The role of marital distress, parental and child depression, family functioning and health care behaviors in treatment adherence and metabolic control among adolescents with diabetes
Abstract (Summary)Fe-five adolescents witb Type 1diabetes, who were receiving secolldary care services 60m diabetes clinics and pediatricians, were n>Uowedfor thnemonhs m tbis exploratory community study. Masures of parental depressicm, marital distress, general family hctiming, and diabetes-specific Eimily functioning were obtained during an assesment of bah parents and adolescent. Tbe 24hour recail adherence inte~ews were conducted separately with bdhthe pareut and adolescent cm six occasions over the three months, and metabolic -01 was measured by HbAlc levels at the awt and end of the study. Multiple regression analyses showed that adherence was not associated with ccmtrol. Adolescents who had been diagnosed longer were in worse metabolic control. Farnily relations were not linked with glycemic controi and their influence varied on the five dimensionsofadhereace. The fàmily relations variables, as a rnodel, was significant in predicting diet arnount adherence, accounting for 32.8% of the variance, with parental depression and general family cdct accounting for most of it. The fâmily relaticms rnodel was significant in predihg exercise adheraice, with diabetesspecincpidance-coatrol, accounting for 37.2% of the variance. Controllhg for duaiological age and gender, adolescent depression, as a masure of child adaptation, was not a significant predictor of glycemic cpitrol or adheraice. However, bdhgender and chronological age accounted for 39.2% of exercise adherence. Glycemic -01 was consistent, with 75% of the adolescents displaying stable caatrolledand non~trolled metaboiic eaiarol throughout the study. Metabolic control, treatment adherence and frequency of insulin omissions were similar fôr those receiving treatment fiorn a diabetes clinic versus a pediatrician. Using an insulia shding sale iniprowd metabolic cootrol, whereaz adherence was similar for the groups. Males and M e s orniacd insulin injections equally across the three adolescent age groupings and metaboiic ccmtrol was wone fbrthose who missed insulin injections. Neither adhemce nor hmily relations diffêreutiated betweenthe adolescents who missed or did not miss insulin injections. Paiental involment in the diam rrgime dinered by gender, xii wrth parents remaining involved with fémaies for loager. Resuits were discussed in the context of adolescent developmentand the systems sociai/ecbIogicalmaiel of adaptation and coping developeû by Katak (1989).
Source Type:Master's Thesis
Date of Publication:01/01/2000