Maternal depressive symptoms and disease care status in youth with type 1 diabetes.

Abstract

Objective The current study assessed relations among maternal depressive symptoms, poorer youth diabetes adherence, and glycemic control. Specifically, hypothesized mediating links of lowered expectations of parental involvement, less parental monitoring and more conflict were examined. Methods Participants included 225 mothers and their young adolescents, aged 11–14 years (M = 12.73 years, SD = 1.2) diagnosed with T1D. Maternal depressive symptoms and outcome expectancies for maternal involvement were evaluated with self-report questionnaires. Multi-source, parent/youth, and multi-method assessment of adherence, parental monitoring, and conflict were evaluated during a baseline assessment from a larger randomized clinical trial. Results The first hypothesized structural equation model demonstrated a good fit and indicated that more maternal depressive symptoms were directly associated with less parental monitoring and more conflict, which in turn each were associated with poorer adherence and glycemic control. Although higher involvement expectancies were associated with more monitoring and less conflict, they were not associated with other model variables. A second alternative model also fit the data well; poorer youth adherence was associated with more conflict that in turn related to maternal depressive symptoms. Conclusions Two models were tested by which maternal depressive symptoms and poorer youth adherence were interrelated via less monitoring and more conflict. Follow-up longitudinal evaluation can best characterize the full extent of these relations.

Treatment Adherence and Psychological Wellbeing in Maternal Carers of Children with Phenylketonuria (PKU)

“…Although at variance with other metabolic conditions such as type 1 diabetes (Driscoll et al 2010;MacKey et al 2014;Skocic et al 2012;Whittemore et al 2012), this is consistent with previous research in PKU (Fehrenback and Peterson 1989;Reber et al 1987) and implies that experiencing increased levels of psychological distress does not affect adherence to treatment.…”

“…However, associations between parental wellbeing and treatment adherence have been identified in other lifelong metabolic conditions. In childhood diabetes, increased maternal depressive symptoms were associated with less parental monitoring, itself associated with poorer adherence and metabolic control (MacKey et al 2014).…”

A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control.

“…Disruptive factors include parental distress such as depressive symptoms, parenting stress, and anxiety about hypoglycemia, while facilitative factors involve parental self-efficacy for diabetes care and authoritative parenting. Although parental distress has been directly related to lower levels of parental monitoring (Mackey et al, 2014; Streisand, Braniecki, Tercyak, & Kazak, 2001; Wiebe et al, 2011) consideration of naturally co-occurring facilitative factors that enhance monitoring may offset disruptive factors and provide a more realistic understanding of how parental distress and monitoring are related.…”

“…Maternal depression is directly associated with poorer youth adherence (Carcone et al, 2012; Jaser & Grey, 2010; Whittemore et al, 2012) and indirectly related to poorer glycemic control (Anderson, Vangness, Connell, Butler, & Laffel, 2002; Eckshtain et al, 2009; McGrady, Laffel, Drotar, Repaske, & Hood, 2009). These associations appear linked by less parental monitoring of diabetes management (Mackey et al, 2014; Wiebe et al, 2011). …”

Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness

“…49,50 Depression among caregivers has been linked to worsened health outcomes and increased utilization for adolescents with some chronic illness. 51,52 Web-based CBT is a feasible, low-cost option to address anxiety and depression amongst caregivers.…”