The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes

Farrell, Stephanie P.; Hains, Anthony A.; Davies, W. Hobart; Smith, Philip L.; Parton, Elaine

doi:10.1016/s1054-139x(03)00215-5

Cited by 75 publications

(67 citation statements)

References 14 publications

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“…Other research has found negative attributions (e.g., focusing exclusively on the negative features of the situation, frequently expecting the worst to happen) to be associated with both diabetes-related stress and general feelings of stress (6). The impact of negative attributions on feelings of stress is consistent with cognitive-behavioral theory, which proposes that individuals respond primarily to cognitive representations of a situation rather than the event itself (7).…”

supporting

confidence: 57%

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Attributions of Adolescents With Type 1 Diabetes in Social Situations

et al. 2006

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OBJECTIVE -To examine the relationships among negative attributions of friend reactions (NAFRs) within a social context, anticipated adherence difficulties, diabetes stress, and metabolic control. RESULTS -Path analysis demonstrated an excellent fit of a model depicting an indirect relationship between NAFRs and metabolic control through the mechanisms of expected adherence difficulties and diabetes stress. RESEARCH DESIGN AND METHODSCONCLUSIONS -Adolescents who make NAFRs are likely to find adherence difficult in social situations and have increased feelings of stress, with the latter associated with poorer metabolic control. Intervention efforts to address negative attributions may impact adherence behavior and feelings of stress, especially if specific contexts of self-care behavior are taken into account. Diabetes Care 29:818 -822, 2006A dolescents with type 1 diabetes have been found to have more problems with adherence to their self-care than younger children, even though they possess greater diabetes knowledge (1,2). With the onset of adolescence, youths tend to spend increasing time with their friends. The adherence decisions made by adolescents with diabetes while with their friends reflect an interaction of situational circumstances and the nature and history of the relationships with particular peers. Furthermore, these factors likely affect the adolescents' expectations and attributions for the reactions they will receive from their friends if they follow their treatment regimens.Adolescents may be aware of potential health complications from poor adherence but still have difficulty maintaining their regimen because they are apprehensive about being singled out by others (3,4). While adolescents demonstrate better problem solving regarding diabetes self-management issues than do children, adolescents become increasingly influenced by what they anticipate would be negative reactions or disapproval from friends in social situations that would require adherence behaviors (2). Decisions not to engage in self-care are misguided because the empirical work available suggests that friends tend to provide emotional support and encourage following the treatment regimen (4).A social information-processing model of adjustment provides an explicit framework for viewing the role of cognitive processes in the problem behavior choices of youth (5). These cognitive processes include filtering only specific aspects of the situation, incorrectly appraising others' intentions, or assessing the situation as threatening in terms of potential consequences. This model may describe processes involved with adherence efforts around peers. The model suggests that adolescents with type 1 diabetes may perceive adherence behavior as difficult in social situations due to a fear of negative friend evaluations. Such attributions and anticipated adherence difficulties (AADs) (and likely poor adherence) are problematic not only because of the health impact but also because the adolescents are missing opportunities for friend support.Ot...

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supporting

confidence: 57%

“…Diabetes stress has been found to have a direct association with metabolic control (6,8). Adherence efforts have not displayed a strong association with metabolic control, possibly due to a variety of measurement issues (9).…”

mentioning

confidence: 99%

Attributions of Adolescents With Type 1 Diabetes in Social Situations

et al. 2006

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“…26 The relationships among certain personality characteristics (e.g., conscientiousness, extroversion, neuroticism, impulsivity, and assertiveness), individual coping styles (e.g., stress management), and diabetes management have also been examined. 27,28 Specifically, high youth conscientiousness and extraversion are associated with higher rates of completing diabetes cares, while high neuroticism and low conscientiousness are predictive of decreased adherence and a need for increased monitoring by parents throughout adolescence. 28 Researchers found that youth's general stress impacts their adherence, especially for completing blood glucose monitoring (BGM), as the endorsement of high levels of general stress is indicative that youth may be experiencing stress regarding health, finances, living situations, parents, siblings, school, and friends.…”

Section: Individualmentioning

confidence: 99%

“…Some researchers suggest that youth with a longer duration of diagnosis feel more comfortable with BGM and are more at ease with doing their diabetes care in public, 29 while other studies have found that longer duration of diabetes is related to lower self-reported adherence rates 27,30 and diabetes 'burnout'. 31 Researchers have looked at the interrelationships of multiple variables that may also impact the association between length of time since diagnosis and adherence.…”

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confidence: 99%

Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

Kichler¹,

Moss²,

Kaugars³

2012

US Endocrinology

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Adherence to medical regimen is often identified as a hallmark modifiable factor that impacts health outcomes for those with chronic medical illnesses. Rapoff suggests that adherence to medical regimens is estimated to be between 50-55 % for all chronically ill patients. 1 He describes a number of patient and family (e.g., demographic, adjustment/coping, family involvement), disease-and regimen-related correlates to adherence; however, correlates do not imply causation and should be interpreted cautiously.1 Researchers have rated non-adherence rates to be between 20 to 93 % 1-3 for youth with type 1 diabetes and have found that adherence is widely accepted as related to diabetes control. 4In a recent review article, Modi et al. make a distinction between two constructs: self-management (i.e., the interactions of health behaviors and related processes that patients and families engage in to carefor chronic medical conditions) and adherence (i.e., the extent to which a person's behavior coincides with medical or health advice). 5 In their Pediatric Self-Management Model, self-management influences adherence, which then affects outcomes, including health outcomes. The authors also suggest that there may be certain self-management factors that impact outcomes without the mediating role of adherence in pediatric conditions. 5This present review article will focus on the first two of three stages in the Pediatric Self-Management Model, self-management and adherence, to discuss the behavioral factors that may influence health outcomes for youth with type 1 diabetes during adolescence (see Figure 1). Findings from individual, family, peer, and group therapy interventions that have targeted these behavioral factors in order to improve health outcomes will then be outlined. Self-managementModi et al. describe the construct of self-management as having three components. 5 The first component is self-management behaviors, which are the actual behaviors performed by the youth and/or family in order to care for a chronic medical illness. Secondly, there are contextual variables, which are four systems that impact how the self-management behaviors occur. These include individual, family, community, and healthcare domains. Finally, there are processes that link the self-management behaviors with the contextual systems.These processes include individuals' cognitive, emotional, and social perceptions. Three components of self-management, self-management behaviors, contextual variables, and processes as they relate to youth with type 1 diabetes, will be reviewed below (see Table 1). Self-management BehaviorsSelf-management behaviors, defined as examples of the 'neutral'behaviors that are employed to help manage a chronic medical illness, have been widely examined in youth with type 1 diabetes.Some examples of self-management behaviors that researchers have repeatedly identified as relevant to the management of diabetes are parental involvement and collaboration, the division of diabetes responsibility in the family and subsequent ...

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“…Type 1 Diabetes Mellitus (T1DM) is associated with multiple sources of stress for affected youth and their families, with increased levels of stress associated with poorer diabetes control [1]. Investigators examining predictors of poor metabolic control have identified family structure [2,3] (i.e.…”

Section: Introductionmentioning

confidence: 99%

The Association of Cortisol Stress Response with Early Adversity and Diabetes Control in Adolescents with Diabetes

Korczak¹,

Manassis²

2016

J Depress Anxiety

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The specific aims of this study were to (1) evaluate the ability of a psychosocial stressor to induce an adequate stress response among adolescents with T1D; (2) examine predictors of stress responsiveness in this population and (3) evaluate the relationship of these factors with diabetes control. Based on previous research demonstrating the ability of a psychosocial stressor to elicit a cortisol response among children with a chronic inflammatory disorder, we hypothesized that the Trier Social Stress Task for Children 17]) would be an adequate stressor that causes a significant and reliable increase in cortisol levels among adolescents with T1DM. Further, we hypothesized that greater burden of stressful life events and increased family dysfunction would be associated with stress responsiveness and poorer overall diabetes control. Methodology ParticipantsSeventeen adolescents (nine male, eight female) with T1DM, followed in the diabetes clinic of a large paediatric hospital, participated in the study. The clinic provides routine diabetes care to 70% of the children and adolescents with T1DM in the Toronto area. English speaking participants aged 11-18 years were included in the study if they had a history of T1DM of at least one year. Clinic patients with comorbid medical illnesses, (apart from treated hypothyroidism or mild asthma), developmental delay, or taking psychotropic medication at the Abstract Objectives: The hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the relationship between increased stress and poor diabetes control in children with type 1 diabetes mellitus (T1DM).The objectives of this study were two-fold: (1) To evaluate the effectiveness of the Trier Social Stress Test for Children (TSST-C) in inducing psychosocial stress in children with T1DM; (2) To investigate predictors of the cortisol stress response to the TSST-C.Methods: Seventeen adolescents with T1DM were exposed to the TSST-C. Salivary cortisol was sampled pre-TSST-C and at six 10-minute intervals following the stress procedure. Measures of anxiety, depression, family functioning and early adversity were completed. Results:The TSST-C induced a significant increase in cortisol response (p<0.01). Early adversity predicted cortisol response to the stressor (p=0.01). Early adversity was also associated with poorer diabetes control (p=0.05). Conclusion:The TSST-C was effective in producing a stress response in children with diabetes. Whereas previous research has emphasized psychological pathways which contribute to the relationship between psychosocial stressors and poor diabetes control, this study suggests that biological dysfunction may also underlie the association.

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The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes

Cited by 75 publications

References 14 publications

Attributions of Adolescents With Type 1 Diabetes in Social Situations

Attributions of Adolescents With Type 1 Diabetes in Social Situations

Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

The Association of Cortisol Stress Response with Early Adversity and Diabetes Control in Adolescents with Diabetes

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