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Keenan ME, Berlin KS, Cook JL, Choquette AE, Ankney RL, Klages KL, Semenkovich KA, Rybak TM, Banks GG, Alemzadeh R, Eddington AR. Brief assessment of diabetes-specific psychological flexibility in racially and income diverse youth with type 1 diabetes. Pediatr Diabetes 2022; 23:370-379. [PMID: 35094464 DOI: 10.1111/pedi.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Diabetes-specific psychological flexibility (the ability to engage in valued behaviors, be open to internal experiences, with present-moment awareness, while living with diabetes) is associated with HbA1c and health-related quality of life in youth with type 1 diabetes (T1D). Having brief diabetes-specific psychological flexibility assessments that perform equivalently across diverse individuals is important for research and clinical work addressing health disparities. The present study aimed to create 9-and 3-item short forms (DAASito-9 and -3) of the Diabetes Acceptance and Action Scale (DAAS-22), and evaluate their validity, reliability, and measurement invariance (MI). RESEARCH DESIGN AND METHODS Youth with T1D (n = 179, Mage = 14.64, 50% female, 56% Black/African American) completed self-report measures at an endocrinology clinic visit. HbA1c was extracted from medical records. One-half of the sample was used to develop the DAASitos with the highest reliability, McDonald's 𝜔 ≥ 0.75, and convergent validity (r ≥ 0.90 to DASS-22). Confirmatory factor analyses evaluated structural validity. MI was assessed across demographic (race, gender, grade, household income) and disease characteristic (illness duration, HbA1c) groups. Correlations with measures of psychological flexibility assessed additional convergent validity, and latent mean differences across groups were evaluated after confirming MI. RESULTS MI was supported. The DAASito-9 and -3 were correlated in expected directions with other psychological flexibility measures, HbA1c, and health-related quality of life. CONCLUSIONS The psychometric properties of the DAASito-9 and -3 support their use in research and clinical care of diverse youth with T1D. Significant differences in psychological flexibility across race, income, and glycemic health warrant further research and clinical intervention.
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Affiliation(s)
- Mary E Keenan
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Kristoffer S Berlin
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Adora E Choquette
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Psychology Department, Oklahoma State University, Stillwater, OK, USA
| | - Kimberly L Klages
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ramin Alemzadeh
- Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.,Endocrinology & Diabetes Clinic, Children's National Hospital, Washington DC, USA
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Toh SH, Kanter JW, Keenan ME, Berlin KS. Testing Functional Analytic Psychotherapy's mediational model of change in social connectedness for people with fear of intimacy. Journal of Contextual Behavioral Science 2022. [DOI: 10.1016/j.jcbs.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Semenkovich KA, Berlin KS, Ankney RL, Keenan ME, L Cook J, Klages KL, Banks GG, Rybak TM, Alemzadeh R, Eddington AR. Development and initial validation of the diabetes family conflict scale (revised)-short form in a racially and income diverse sample. Pediatr Diabetes 2021; 22:529-539. [PMID: 33476074 DOI: 10.1111/pedi.13182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/03/2020] [Accepted: 01/18/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of the study was to develop a short form of the revised diabetes family conflict scale (DFCS) in a racially and income diverse sample while retaining strong psychometric properties. METHODS One seventy nine youth with type 1 diabetes (ages 12-18 years) and caregivers completed the DFCS-Revised as well as assessments of adherence, psychosocial functioning, and diabetes-related stress. Hemoglobin A1c was also obtained. The sample was split at random into a development sample and validation sample. RESULTS Confirmatory factor analyses in the validation sample supported the use of a six-item short form (DFCS-SF) either as a total score (6-items) or a direct (3-item) and indirect (3-item) score. Variations of the DFCS-SF (three items of the 6-item short form) also had acceptable model fit. The short-form questionnaires had acceptable internal consistency and convergent validity (6-item: Cronbach's a = 0.865, full scale DFCS r = 0.954; 3-item: Cronbach's a = 0.757, full scale DFCS r = 0.912). The DFCS-SF showed measurement invariance across both youth and caregiver respondents. Greater report of the DFCS-SF by both youth and caregivers was significantly associated with higher HbA1c, more diabetes-related stress, and more psychosocial concerns. CONCLUSIONS The DFCS-SF developed in the present study shows psychometric integrity in a diverse population of youth and can be utilized by providers to rapidly assess and potentially implement interventions to reduce diabetes family conflict, a psychosocial concern which is associated with elevated HbA1c, non-optimal adherence, diabetes-related stress, and psychological distress.
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Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Mary E Keenan
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Mississippi Medical Center, Mississippi, USA
| | - Tiffany M Rybak
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ramin Alemzadeh
- Department of Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Klages KL, Berlin KS, Cook JL, Keenan ME, Semenkovich K, Banks GG, Rybak TM, Ankney RL, Decker KM, Whitworth JR, Corkins MR. Examining Risk Factors of Health-Related Quality of Life Impairments Among Adolescents with Inflammatory Bowel Disease. Behav Med 2021; 47:140-150. [PMID: 34048329 DOI: 10.1080/08964289.2019.1676193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Inflammatory Bowel Disease (IBD) is a chronic, costly, and burdensome disease that is typically diagnosed during adolescence. Despite the use of effective treatments, rates of relapse and intestinal inflammation remain high and put patients at risk for long term physical and psychosocial health complications. Given the costs associated with IBD, it is critical to examine potential risk factors of poor health-related quality of life (HRQoL) among patients for the enhancement and further development of interventions. As such, the aim of the current study was to examine how sociodemographic and disease characteristics, psychosocial problems, and adherence behaviors impact HRQoL among a sample of youth with IBD. 107 adolescents with IBD and their caregiver completed self- and parent-report measures as part of a psychosocial screening service. Medical records were reviewed to obtain information regarding diagnosis, insurance, medication use, illness severity, and disease activity. Results revealed lower HRQoL scores among adolescents with more psychosocial problems (Est. = -3.08; p < .001), greater disease severity (Est. = -.40; p = .001), and those who identified as Black (Est. = -.38; p < .05). Greater disease severity (Est. = .13 p = .004), use of nonpublic insurance (Est. = .32 p = .004), and fewer psychosocial problems (Est. = -.13 p = .04) were associated with greater adherence behaviors. These findings suggest that implementing individually tailored, evidence-based psychological interventions focused on coping with psychosocial problems and symptoms may be important in enhancing adherence behaviors and HRQoL among adolescents with IBD.
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Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Sciences Center
| | | | | | | | | | | | | | | | - John R Whitworth
- Department of Pediatrics, University of Tennessee Health Sciences Center
| | - Mark R Corkins
- Department of Pediatrics, University of Tennessee Health Sciences Center
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Berlin KS, Klages KL, Banks GG, Rybak TM, Ankney RL, Semenkovich K, Keenan ME, Ellis DA, Diaz-Thomas AM, Alemzadeh R, Eddington AR. Toward the Development of a Culturally Humble Intervention to Improve Glycemic Control and Quality of Life among Adolescents with Type-1 Diabetes and Their Families. Behav Med 2021; 47:99-110. [PMID: 31580213 DOI: 10.1080/08964289.2019.1660299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Type-1 Diabetes (T1D) is a prevalent and costly disorder associated with substantial morbidity that differentially impacts low-income and/or minority adolescents and their families. The primary study objective was to develop a guiding model to inform culturally humble interventions for Mid-southern youth with T1D presenting with multiple correlates of suboptimal glycemic control and their families. In order to develop a clinic specific guiding model, conceptualizations of health, the need/type of intervention thought to be most helpful, the optimal structure, and strategies to improve the cultural/regional fit was ascertained from (A) youth with T1D (n = 13) and caregivers (n = 11) via qualitative interviews and, (B) pediatric endocrinologists and nurse practitioners (n = 6), and (C) nurses, diabetes educators, dietitians, and social workers (n = 9) via focus groups. Qualitative themes were synthesized to guide the treatment development model whereby Quality of Life and Glycemic Control would be directly enhanced by interventions to promote Coping, Support, Education, and Improved Psychosocial Functioning and indirectly through improved Adherence and T1D Autonomy delivered in a culturally humble way that affirms youths' T1D identify. These finding suggest that existing evidence-based treatments may provide a great fit for low-income, and/or minority youth with T1D and their families living in the mid-south, provided these interventions are delivered in culturally humble manner.
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Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
| | | | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | | | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
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Keenan ME, Berlin KS, Cook JL, Ankney RL, Klages KL, Semenkovich KA, Rybak TM, Banks GG, Choquette AE, Alemzadeh R, Eddington AR. Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes. J Pediatr Psychol 2021; 46:241-250. [PMID: 33398334 DOI: 10.1093/jpepsy/jsaa124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Following the Journal of Pediatric Psychology's special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control. METHODS One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics. RESULTS Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups. CONCLUSIONS Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.
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Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | | | | | | | | | - Tiffany M Rybak
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Ramin Alemzadeh
- Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
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Keenan ME, Loew M, Berlin KS, Hodges J, Alberts NM, Hankins JS, Porter JS. Empirically Derived Profiles of Health-Related Quality of Life in Youth and Young Adults with Sickle Cell Disease. J Pediatr Psychol 2021; 46:293-303. [PMID: 33249456 PMCID: PMC7977438 DOI: 10.1093/jpepsy/jsaa104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Determining how the health-related quality of life (HRQOL) is impacted by living with Sickle Cell Disease (SCD) can inform psychosocial interventions. The purpose of the present study is to determine if demographic and treatment variables predict membership into empirically derived subgroups of HRQOL among youth and young adults with SCD. METHODS Three hundred and seven youth and young adults with SCD (mean 17.63 years ± 3.74 years, 50.5% female) completed the Pediatric Quality of Life InventoryTM Sickle Cell Disease Module. Latent profile analysis examined subgroups/classes of HRQOL and relationships with demographic and treatment variables. RESULTS Three distinct classes emerged: High HRQOL (34% of the sample), Moderate HRQOL (44% of the sample), and Low HRQOL (22% of the sample). Being female was associated with increased odds of being in the moderate or low groups. Living with more severe SCD (genotypes HbSS and HbSβ0 thalassemia) was associated with increased odds of being in the Low HRQOL group. Treatment with chronic red blood cell transfusion therapy was associated with increased odds of being in the High HRQOL group. Older age predicted a small increase in the odds of being in the Low versus High HRQOL group. CONCLUSIONS The present study adds to the literature on HRQOL in SCD by exploring person-centered, empirically derived groups of HRQOL. Identification of demographic and treatment factors that predict membership into those groups within a large sample assists in tailoring needed psychosocial interventions for youth with SCD.
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Affiliation(s)
- Mary E Keenan
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, The University of Memphis, Memphis, TN
| | - Megan Loew
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Jason Hodges
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, Concordia University, Montreal, Canada
| | - Jane S Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Berlin KS, Keenan ME, Cook JL, Ankney RL, Klages KL, Semenkovich K, Rybak TM, Banks GG, Alemzadeh R, Eddington AR. Measuring psychological flexibility in youth with type 1 diabetes. Pediatr Diabetes 2020; 21:1566-1574. [PMID: 32915520 DOI: 10.1111/pedi.13110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine reliability and validity of the acceptance and action diabetes questionnaire (AADQ) and the diabetes acceptance and action scale for children and adolescents (DAAS), measures of diabetes-specific psychological flexibility. METHODS One hundred and eight-one youth with type 1 diabetes completed the AADQ, DAAS, and measures of mindfulness, cognitive fusion, and health-related quality of life. HbA1c was extracted from medical records. Confirmatory factor analysis (CFA) was used to cull items and evaluate the factor structures of the AADQ and DAAS. Bivariate correlations were conducted between all measures to explore content validity. RESULTS CFAs supported a one-factor structure of the AADQ (for youth and parent report) and a second-order DAAS solution with a total score indicated by avoidance, values impairment, and avoidance subscales. All scales and subscales displayed strong internal consistency (α = .86-.95). The AADQ and DAAS evidence good content validity based on associations with other measures. CONCLUSIONS The AADQ and DAAS are reliable, valid measures of diabetes-specific psychological flexibility.
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Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mary E Keenan
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | | | - Tiffany M Rybak
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Banks GG, Berlin KS, Keenan ME, Cook J, Klages KL, Rybak TM, Ankney R, Semenkovich K, Cohen R, Thurston I, Diaz-Thomas A, Alemzadeh R, Eddington A. How Peer Conflict Profiles and Socio-Demographic Factors Influence Type 1 Diabetes Adaptation. J Pediatr Psychol 2020; 45:663-672. [PMID: 32483599 DOI: 10.1093/jpepsy/jsaa036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aimed to (a) validate the factor structure for a measure of peer conflict in youth with type 1 diabetes (T1D); (b) determine empirical patterns of peer conflict in terms of context (friend vs. nonfriend) and content (diabetes-specific vs. general) within a broader context of socio-demographic factors; and (c) examine how these patterns and socio-demographic factors relate to adolescents' T1D adherence, quality of life, and glycemic control (HbA1c). METHODS Youth with T1D (N = 178), ages 12-18, reported demographic variables, illness duration, adherence, quality of life, and peer conflict. HbA1c was extracted from medical records. Confirmatory factor analysis validated a factor structure for the Diabetes Peer Conflict Scale (DPCS) and latent profile analysis (LPA) determined profiles of peer conflict. RESULTS A four-factor structure emerged for the DPCS: general friend conflict, general nonfriend conflict, T1D friend conflict, and T1D nonfriend conflict. Using these factors as indicators in LPA, four profiles were confirmed: (a) Low Overall Conflict (LOC) and (b) Moderate Overall Conflict (MOC), (c) a Nonfriend Conflict (NFC), and (d) a Friend Conflict (FC) profile. Differences were not identified between diabetes specific versus general conflict. Socio-demographic variables did not predict class membership. The LOC profile reported the highest quality of life and best glycemic control, whereas the FC profile reported the lowest adherence behaviors. Conclusions: Peer conflict uniquely contributes to diabetes adaptation above and beyond socio-demographic and illness factors.
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Affiliation(s)
| | | | | | - Jessica Cook
- Department of Psychology, The University of Memphis
| | - Kimberly L Klages
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | - Tiffany M Rybak
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Robert Cohen
- Department of Psychology, The University of Memphis
| | - Idia Thurston
- Department of Psychology & Brain Science, Texas A&M University
| | - Alicia Diaz-Thomas
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
| | - Ramin Alemzadeh
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
| | - Angelica Eddington
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
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Semenkovich K, Berlin KS, Ankney RL, Klages KL, Keenan ME, Rybak TM, Banks GG, Alemzadeh R, Eddington A. Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes. Health Psychol 2019; 38:577-585. [PMID: 30973748 DOI: 10.1037/hea0000719] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with Type 1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts. METHOD Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict the number of DKA hospitalizations and HbA1c approximately 1 year after assessment, accounting for sociodemographics. A total of 174 youth 12-18 years old with T1D (M = 14.68, SD = 1.77) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c at 1-year follow-up. RESULTS Thirty-one participants had at least 1 episode of DKA based on chart review. Greater duration of diabetes, higher baseline HbA1c, lower income, identifying as non-Hispanic White, and higher youth report of internalizing symptoms were significant predictors of DKA at follow-up (p < .05). Identifying as Black-African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up (p < .05). CONCLUSIONS Future studies should assess the utility and accuracy of using screeners for internalizing symptoms in pediatric endocrinology clinics to identify youth at risk for DKA hospitalizations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Kattwinkel J, Brooks JG, Keenan ME, Malloy M, Willinger M. Back to sleep: good advice for parents but not for hospitals? Pediatrics 2001; 108:522. [PMID: 11491118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Kattwinkel J, Brooks J, Keenan ME, Malloy M. Infant sleep position and sudden infant death syndrome (SIDS) in the United States: joint commentary from the American Academy of Pediatrics and selected agencies of the Federal Government. Pediatrics 1994; 93:820. [PMID: 8165086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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