Longitudinal Associations of Maternal Depressive Symptoms, Maternal Involvement, and Diabetes Management Across Adolescence

Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9044, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 02/2011; 36(7):837-46. DOI: 10.1093/jpepsy/jsr002
Source: PubMed


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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Available from: Deborah J Wiebe, Apr 09, 2015
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    • "Metabolic outcomes will be measured using glycosylated hemoglobin (HbA1c) which is a measure of glycemic control based on average blood glucose concentration levels in the 3 to 4 month period prior to the HbA1c test [56,57]. HbA1c levels which are collected as part of the adolescents’ routine care at the regular clinic visit will be obtained from the participants’ endocrinologist at four time points over a 12 month period (two levels prior to commencement in the study, and the two levels following completion of the intervention/waiting period). "
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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.
    Full-text · Article · Dec 2013 · BMC Public Health
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    • "Glycated haemoglobin level (HbA1c), as recorded during the clinic visit in which the study was carried out, was used as an indicator of metabolic control. HbA1c, measured by blood test, is a measure of glycemic control based on average blood glucose concentration levels in the 3–4 month period prior to the HbA1c test [27,28]. "
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    ABSTRACT: Background Adolescents with Type 1 diabetes (T1D) show less effective metabolic control than other age groups, partly because of biological changes beyond their control and partly because in this period of developmental transition, psychosocial factors can militate against young people upholding their lifestyle and medical regimens. Parents have an important role to play in supporting adolescents to self-manage their disease, but resultant family tensions can be high. In this study, we aimed to assess family functioning and adolescent behaviour/ adjustment and examine the relationships between these parent-reported variables and adolescent metabolic control (HbA1c), self-reported health and diabetes self-care. Method A sample of 76 parents of Australian adolescents with T1D completed the Child Health Questionnaire –Parent form. Their adolescent child with T1D provided their HbA1c level from their most recent clinic visit, their self-reported general health, and completed a measure of diabetes self-care. Results Parent-reported family conflict was high, as was disease impact on family dynamics and parental stress. Higher HbA1c (poorer metabolic control) and less adequate adolescent self-care were associated with lower levels of family functioning, more adolescent behavioural difficulties and poorer adolescent mental health. Conclusions The implication of these findings was discussed in relation to needs for information and support among Australian families with an adolescent with T1D, acknowledging the important dimension of family functioning and relationships in adolescent chronic disease management.
    Full-text · Article · Mar 2013 · Health and Quality of Life Outcomes
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    • "For instance, higher daily blood glucose was associated with adolescents' lower perceptions of competence for dealing with daily diabetes problems (Fortenberry et al., 2009). In addition, higher maternal anxiety was associated with appraisals of parental overprotection among adolescents with diabetes (Cameron, Young, & Wiebe, 2007), and higher maternal depressive symptoms were associated with sustained maternal behavioral involvement across adolescence (Wiebe et al., 2011). "
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    ABSTRACT: Objective: The study examined (1) whether daily diabetes problems that adolescents experience were associated with parental persuasive strategies (e.g., persuading the adolescent to do more to manage diabetes), (2) whether this association was mediated through greater parental worry and lower confidence in adolescents' abilities, and (3) how parental persuasive strategies may provide corrections for subsequent blood glucose control but reduce adolescent confidence for adolescents high in self-efficacy. Method: Adolescents with Type 1 diabetes (N = 180, ages 10.50-15.58 years) and their mothers (N = 176) and fathers (N = 139) completed diaries for 14 days reporting on problems experienced with diabetes, maternal and paternal use of persuasive strategies, and confidence in adolescents' ability to manage diabetes. Parents reported their daily worry about diabetes, adolescents reported their general self-efficacy for diabetes management, and blood glucose was downloaded from glucometers. Results: Across reporters, multilevel modeling revealed that parents used more persuasive strategies on days when more diabetes problems were experienced. This association was mediated through parents' greater worry and lower confidence in adolescents' ability to manage diabetes. Lagged analyses revealed that adolescents' perceptions of maternal persuasive strategies were associated with improvements in next-day blood glucose, but also with reductions in adolescents' daily confidence for those high in self-efficacy. Conclusions: Parental persuasive strategies appear responsive to daily problems that adolescents experience in diabetes management. Mothers' persuasive strategies may have the dual effects of correcting blood glucose levels but reducing the more self-efficacious adolescents' confidence in their own ability to manage diabetes.
    Full-text · Article · Aug 2012 · Health Psychology
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