and mental health. Our findings highlight targets for intervention to improve the well-being of parents of young children with CHD.
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Affiliation(s)
| | - Jensi E Gise
- Department of Psychology, Georgia State University
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Kentor RA, Hilliard ME. JPP Student Journal Club Commentary: Considerations on Depression, Distress, and Resilience in Parents of Children With Chronic Health Conditions. J Pediatr Psychol 2019; 44:150-152. [PMID: 30590517 DOI: 10.1093/jpepsy/jsy096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Rachel A Kentor
- Baylor College of Medicine.,Texas Children's Hospital, Houston, TX
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Dempster KW, Liu A, Nansel TR. Depression and parenting in youth with type 1 diabetes: Are general and diabetes-specific parenting behaviors associated with depressive symptoms over a 2-year period? J Behav Med 2019; 42:842-850. [PMID: 30694403 DOI: 10.1007/s10865-019-00011-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 01/12/2019] [Indexed: 12/31/2022]
Abstract
To examine cross-sectional and longitudinal associations of general parenting style and diabetes-specific parenting behaviors with depression in youth with type 1 diabetes. Participants (n = 390) completed self-report measures of depression at baseline and 2-year follow-up, general parenting style at baseline, and diabetes-specific parenting (conflict, task involvement, and collaborative involvement) at baseline and every 6 months. Logistic regression examined associations of parenting with depression at baseline and 2-year follow-up. A less authoritative parenting style, lower parent collaborative involvement, and greater diabetes-related conflict were associated with baseline depression in the model simultaneously including all parenting variables and covariates. Lower parent collaborative involvement and higher diabetes-related conflict were associated with depression at 2-year follow-up, adjusting for baseline depression and covariates. Parent task involvement was not associated with depression at either time. Findings suggest a protective role of parenting in reducing the risk of depression in youth with type 1 diabetes.
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Affiliation(s)
- Katherine W Dempster
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Aiyi Liu
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Tonja R Nansel
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
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Prikken S, Oris L, Rassart J, Missotten LC, Weets I, Moons P, Goubert L, Luyckx K. Parental illness intrusiveness and youth glycaemic control in type 1 diabetes: intergenerational associations and processes. Psychol Health 2019; 34:438-455. [PMID: 30636450 DOI: 10.1080/08870446.2018.1538451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined associations between the functioning of youth with type 1 diabetes and their parents, including parenting dimensions as intervening mechanisms. The study adds to the existing literature by focusing on (1) the concept of parental illness intrusiveness; (2) the (understudied) periods of adolescence and emerging adulthood; and (3) maternal and paternal functioning. DESIGN Questionnaires were completed by 317 patient-mother dyads and 277 patient-father dyads. All patients (aged 14-25) had type 1 diabetes. The hypothesised model was compared to an alternative model using structural equation modelling. MAIN OUTCOME MEASURES Youth reported on depressive symptoms and treatment adherence; Physicians provided HbA1c-values. Parents reported on illness intrusiveness, depressive symptoms, and their child's treatment adherence. Patients and parents reported on psychological control and overprotection. RESULTS The hypothesised path model had a good fit to the data. Parental illness intrusiveness was positively associated with depressive symptoms and both were positively related to overprotection and psychological control. Psychological control was positively related to patients' depressive symptoms and negatively to treatment adherence. Poorer treatment adherence was associated with worse HbA1c-values. CONCLUSION These findings underscore the relevance of parental illness intrusiveness and emphasise the importance of mothers' and fathers' roles throughout adolescence and emerging adulthood.
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Affiliation(s)
- Sofie Prikken
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | - Leen Oris
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | - Jessica Rassart
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | | | - Ilse Weets
- c Free University Brussels , Brussels , Belgium
| | - Philip Moons
- a KU Leuven , Leuven , Belgium.,d University of Gothenburg , Gothenburg , Sweden
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Maternal Parenting Styles and Glycemic Control in Children with Type 1 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020214. [PMID: 30646525 PMCID: PMC6352042 DOI: 10.3390/ijerph16020214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
The purpose of this study is to examine differences in parenting styles between mothers of children with type 1 diabetes and mothers of healthy children and to explore relationships between parenting styles and glycemic control of children with diabetes. Mothers of 63 children with diabetes and mothers of 83 children without diabetes reported their parenting styles using the Blocks' Child Rearing Practices Report, when their child was 9⁻10 years old. Glycemic control of the children with diabetes was evaluated 1 year after diagnosis (<6 years of age) and at the time of the study (at 9⁻10 years). Mothers of children with diabetes used more psychological control than mothers of healthy children. Among girls with diabetes, poorer early glycemic control was associated with mothers' subsequent greater use of psychological control. Behavioral control was positively associated with poorer current glycemic control. In boys, psychological control was positively associated with poorer current glycemic control. Psychological control in families with diabetes needs attention, because it has shown to be associated with poorer diabetes care.
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Ferrito L, Predieri B, Pjetraj D, Alessandrelli MC, Pagnini M, Iannilli A, Marino M, Tombolini S, Pintaudi B, Lucisano G, Zani F, Iughetti L, Nicolucci A, Cherubini V. Weekend-Based Parent-Group Intervention to Reduce Stress in Parents of Children and Adolescents with Type 1 Diabetes: A Pilot Study. J Diabetes Res 2019; 2019:7935945. [PMID: 31871949 PMCID: PMC6906866 DOI: 10.1155/2019/7935945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/28/2019] [Accepted: 09/12/2019] [Indexed: 02/07/2023] Open
Abstract
Diagnosis of type 1 diabetes (T1D) in a child is often associated with anger, denial, fear, and depression from the parents. The aim of the study was to improve parents' adaptation to the diagnosis of diabetes of their child. Sixty-two parents (29 mothers, 33 fathers) of 36 children with type 1 diabetes (mean age = 11.3-3.3 years; diabetes duration > 1 year; HbA1c = 57 ± 11 mmol/mol) participated in a three-day educational working group pilot intervention study. Intervention was based on the reexamination of the traumatic event of diagnosis of T1D through spatial and time-line anchorage, retracing of the future, emotional awareness, and interactive discussion. Relaxing technique, diaphragmatic breathing, and guided visualization were used by 2 psychologists and 1 pediatric endocrinologist. The study was approved by EC and participants filled a consent form. At baseline and after intervention, parents filled in a questionnaire including Diabetes-Related Distress (DRD), Parent Health Locus of Control Scale (PHLOC), Parent Stress Index Short Form (PSI-SF), Hypoglycemia Fear Survey-Parents (HFS-P) and Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC), and Health Survey Short Form-36 (SF-36). Three months after the intervention, both parents reported a reduction in the "difficult child" subscale of the PSI-SF (p < 0.05) and increased scores of social functioning of the SF-36 (p < 0.05). DRD score was significantly reduced in mothers (p = 0.03), while the "parental distress" subscale of the PSI-SF was significantly improved in fathers (p = 0.03). This weekend-based parent group intervention seems to reduce stress and improve social functioning of parents of children and adolescents with type 1 diabetes.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Adolescent Behavior
- Adult
- Age Factors
- Breathing Exercises
- Child
- Child Behavior
- Child, Preschool
- Cost of Illness
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Emotions
- Feasibility Studies
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Imagery, Psychotherapy
- Male
- Middle Aged
- Parents/education
- Parents/psychology
- Pilot Projects
- Psychotherapy, Group
- Relaxation Therapy
- Social Behavior
- Stress, Psychological/diagnosis
- Stress, Psychological/prevention & control
- Stress, Psychological/psychology
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Lucia Ferrito
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Manuela Pagnini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Antonio Iannilli
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Monica Marino
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Stefano Tombolini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Giuseppe Lucisano
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Fabiana Zani
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Nicolucci
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
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Robinson DJ, Coons M, Haensel H, Vallis M, Yale JF. Diabetes and Mental Health. Can J Diabetes 2018; 42 Suppl 1:S130-S141. [PMID: 29650085 DOI: 10.1016/j.jcjd.2017.10.031] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 01/28/2023]
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Wherrett DK, Ho J, Huot C, Legault L, Nakhla M, Rosolowsky E. Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S234-S246. [DOI: 10.1016/j.jcjd.2017.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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41
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Crandell JL, Sandelowski M, Leeman J, Havill NL, Knafl K. Parenting behaviors and the well-being of children with a chronic physical condition. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2018; 36:45-61. [PMID: 29172624 PMCID: PMC5880719 DOI: 10.1037/fsh0000305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Numerous studies have identified the importance of parenting behaviors to the well-being of children with chronic physical conditions. Synthesizing the findings of these studies has potential to identify which parenting behaviors are associated with specific aspects of child well-being. METHOD We retrieved research reports addressing the relationship between parenting behaviors and well-being in children with chronic physical conditions, and categorized parenting behaviors based on Skinner, Johnson, and Snyder's (2005) core dimensions of parenting (warmth, rejection, structure, chaos, autonomy support, and coercion) Through meta-analysis, we examined relationships between parenting dimension and child well-being variables. RESULTS Fifty-four reports from 47 unique studies met inclusion criteria. Parent warmth was associated with less child depression, better quality of life, better physical functioning, and fewer externalizing behavior problems. Parent rejection was associated with more child depression, internalizing/externalizing behavior problems, and poorer physical functioning. Parent structure was associated with better child physical functioning. Parent chaos was associated with poorer child physical functioning. Parent autonomy support was associated with better quality of life and fewer externalizing behavior problems. Parent coercion was associated with more child depression, poorer quality of life, poorer physical function, and more internalizing behavior problems. CONCLUSION The results identify multiple, potentially modifiable parenting dimensions associated with well-being in children with a chronic condition, which could be targeted in developing family-focused interventions. They also provide evidence that research using Skinner's core dimensions could lead to conceptualization and study of parenting behaviors in ways that would enable comparison of parenting in a variety of health and sociocultural contexts. (PsycINFO Database Record
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Affiliation(s)
| | | | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill
| | - Nancy L Havill
- School of Nursing, University of North Carolina at Chapel Hill
| | - Kathleen Knafl
- School of Nursing, University of North Carolina at Chapel Hill
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Whittemore R, Zincavage RM, Jaser SS, Grey M, Coleman JL, Collett D, Delvy R, Basile Ibrahim B, Marceau LD. Development of an eHealth Program for Parents of Adolescents With Type 1 Diabetes. DIABETES EDUCATOR 2017; 44:72-82. [PMID: 29262747 DOI: 10.1177/0145721717748606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose The purpose of this study was to understand the experience of parenting an adolescent with type 1 diabetes (T1DM), to develop a prototype of an eHealth program for parents of adolescents with T1DM, and to evaluate the prototype content and acceptability from the perspective of parents and health care providers. Methods A multiphase method was used generating both qualitative and quantitative data at multiple time points. There were 27 parents of adolescents aged 12 to 18 years with T1DM and 16 health care providers who participated in semistructured interviews to identify parental challenges; 53 parents and 27 providers evaluated the prototype. Thematic content analysis was used to analyze interview transcripts, and descriptive statistics were used to summarize survey data. Results Challenges experienced by parents of adolescents with T1DM included understanding the developmental and hormonal changes of adolescence that affect diabetes care, feeling tension between adolescent independence and parent control, communicating without nagging or conflict, transferring diabetes care responsibility safely, dealing with feelings of stress and distress, and perceiving a lack of resources for T1DM care and insufficient personal time for self-care. In the prototype evaluation, both parents and providers found content to be relevant and provided feedback to guide the development of the full program. Conclusions Parents of adolescents with T1DM and providers expressed a need for parents to have more support in transitioning diabetes care from parent to adolescent. eHealth programs offer an ideal way to address these needs and ultimately can be linked to electronic medical records improving quality and efficiency of health care in this population.
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Kelly LM, Becker SJ, Spirito A. Parental monitoring protects against the effects of parent and adolescent depressed mood on adolescent drinking. Addict Behav 2017; 75:7-11. [PMID: 28662437 PMCID: PMC6502636 DOI: 10.1016/j.addbeh.2017.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/06/2017] [Accepted: 06/16/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Parental monitoring is a well-established protective factor for adolescent drinking. This study examined whether parental monitoring protected against three common risk factors for alcohol use in a sample of high-risk adolescents: parental depressed mood, adolescent depressed mood, and parental alcohol use. METHODS Participants included 117 adolescents (mean age=15.5; 52% female) who presented to the hospital emergency department due to an alcohol-related event and their primary parent/guardian. Adolescents completed self-report measures of alcohol use frequency, depressed mood, and parental monitoring, while parents completed self-report measures of problematic alcohol use and depressed mood. RESULTS Hierarchical regression confirmed that parental monitoring was associated with lower frequency of adolescent alcohol use, even after controlling for the three risk factors. Significant interactions were found between parental monitoring and both adolescent and parental depressed mood. Parental monitoring had significant protective effects against drinking frequency among adolescents with higher levels of depressed mood, but not among adolescents with lower levels of depressed mood. By contrast, parental monitoring only had protective effects among those parents with lower levels of depressed mood. Parental problematic alcohol use did not affect the relationship between parental monitoring and adolescent alcohol use. CONCLUSIONS Our results suggest that adolescents with high levels of depressed mood may be more likely to benefit from parental monitoring, whereas parents with high levels of depressed mood may be less likely to monitor effectively. Interventions targeting parental monitoring in high-risk adolescents should take into account the influence of both adolescent and parental depressed mood.
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Affiliation(s)
- Lourah M Kelly
- Department of Psychology, Suffolk University, 73 Tremont St, Boston, MA 02108, USA.
| | - Sara J Becker
- Center for Alcohol and Addictions Studies, Brown University, 121 South Main Street, Providence, RI 02903, USA; Department of Psychiatry and Human Behavior, Brown University Medical School, Duncan Building, Duncan Building Box G-BH, Providence, RI 02912, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University Medical School, Duncan Building, Duncan Building Box G-BH, Providence, RI 02912, USA
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Berg CA, Butner J, Wiebe DJ, Lansing AH, Osborn P, King PS, Palmer DL, Butler JM. Developmental model of parent-child coordination for self-regulation across childhood and into emerging adulthood: Type 1 diabetes management as an example. DEVELOPMENTAL REVIEW 2017; 46:1-26. [DOI: 10.1016/j.dr.2017.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Jaser SS, Lord JH, Savin K, Gruhn M, Rumburg T. Developing and Testing an Intervention to Reduce Distress in Mothers of Adolescents with Type 1 Diabetes. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2017; 6:19-30. [PMID: 30345210 DOI: 10.1037/cpp0000220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives To develop and pilot test a program to meet the needs of mothers of adolescents with type 1 diabetes (T1D) and improve outcomes in adolescents with type 1 diabetes. Methods We conducted focus groups with mothers of adolescents to identify needs and develop a cognitive behavioral intervention aimed at reducing maternal distress, improving parenting practices, and reducing family conflict. This intervention was pilot tested in a randomized trial; mothers were randomized to either the Coping & Communication (N=15) intervention or Usual Care (N=15). Mothers and adolescents completed questionnaires measuring distress, parenting, and family conflict pre- and post-intervention, and HbA1c values were obtained from adolescents' medical records pre- and post-intervention. Results Intervention materials (Communication & Coping) received high scores on health literacy and engagement. There was a significant Time × Group interaction for maternal diabetes distress, family conflict (as reported by both mothers and adolescents) and adolescent quality of life. Mothers and adolescents randomized to the intervention group reported significant improvements on these factors as compared to those randomized to usual care. Conclusions The Communication & Coping program was developed by adapting existing interventions proven to reduce depressive symptoms and improve parenting practices to address the specific needs of mothers of adolescents with T1D. The program shows promise for not only reducing distress in mothers, but also for improving adolescent outcomes, possibly through reductions in family conflict.
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Affiliation(s)
- Sarah S Jaser
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Jadienne H Lord
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Kimberly Savin
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Meredith Gruhn
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Tamara Rumburg
- Department of Pediatrics, Vanderbilt University, Nashville, USA
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Pierce JS, Kozikowski C, Lee JM, Wysocki T. Type 1 diabetes in very young children: a model of parent and child influences on management and outcomes. Pediatr Diabetes 2017; 18:17-25. [PMID: 26712357 PMCID: PMC7418073 DOI: 10.1111/pedi.12351] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022] Open
Abstract
The incidence of type 1 diabetes (T1D) in very young children (YC-T1D) is increasing globally. Managing YC-T1D is challenging from both a medical and psychosocial perspective during this vulnerable developmental period when complete dependence upon parental caretaking is normative and child behavior is unpredictable. The consequences of suboptimal glycemic control during this age range are substantial since these children will have T1D for many years and they are prone to adverse neuropsychological sequelae. Poor adaptation to T1D during these early years may engender a persistent trajectory of negative outcomes that can be very resistant to change. The empirical research on the YC-T1D population (age <6 yr) has indicated multiple mechanisms through which parent characteristics, parent coping skills, and child characteristics interact to yield a pattern of T1D management behaviors that affect T1D outcomes. However, this research has not yet led to a well-conceived conceptual model for identifying and understanding these mechanisms or for specifying research gaps and future research directions. The aim of this review is to propose such a conceptual model linking parent characteristics, parent coping, and child characteristics to T1D management behaviors and outcomes. This article reviews the literature focusing on research pertinent to YC-T1D and elements of our proposed model, identifies and discusses gaps in the literature, offers directions for future research, and considers a range of possible interventions targeting the unique needs of this special population.
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Affiliation(s)
- Jessica S Pierce
- Nemours Research Institute, Center for Health Care Delivery Science, Nemours Children’s Health System, Orlando, FL, USA
| | - Chelsea Kozikowski
- Department of Biomedical Research, Center for Health Care Delivery Science, Nemours Children’s Health System, Jacksonville, FL, USA
| | - Joyce M Lee
- Division of Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, USA
| | - Tim Wysocki
- Department of Biomedical Research, Center for Health Care Delivery Science, Nemours Children’s Health System, Jacksonville, FL, USA
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Markowitz B, Parsons JA, Advani A. Diabetes in Emerging Adulthood: Transitions Lost in Translation. Can J Diabetes 2016; 41:1-5. [PMID: 27658766 DOI: 10.1016/j.jcjd.2016.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/03/2016] [Accepted: 06/07/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Benjamin Markowitz
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Janet A Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Physical Therapy and the Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Advani
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
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Robinson EM, Weaver P, Chen R, Streisand R, Holmes CS. A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control. Health Psychol 2016; 35:1373-1382. [PMID: 27513476 DOI: 10.1037/hea0000406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Parental monitoring of adolescents' diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. METHOD Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: (a) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting), and (b) assessed their relation to parental monitoring, youth adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical implications of daily parental monitoring. RESULTS Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which, in turn, related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%). CONCLUSIONS A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. (PsycINFO Database Record
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Affiliation(s)
| | | | - Rusan Chen
- Center For New Designs In Learning and Scholarship, Georgetown University
| | - Randi Streisand
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine and Clinical Psychology, Children's National Medical Center
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Gruhn MA, Lord JH, Jaser SS. Collaborative and Overinvolved Parenting Differentially Predict Outcomes in Adolescents With Type 1 Diabetes. Health Psychol 2016; 35:2016-13811-001. [PMID: 26998735 PMCID: PMC5031507 DOI: 10.1037/hea0000349] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The current study examined the impact of collaborative and intrusive parenting on depression and glycemic control in children with Type 1 diabetes (T1D). Research examining the association between parenting and child adjustment in this population has been limited by a reliance primarily on questionnaire data and cross-sectional analyses. To address these gaps, the current study used an observational coding system to measure the effects of parenting on child adjustment over a 1-year period. METHOD Youth (10 to 16 years old) with T1D and their mothers (N = 81) were recruited from an outpatient pediatrics diabetes clinic. Mothers' symptoms of anxiety and depression and children's depressive symptoms were assessed by self- reports; parenting behaviors were assessed via video-recorded observations coded using the Iowa Family Interaction Rating Scales; and adolescents' glycosylated hemoglobin (HbA1c) was obtained from medical records. RESULTS Bivariate correlations and linear regression analyses revealed that higher levels of observed collaborative parenting were related to significantly lower HbA1c 12 months later, and higher levels of observed overinvolved parenting were related to significantly greater child depressive symptoms 12 months later. Further, age and treatment type moderated the relation between overinvolved parenting and child depressive symptoms. CONCLUSIONS Collaborative and overinvolved parenting appears important for adolescents in predicting both psychological and health-related outcomes over time. Parenting behaviors may serve as an important target for future interventions to enhance adjustment in these children. (PsycINFO Database Record
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50
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van der Ende PC, van Busschbach JT, Nicholson J, Korevaar EL, van Weeghel J. Strategies for parenting by mothers and fathers with a mental illness. J Psychiatr Ment Health Nurs 2016; 23:86-97. [PMID: 26868044 DOI: 10.1111/jpm.12283] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The combination of coping with their mental health problems and caring for children makes parents vulnerable. Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of a parent with a mental illness, all contributing to the recovery of the person with the mental illness. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Taking the strength and the opportunities formulated by parents themselves as a starting point is fairly new. Parents with severe mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting, whereas parenthood also offers a basis for social participation through school contacts and the child's friendships. Dedication to the parent role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children; and parenting prompts them to find adequate sources of social support. In this study these strategies were found to be the fundamentals of recovery related to parenting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can support and coach patients who are identified as parents, and self-chosen parenting related goals are set and addressed. A family-focused approach by nurses can be used to prevent problems for children and their families, identify their strengths as well as vulnerabilities, and address the challenges to build resilience. INTRODUCTION Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new. QUESTION What are the strategies of parents with a mental illness to be successful? METHOD Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods. RESULTS Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children. DISCUSSION Strategies like being fully dedicated to the parental role, finding a balance between attention for one's own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role. Implications for practice Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals.
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Affiliation(s)
- P C van der Ende
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | - J T van Busschbach
- Department of Psychiatry and Rob Giel Research Centre, University Medical Centre, Groningen, The Netherlands.,Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - J Nicholson
- Dartmouth Psychiatric Research Center, The Geisel School of Medicine, Dartmouth, Lebanon, NH, USA
| | - E L Korevaar
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | - J van Weeghel
- Department of Social and Behavioral Science, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.,Phrenos Centre of Expertise on Severe Mental Illness, Utrecht, The Netherlands.,Research and Development, Dijk en Duin Mental Health Centre, Castricum, The Netherlands
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