The mediating role of extreme peer orientation in the relationships between adolescent–parent relationship and diabetes management.

The study examined whether the quality of the adolescent–parent relationship was associated with better diabetes management in adolescents with Type 1 diabetes by decreasing adolescents' extreme peer orientation. Adolescents (n = 252; 46% male and 54% female) aged 10 to 14 years with Type 1 diabetes completed assessments of extreme peer orientation (i.e., tendency to ignore parental advice and diabetes care to fit in with friends), adolescent–parental relationship, and adherence; HbA1c scores indexed metabolic control. Adolescents with higher quality relationships with parents reported less peer orientation and better diabetes care. The mediational model revealed that adolescents' high quality relationships with their parents (mother and father) were associated with better treatment adherence and metabolic control through less peer orientation. It is likely that high quality adolescent–parent relationships may be beneficial to adolescent diabetes management through a healthy balance between peer and parental influence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benefit finding, affective reactions to diabetes stress, and diabetes management among early adolescents.

Objective: To examine whether benefit finding was associated with better adjustment among adolescents with diabetes by buffering negative affective reactions to diabetes stress and by promoting positive affective reactions. Design: Early adolescents aged 10–14 with Type 1 diabetes (n = 252) described recent diabetes stressors, affective reactions, and perceived coping effectiveness. They also completed measures of benefit finding, depressive symptoms, and adherence. Metabolic control (i.e., HbA1c) was obtained from medical records. Main Outcome Measures: The main outcome measures were perceived coping effectiveness, depressive symptoms, adherence, and HbA1c. Results: Benefit finding was associated with lower depressive symptoms, higher perceived coping effectiveness and better adherence, and with higher positive as well as negative affective reactions to diabetes stress. Benefit finding interacted with negative affective reactions to predict depressive symptoms and HbA1c. Negative affective reactions to stress were associated with poorer adjustment among those with low benefit finding, but were unrelated or more weakly related to poor adjustment among those with high benefit finding. Positive affective reactions did not mediate associations between benefit finding and any outcome. Conclusions: Consistent with a stress-buffering process, benefit finding may be a resource that buffers the disruptive aspects of negative affective reactions to stress for adolescents' diabetes management. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial.

Patients in a low-income community health center with Type 2 diabetes (N = 81) taking a one-day education workshop as part of their diabetes medical management were randomly assigned either to education alone or to a combination of education and acceptance and commitment therapy (ACT). Both groups were taught how to manage their diabetes, but those in the ACT condition also learned to apply acceptance and mindfulness skills to difficult diabetes-related thoughts and feelings. Compared with patients who received education alone, after 3 months those in the ACT condition were more likely to use these coping strategies, to report better diabetes self-care, and to have glycated hemoglobin (HbA1C) values in the target range. Mediational analyses indicated that changes in acceptance coping and self-management behavior mediated the impact of treatment on changes in HbA1C. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental negative affect and adolescent efficacy for diabetes management.

The authors investigated whether parental perceptions of adolescent efficacy are colored by parental negative affect and are associated with adolescents’ self-perceptions of efficacy for diabetes management. Adolescents (n = 183, M age = 12.53) with Type 1 diabetes and their mothers and fathers separately reported perceptions of adolescents’ efficacy for diabetes management and parents reported their own negative affect (depressed mood and trait anxiety). glycosolated hemoglobin (HbA1c) levels were obtained from medical records. The results indicated that parental negative affect was associated with parental perceptions of poorer adolescent efficacy beyond the association of HbA1c scores. The relationship between fathers’ negative affect and adolescents’ self-efficacy was mediated by fathers’ perceptions of adolescent efficacy. The results suggest that parental negative affect may negatively color their views of adolescents’ efficacy and, in the case of fathers’ beliefs, may relate to adolescent self-efficacy. Parental negative affect should be considered when evaluating perceptions of adolescents’ efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Value transmissions between fathers, mothers, and adolescent and emerging adult children: The role of the family climate.

Using structural equation modeling, this study investigates father–child, mother–child, and father–mother transmissions on “work-as-duty” and “hedonism” across a 5-year period when children traverse late adolescence and emerging adulthood (N = 402 families). We found bidirectional father–child and child-to-mother transmissions on work-as-duty and child-to-father and bidirectional father–mother transmissions on hedonism. In addition, we examined whether family adaptability and cohesion influence these value transmissions. Father-to-child transmission on work-as-duty occurred regardless of family system levels, whereas child-to-parent transmissions on work-as-duty occurred only within more structured families. Furthermore, a more connected family climate tended to facilitate inter- and intragenerational value transmissions, but multiple-group analyses did not reveal strong evidence. All in all, this study showed that value socialization in the family is not a one-way-traffic process with parents solely influencing their children. Late adolescents and emerging adults also serve to socialize their parents and parents socialize each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work and Mexican American parent–adolescent relationships: The mediating role of parent well-being.

This study of Mexican American two-parent families (N = 246) examined the role of parents' well-being (i.e., depressive symptoms, role overload) as a potential mechanism through which parent occupational conditions (i.e., self-direction, hazardous conditions, physical activity, work pressure) are linked to parent–adolescent relationship qualities (i.e., warmth, conflict, disclosure). Depressive symptoms mediated the links between maternal and paternal work pressure and parent–adolescent warmth, conflict, and disclosure. For mothers, depressive symptoms also mediated the links between self-direction and mother–adolescent warmth, conflict, and disclosure; for fathers, role overload mediated the links between work pressure and hazardous conditions with father–adolescent warmth. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The relationship between parental anger and behavior problems in children and adolescents.

Two studies examined the relationship between parental trait anger, parental symptomatology, and children's and adolescents' emotional/behavioral problems. Results of Study 1 suggested that parental trait anger did not serve as a mediator between parental symptoms and children's emotional/behavioral problems. Study 2, however, suggested that parental trait anger did serve as a mediator between parental depression and adolescents' emotional/behavioral problems. For internalizing behaviors, inward anger expression and trait anger were mediators in father–son dyads, and outward anger expression was a mediator in mother–daughter dyads. For externalizing behavior, inward anger expression was a mediator in father–son dyads, and outward anger expression was a mediator in mother–son dyads. These results suggest the importance of examining parental dispositions toward anger in relation to the psychological symptoms family members may experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent–child acculturation, parenting, and adolescent depressive symptoms in Chinese immigrant families.

Using a sample of 388 father–adolescent and 399 mother–adolescent dyads in Chinese immigrant families, the current investigation tested Portes and Rumbaut’s (1996) assertion that generational dissonance may indicate a family context that places children at increased risk for adverse outcomes. Study findings suggest that a high discrepancy in father–adolescent acculturation levels relates significantly to more adolescent depressive symptoms. The study further demonstrates that the quality of the parenting relationship between fathers and adolescents operates as a mediator between father–adolescent acculturation discrepancy and adolescent depressive symptoms. Specifically, a high level of discrepancy in American orientation between fathers and adolescents is associated with unsupportive parenting practices, which, in turn, are linked to more adolescent depressive symptoms. These relationships are significant even after controlling for the influence of family socioeconomic status and parents’ and adolescents’ sense of discrimination within the larger society. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning processes and diabetic ketoacidosis in youths with type I diabetes.

Purpose/Objective: To examine relations between episodes of diabetic ketoacidosis (DKA) and parental warmth, parental negativity, and lack of responsibility for diabetes-related tasks in a sample of youths with Type 1 diabetes (T1D). Research Method/Design: 100 youths with T1D and their caregivers, recruited from an inpatient diabetes unit and an outpatient diabetes clinic, participated. Participants completed disease-specific measures of family functioning (e.g., parental warmth, parent and child perceptions of negativity, family responsibility for diabetes regimen), and medical information (e.g., glycosylated hemoglobin and incidences of DKA) was obtained from medical records. Results: Results showed that higher child perceptions of parental warmth and caring related to the regimen were associated with decreased odds of experiencing a DKA episode. Child reports of higher parental negativity about the regimen were associated with increased odds of experiencing a DKA episode. Reports of who in the family was responsible for the diabetes regimen were not related to episodes of DKA. Conclusions/Implications: Findings suggested that family factors play a significant role in the occurrence or absence of DKA in children's long-term management of diabetes. Future intervention efforts should focus on warmth, caring, and negativity when children and their parents are problem solving and communicating about the diabetes regimen. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family members' uncertainty about parental chronic illness: the relationship of hemophilia and HIV infection to child functioning

Examined the relationships among parental and child uncertainty about fathers' illnesses and child internalizing problems. Participants included 65 families in which the father had hemophilia, approximately one half of the fathers also were HIV infected. Within each family, respondents included the father, the mother and one child. Outcome variables included both self- and parent-reported child internalizing behaviors. Results indicated that family members' illness uncertainty was intercorrelated, that child uncertainty about the father's illness predicted both anxiety and depressive symptoms in the child, and that mother's uncertainty predicted child-reported anxiety beyond the child's uncertainty.     

Gender-specific pathways between maternal depressive symptoms, family discord, and adolescent adjustment.

Relations among maternal depressive symptoms, family discord, and adolescent psychological adjustment were examined in a sample of 443 middle adolescents and their mothers. Histories of maternal depressive symptoms, gathered at 3 occasions with 6-month intervals, were related to subsequent adolescent reports of depressive symptoms, conduct problems, and academic difficulties for girls but not for boys. Mediational tests indicated that girls' greater vulnerability to family discord (e.g., marital discord, low family intimacy, parenting impairments) accounted for the impact of maternal depressive symptoms on their social and emotional adjustment. Analyses suggest that family discord is a strong mediator in the development of girls' conduct disturbances and a modest mediator of girls' depressive symptoms. Results are discussed within a framework that integrates interpersonal models of parental depressive symptoms with the gender intensification hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus

OBJECTIVES: The goal of this study was to identify parental behaviors that relate to adherence and metabolic control in a population of young adolescents with insulin-dependent diabetes mellitus (IDDM), and to understand the interrelationships among the variables of parental involvement, adherence to blood glucose monitoring, and glycemic control. STUDY DESIGN: A cross-sectional design was used to investigate parental involvement in diabetes regimen tasks in 89 youth, aged 10 to 15 years, with IDDM. Levels of parental involvement in blood glucose monitoring (BGM) and insulin administration were evaluated through interviews. Assessment of adherence was made by physicians or nurses, independent of patient or parent reports of adherence. Glycemic control was assessed with glycosylated hemoglobin (HbA1c) (reference range, 4% to 6%). RESULTS: There were significant differences in the mean HbA1c values between the older (13 to 15 years of age) (HbA1c = 8.9% +/- 1.03%) and younger (10 to 12 years) patients (HbA1c = 8.4% +/- 1.06%) (p < 0.02). Parental involvement in BGM was significantly related to adherence to BGM (number of blood sugar concentrations checked daily) in both groups of adolescent patients. The younger patients monitored their blood glucose levels more frequently than did the older patients, 39% of the younger patients checked sugar concentrations four or more times daily compared with only 10% of the older group (p < 0.007). In a multivariate model controlling for age, gender, Tanner staging, and duration of diabetes, the frequency of BGM was a significant predictor of glycemic control (R2 = 0.19, p < 0.02). Increased frequency of BGM was associated with lower HbA1c levels. When the frequency of BGM was zero or once a day, the mean HbA1c level was 9.9% +/- 0.44 (SE); when the frequency of BGM was two or three times a day, the mean HbA1c level was 8.7% +/- 0.17; and when the frequency of BGM was four or more times daily, the mean HbA1c level was 8.3% +/- 0.22. CONCLUSIONS: Parental involvement in BGM supports more frequent BGM in 10- to 15-year-old patients with IDDM. This increased adherence to BGM is associated with better metabolic control (i.e., lower HbA1c levels). These findings suggest that encouraging parental involvement in BGM with 10- to 15-year-old patients with IDDM may help to prevent the well-documented deterioration in glycemic control and adherence to treatment that often occurs in later adolescence.     

Glycemic control among Latinos with type 2 diabetes: The role of social-environmental support resources.

Objective: Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources. Methods: Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support resources for disease management influence hemoglobin A1c (HbA1c) levels in a sample of 208 Latinos with Type 2 diabetes recruited from low-income serving community clinics in San Diego County. We hypothesized that the relationship between support resources for disease-management and HbA1c would be mediated by diabetes self-management and/or depression. Results: Participants who perceived greater support resources for disease-management reported better diabetes self-management (β = .40, p     

The fit between stress appraisal and dyadic coping in understanding perceived coping effectiveness for adolescents with type 1 diabetes.

This study examined whether perceived coping effectiveness (PCE) was associated with better diabetes management and was higher when adolescents’ dyadic coping was matched to shared stress appraisals. There were 252 adolescents with Type 1 diabetes who completed stress and coping interviews where they appraised mothers’ and fathers’ involvement in stress ownership (mine, indirectly shared, directly shared with parent), in coping (uninvolved, supportive, collaborative, or controlling), and rated their effectiveness in coping. Adolescents completed assessments of depressive symptoms (Children’s Depression Inventory), self-care behaviors (Self-Care Inventory), and efficacy of disease management (Diabetes Self-Efficacy). Glycosylated hemoglobin levels were obtained from medical records. Higher PCE was associated with fewer depressive symptoms, self-care behaviors, and efficacy across age and, more strongly for older adolescents’ metabolic control. Appraisals of support or collaboration from parents were more frequent when stressors were appraised as shared. PCE was enhanced when dyadic coping with mothers (but not fathers) was consistent with stress appraisals (e.g., shared stressors together with collaborative coping). Stress and coping is embedded within a relational context and this context is useful in understanding the coping effectiveness of adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interparental conflict, negative parenting, and children's adjustment: Bridging links between parents' depression and children's psychological distress.

Pathways linking parental depressive symptoms, adult relationship insecurity, interparental conflict, negative parenting, and children's psychological adjustment (internalizing symptoms and externalizing problems) were assessed using a 3-wave longitudinal research design. Two-parent families (N = 352) with 11- to 13-year-old children (179 boys, 173 girls) participated in the study. Maternal and paternal depressive symptoms were associated with insecurity in adult close relationships assessed 12 months later, which was concurrently related to heightened levels of interparental conflict. Controlling for children's initial symptom levels, interparental conflict was related to child appraisals of father and mother rejection assessed an additional 12 months later, which were related to children's internalizing symptoms and externalizing problems, respectively. Results are discussed with regard to the implications for understanding the complex interplay between adult depressive symptoms, attributions in close adult relationships, interparental conflict, negative parenting, and children's psychological adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping, control, and adjustment in type 2 diabetes.

The relationships of both coping strategies and perceived control to psychological and physiological adjustment were investigated in 115 adults (65 women, 50 men) with Type 2 diabetes. Results showed that (a) emotional preoccupation and palliative coping were positively correlated with depression and state anxiety, whereas perceived control was negatively correlated with depression, state anxiety, and hemoglobin A1c (HbA1c); (b) instrumental coping predicted lower depression; (c) perceived control moderated the relationships between instrumental coping and depression, and emotional preoccupation coping and HbA1c; and (d) emotional preoccupation coping mediated the relationships between perceived control and depression, and perceived control and state anxiety. Results are discussed in terms of the goodness-of-fit hypothesis (V. J. Conway & D. J. Terry, 1992), optimal coping, and the importance of perceived control in psychological and physiological adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of parental separation and divorce on very young children.

Data from the National Institute of Child Health and Human Development Study of Early Child Care were analyzed to explore effects of marital separation on children in the first 3 years of life. The sample included 73 never-married mothers and 97 separated mothers; a comparison group of 170 was conditionally randomly selected from the 2-parent families. Children in 2-parent families performed better than children in 1-parent families on assessments of cognitive and social abilities, problem behavior, attachment security, and behavior with mother. However, controlling for mothers' education and family income reduced these differences, and associations with separated-intact marital status were nonsignificant (the effect size was .01). Thus, children's psychological development was not affected by parental separation per se; it was related to mothers' income, education, ethnicity, childrearing beliefs, depressive symptoms, and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptomatology and coronary heart disease in Type I diabetes mellitus: A study of possible mechanisms.

Recent evidence has suggested that depressive symptomatology is a risk factor for the development of coronary heart disease (CHD) in patients with diabetes mellitus, although little is understood about mechanisms that may explain this association. The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study is a natural history study of 658 men and women with childhood-onset Type I diabetes. Participants from the EDC Study who reported the fewest depressive symptoms on the Beck Depression Inventory at baseline examination were least likely to develop CHD over 10 years. Differences in insulin resistance, autonomic dysregulation, inflammation, smoking, and complications associated with Type I diabetes appear to help explain this relationship. Future research should clarify causal pathways between depressive symptomatology, behavioral and physiological processes, and CHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does parental ADHD bias maternal reports of ADHD symptoms in children?

Within families, co-occurring attention-deficit/hyperactivity disorder (ADHD) in parents and children may be common. The authors evaluated the hypothesis that parental ADHD may lead to a reporting bias of ADHD symptoms in offspring. They combined 2 family case-controlled studies of ADHD using structured interviews. They compared rates of maternal reported ADHD symptoms among 3 groups of ADHD children: no parental ADHD (n=231), mother with ADHD (n=63), and father with ADHD (n=57). With the exception of 1 symptom, the rates of reporting between groups did not differ. There was no evidence that the discrepancy between maternal reports and self-reports of symptoms differed by parental ADHD. Results were similar across child gender or referral status. These results do not support the notion that parental ADHD affects maternal reports of offspring ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)