Longitudinal associations of maternal depressive symptoms, maternal involvement, and diabetes management across adolescence.
ABSTRACT To examine whether maternal depressive symptoms: (a) predicted the level of maternal involvement in diabetes management tasks across adolescence; and (b) moderated associations of involvement with adolescent adherence, metabolic control, and depression.
Eighty-two youth aged 10-15 years with type 1 diabetes and their mothers completed measures at baseline and 16 months later. Participants rated maternal involvement in diabetes tasks, adherence, and depressive symptoms; metabolic control was indexed from medical records.
Maternal depressive symptoms were associated with higher involvement at baseline, and slower declines in involvement across time. At baseline, involvement was associated with lower adolescent depression and better metabolic control, but this association was stronger when mothers reported fewer depressive symptoms. Interactions of maternal depression with involvement across time suggested maternal involvement was associated with better subsequent adherence primarily when mothers reported fewer depressive symptoms.
Mothers' depressive symptoms may undermine her care-giving effectiveness during adolescence.
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ABSTRACT: Declining diabetes management and control are common as children progress through adolescence, yet many youths with diabetes do remarkably well. Risk factors for poor diabetes outcomes are well-researched, but fewer data describe processes that lead to positive outcomes such as engaging in effective diabetes self-management, experiencing high quality of life, and achieving in-range glycemic control. Resilience theory posits that protective processes buffer the impact of risk factors on an individual's development and functioning. We review recent conceptualizations of resilience theory in the context of type 1 diabetes management and control and present a theoretical model of pediatric diabetes resilience. Applications to clinical care and research include the development of preventive interventions to build or strengthen protective skills and processes related to diabetes and its management. The ultimate goal is to equip youths with diabetes and their families with the tools to promote both behavioral and health-related resilience in diabetes.Current Diabetes Reports 09/2012; · 3.17 Impact Factor
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ABSTRACT: The purpose of this study was to describe coping in mothers of adolescents with type 1 diabetes and to examine the association among mothers' diabetes-related stress and coping strategies and maternal psychological distress (e.g., symptoms of anxiety and depression), adolescent adjustment (e.g., symptoms of depression, quality of life), diabetes-related family conflict, and glycemic control. One hundred and eighteen mother-adolescent dyads completed measures of diabetes-related stress, coping, symptoms of anxiety and depression, quality of life, and family conflict. Data on glycemic control were collected from adolescents' medical charts. Single/divorced mothers and mothers of color were significantly more likely to use disengagement coping strategies (e.g., avoidance) than White and married/partnered mothers. Mothers' use of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance) strategies was related to fewer symptoms of anxiety (r = - .51, -.39) and depression (r = - .32, -.37) and less family conflict (r = - .22, -.30, all p < .05). Mothers' use of disengagement coping strategies was related to greater symptoms of anxiety (r = .30) and depression (r = .27, both p < .01). Further, secondary control coping was found to mediate the relationship between diabetes-related stress and maternal symptoms of anxiety and depression. Maternal coping was not significantly associated with adolescent outcomes. The ways in which mothers of adolescents with type 1 diabetes cope with diabetes-related stress are associated with psychological distress and family conflict. By identifying and improving mothers' coping through screening and targeted interventions, we may have the potential to improve both maternal and adolescent outcomes.Maternal and Child Health Journal 02/2013; · 2.24 Impact Factor
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ABSTRACT: Management of Type 1 diabetes is associated with substantial personal and psychological demands which are often exacerbated during adolescence thus placing young people at significant risk for mental health problems. Supportive parenting can mitigate these risks, however the challenges and stresses associated with parenting a child with a chronic illness can interfere with a parent's capacity to parent effectively. Therefore, interventions that provide support for both the adolescent and their parents are needed to prevent mental health problems in adolescents; to build and maintain positive parent-adolescent relationships; and to empower young people to better self-manage their Type 1 diabetes. This paper presents the research protocol for a study evaluating the efficacy of the Nothing Ventured Nothing Gained online adolescent and parenting intervention. The intervention aims to improve the mental health outcomes of adolescents with Type 1 diabetes.Method/design: A randomized controlled trial using repeated measures with two arms (intervention and wait-list control) will be used to evaluate the efficacy and acceptability of the online intervention. Approximately 120 adolescents with Type 1 diabetes, aged 13-18 years and one of their parents/guardians will be recruited from pediatric diabetes clinics across Victoria, Australia. Participants will be randomized to receive the intervention immediately or to wait 6 months before accessing the intervention. Adolescent, parent and family outcomes will be assessed via self-report questionnaires at three time points (baseline, 6 weeks and 6 months). The primary outcome is improved adolescent mental health (depression and anxiety). Secondary outcomes include adolescent behavioral (diabetes self-management and risk taking behavior), psychosocial (diabetes relevant quality of life, parent reported child well-being, self-efficacy, resilience, and perceived illness benefits and burdens); metabolic (HbA1c) outcomes; parent psychosocial outcomes (negative affect and fatigue, self-efficacy, and parent experience of child illness); and family outcomes (parent and adolescent reported parent-adolescent communication, responsibility for diabetes care, diabetes related conflict). Process variables including recruitment, retention, intervention completion and intervention satisfaction will also be assessed. The results of this study will provide valuable information about the efficacy, acceptability and therefore the viability of delivering online interventions to families affected by chronic illnesses such as Type 1 diabetes.Trial registration: Australian New Zealand clinical trials registry (ANZCTR); ACTRN12610000170022.BMC Public Health 12/2013; 13(1):1185. · 2.08 Impact Factor