Stress and Coping Predicts Adjustment and Glycemic Control in Adolescents with Type 1 Diabetes
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ORIGINAL ARTICLE
Stress and Coping Predicts Adjustment and Glycemic Control in Adolescents with Type 1 Diabetes Sarah S. Jaser, PhD 1 & Niral Patel, MPH 1 & Meng Xu, MS 1 & William V. Tamborlane, MD 2 & Margaret Grey, DrPH, RN 2
# The Society of Behavioral Medicine 2016
Abstract Background Adolescents with type 1 diabetes are at increased risk for deteriorating glycemic control, poor quality of life, and depressive symptoms. Stress and coping are related to these outcomes in adolescents with diabetes, yet few studies have examined these constructs longitudinally. Purpose This study aimed to describe stress and coping in adolescents with type 1 diabetes and to examine coping strategies as predictors of adolescent adjustment (i.e., depressive symptoms, quality of life) and glycemic control. Methods Adolescents with type 1 diabetes completed measures of diabetes-related stress, coping, symptoms of depression, and quality of life at baseline, 6 months, and 12 months. Data on glycemic control were collected from the adolescents’ medical charts. Results The adolescents’ use of primary control coping (e.g., problem solving) and secondary control engagement coping (e.g., positive thinking) strategies predicted significantly fewer problems with quality of life and fewer depressive symptoms over time. In contrast, the use of disengagement coping strategies (e.g., avoidance) predicted more problems with quality of life and depressive symptoms. Coping was not a significant predictor of glycemic control. Coping mediated the effects of diabetes-related stress on depressive symptoms and quality of life. Conclusions The ways in which adolescents with type 1 diabetes cope with diabetes-related stress predict quality of life
* Sarah S. Jaser [email protected]
1
Vanderbilt University, DOT 11136, 2200 Children’s Way, Nashville, TN 37232, USA
2
Yale University, New Haven, CT, USA
and symptoms of depression but not glycemic control. Through the use of screening to identify adolescent’s diabetes-related stress and targeted interventions to improve coping strategies, there is potential to improve outcomes. Keywords Coping . Type 1 diabetes . Adolescents . Quality of life . Depression . Stress Type 1 diabetes is one of the most common chronic health conditions in youth, with over 18,000 new cases diagnosed each year, and the prevalence is increasing [1]. The recommended intensive treatment regimen is often burdensome for adolescents, requiring frequent daily blood glucose checks, multiple insulin injections/boluses, consistent monitoring of carbohydrate intake and exercise, and checking urine for ketones when necessary [2]. As children transition into adolescence, they are at risk for deteriorating glycemic control [3]; a recent national study found that only 17 % of adolescents were meeting recommended targets [4]. In addition, youth with type 1 diabetes are at risk for elevated levels of depressive symptoms [5] and poorer quality of life [3]. The negative effects of chronic stress on physical and mental health are well
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