Skip to main content

Advertisement

SpringerLink
Log in

Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abidin, R. R. (1995). Parenting stress index: Professional manual (3rd ed.). Odessa, FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Anderson, B. (2004). Family conflict and diabetes management in youth: Clinical lessons from child development and diabetes research. Diabetes Spectrum, 17, 22–26. doi:10.2337/diaspect.17.1.22.

    Article  Google Scholar 

  • Anderson, B., Ho, J., Brackett, J., Finkelstein, D., & Laffel, L. (1997). Parental involvement in diabetes management tasks: Relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. The Journal of Pediatrics, 130, 257–265.

    Article  PubMed  Google Scholar 

  • Baars, R., Atherton, C., Koopman, H., Bullinger, M., Power, M., & the DISABKIDS group. (2005). The European DISABKIDS project: Development of seven condition-specific modules to measure health related quality of life in children and adolescents. Health and Quality of Life Outcomes, 3, 70. doi:10.1186/1477-7525-3-70.

    Article  PubMed Central  PubMed  Google Scholar 

  • Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.

    Google Scholar 

  • Blankfeld, D., & Holahan, C. (1996). Family support, coping strategies, and depressive symptoms among mothers of children with diabetes. Journal of Family Psychology, 10, 173–179.

    Article  Google Scholar 

  • Bullinger, M., Schmidt, S., Petersen, C., & Ravens-Sieberer, U. (2006). Quality of life: Evaluation criteria for children with chronic conditions in medical care. Journal of Public Health, 14, 343–355. doi:10.1007/s10389-006-0066-0.

    Article  Google Scholar 

  • Burke, P., Neigut, D., Kocoshis, S., Chandra, R., & Sauer, J. (1994). Correlates of depression in new onset pediatric inflammatory bowel disease. Child Psychiatry and Human Development, 4, 275–283. doi:10.1007/BF02353203.

    Article  Google Scholar 

  • Cameron, L., Young, M., & Wiebe, D. (2007). Maternal trait anxiety and diabetes control in adolescence with type 1 diabetes. Journal of Pediatric Psychology, 32, 733–744. doi:10.1093/jpepsy/jsl053.

    Article  PubMed  Google Scholar 

  • Carona, C., Crespo, C., Silva, N., Lopes, A. F., Canavarro, M. C., & Bullinger, M. (2012). Examining a developmental approach to health-related quality of life assessment: Psychometric analysis of DISABKIDS generic module in a Portuguese sample. Vulnerable Children and Youth Studies. Advance online publication. doi: 10.1080/17450128.2012.736647.

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Cohen, D., Lumley, M., Naar-King, S., Partridge, T., & Cakan, N. (2004). Child behavior problems and family functioning as predictors of adherence and glycemic control in economically disadvantaged children with Type 1 Diabetes: A prospective study. Journal of Pediatric Psychology, 29, 171–184. doi:10.1093/jpepsy/jsh019.

    Article  PubMed  Google Scholar 

  • Coyne, J. C., & Downey, G. (1991). Social factors and psychopathology: Stress, social support, and coping processes. Annual Review of Psychology, 42, 401–425.

    Article  PubMed  Google Scholar 

  • Cunningham, N., Vesco, A., Dolan, L., & Hood, K. (2011). From caregiver psychological distress to adolescent glycemic control: The mediating role of perceived burden around diabetes management. Journal of Pediatric Psychology, 36, 196–205. doi:10.1093/jpepsy/jsq071.

    Article  PubMed  Google Scholar 

  • Driscoll, K., Johnson, S., Barker, D., Quittner, A., Deeb, L., Geller, D., et al. (2010). Risk factors associated with depressive symptoms in caregivers of children with type 1 diabetes or cystic fibrosis. Journal of Pediatric Psychology, 35, 814–822. doi:10.1093/jpepsy/jsp138.

    Article  PubMed  Google Scholar 

  • Drotar, D. (1997). Relating parent and family functioning to the psychological adjustment of children with chronic health conditions: What have we learned? What do we need to know? Journal of Pediatric Psychology, 22, 149–165. doi:10.1093/jpepsy/22.2.149.

    Article  PubMed  Google Scholar 

  • Eckshtain, D., Ellis, D., Kolmodin, K., & Naar-King, S. (2010). The effects of parental depression and parenting practices on depressive symptoms and metabolic control in urban youth with insulin dependent diabetes. Journal of Pediatric Psychology, 35, 426–435. doi:10.1093/jpepsy/jsp068.

    Article  PubMed  Google Scholar 

  • Eiser, C., & Morse, R. (2001a). Can parents rate their child’s health-related quality of life? Results of a systematic review. Quality of Life Research, 10, 347–357. doi:10.1023/A:1012253723272.

    Article  PubMed  Google Scholar 

  • Eiser, C., & Morse, R. (2001b). The measurement of quality of life in children: Past and future perspectives. Developmental and Behavioral Pediatrics, 22, 248–256.

    Article  Google Scholar 

  • Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*power 3: A flexible statistical power analysis program for the social, behavioural, and biomedical sciences. Behaviour Research Methods, 39, 175–191. doi:10.3758/BF03193146.

    Article  Google Scholar 

  • Field, C., & Duchoslav, R. (2009). Family influence on adolescent treatment outcomes. In W. T. O’Donohue & L. W. Tolle (Eds.), Behavioral approaches to chronic disease in adolescence (pp. 47–54). New York: Springer.

    Chapter  Google Scholar 

  • Gaspar, T., & Matos, M. G. (Eds.). (2008). Qualidade de vida em crianças e adolescentes: Versão portuguesa dos instrumentos KIDSCREEN-52 [quality of life in children and adolescents: Portuguese version of the instruments KIDSCREEN-52]. Cruz Quebrada: Aventura Social e Saúde.

    Google Scholar 

  • Hamlett, K., Pellegrini, D., & Katz, K. (1992). Childhood chronic illness as a family stressor. Journal of Pediatric Psychology, 17, 33–47. doi:10.1093/jpepsy/17.1.33.

    Article  PubMed  Google Scholar 

  • Hauser, S., Jacobson, A., Lavori, P., Wolfsdorf, J., Herskowitz, R., Milley, J., et al. (1990). Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: II. Immediate and long-term linkages with the family milieu. Journal of Pediatric Psychology, 15, 527–542. doi:10.1093/jpepsy/15.4.527.

    Article  PubMed  Google Scholar 

  • Hayes, A. F. (2011). SPSS MODMED macro syntax reference. Retrieved from http://www.afhayes.com/public/modmed.pdf.

  • Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [white paper]. Retrieved from http://www.afhayes.com/ public/process2012.pdf.

  • Holmbeck, G., Coakley, R., Hommeyer, J., Shapera, W., & Westhoven, V. (2002). Observed and perceived dyadic and systemic functioning in families of preadolescents with spina bifida. Journal of Pediatric Psychology, 27, 177–189. doi:10.1093/jpepsy/27.2.177.

    Article  PubMed  Google Scholar 

  • Horsch, A., McManus, F., Kennedy, P., & Edge, J. (2007). Anxiety, depressive, and posttraumatic stress symptoms in mothers of children with type 1 diabetes. Journal of Traumatic Stress, 20, 881–891. doi:10.1002/jts.20247.

    Article  PubMed  Google Scholar 

  • Jaser, S., Whittemore, R., Ambrosino, J., Lindemann, E., & Grey, M. (2008). Mediators of depressive symptoms in children with type 1 diabetes and their mothers. Journal of Pediatric Psychology, 33, 509–519. doi:10.1093/jpepsy/jsm104.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kazak, A. (1997). A contextual family/systems approach to pediatric psychology: Introduction to the special issue. Journal of Pediatric Psychology, 22, 141–148. doi:10.1093/jpepsy/22.2.141.

    Article  PubMed  Google Scholar 

  • Kazak, A., Rourke, M., & Navsaria, N. (2009). Families and other systems in pediatric psychology. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 656–671). New York: The Guilford Press.

    Google Scholar 

  • Kovaks, M., Obrosky, D., Goldston, D., & Bonar, L. (1997). Psychiatric disorders in youths with IDDM: Rates and risk factors. Diabetes Care, 20, 36–44. doi:10.2337/diacare.20.1.36.

    Article  Google Scholar 

  • Lewin, A., Heidgerken, A., Geffken, G., Williams, L., Storch, E., Gelfand, K., et al. (2006). The relation between family factors and metabolic control: The role of diabetes adherence. Journal of Pediatric Psychology, 31, 174–183. doi:10.1093/jpepsy/jsj004.

    Article  PubMed  Google Scholar 

  • MacCallum, R. C., Zhang, S., Preacher, K. J., & Rucker, D. D. (2002). On the practice of dichotomization of quantitative variables. Psychological Methods, 7, 19–40.

    Article  PubMed  Google Scholar 

  • Matos, P.M., & Fontaine, M. (1992). Family Environment Scale. Adaptação portuguesa [Family Environment Scale—Portuguese version]. Unpublished manuscript, Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Porto, Portugal.

  • Missotten, L., Luyckx, K., & Seiffge-Krenke, I. (2012). Family climate of adolescents with and without type 1 diabetes: Longitudinal associations with psychosocial adaptation. Journal of Child and Family Studies. Advance online publication. doi: 10.1007/s10826-012-9585-1.

  • Moos, R. H., & Moos, B. S. (1986). Family environment scale manual (2nd ed.). Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Mullins, L., Fuemmeler, B., Hoff, A., Chaney, J., Pelt, J., & Ewing, C. (2004). The relationship of parental overprotection and perceived child vulnerability to depressive symptomatology in children with type 1 diabetes mellitus: The moderating influence of parenting stress. Children’s Health Care, 33, 21–34. doi:10.1207/s15326888chc3301_2.

    Article  Google Scholar 

  • Northam, E., Anderson, P., Adler, R., Werther, G., & Warne, G. (1996). Psychosocial and family functioning in children with insulin-dependent diabetes at diagnosis and one year later. Journal of Pediatric Psychology, 21, 699–717. doi:10.1093/jpepsy/21.5.699.

    Article  PubMed  Google Scholar 

  • Overstreet, S., Goins, J., Chen, R., Holmes, S., Greer, T., Dunlap, W., et al. (1995). Family environment and the interrelation of family structure, child behavior, and metabolic control for children with diabetes. Journal of Pediatric Psychology, 20, 435–447. doi:10.1093/jpepsy/20.4.435.

    Article  PubMed  Google Scholar 

  • Pais-Ribeiro, J., Silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007). Validation study of a portuguese version of the hospital anxiety and depression scale. Psychology, Health & Medicine, 12, 225–235. doi:10.1080/13548500500524088.

    Article  Google Scholar 

  • Peterson, C., Schmidt, S., Power, M., Bullinger, M., & The DISABKIDS Group. (2005). Development and pilot-testing of a health-related quality of life chronic generic module for children and adolescents with chronic health conditions: A European perspective. Quality of Life Research, 14, 1065–1077. doi:10.1007/s11136-004-2575-z.

    Article  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi:10.3758/BRM.40.3.879.

    Article  PubMed  Google Scholar 

  • Ravens-Sieberer, U., Erhart, M., Rajmil, L., Herdman, M., Auquier, P., Bruil, J., et al. (2010). Reliability, construct and criterion validity of the KIDSCREEN-10 score: A short measure for children and adolescents’ well-being and health-related quality of life. Quality of Life Research, 19, 1487–1500. doi:10.1007/s11136-010-9706-5.

    Article  PubMed Central  PubMed  Google Scholar 

  • Rentinck, I. C., Ketelaar, M., Jongmans, M. J., & Gorter, J. W. (2006). Parents of children with cerebral palsy: A review of factors related to the process of adaptation. Child: Care, Health and Development, 33, 161–169.

    Google Scholar 

  • Sameroff, A. (1975). Transactional models of early social relations. Human Development, 18, 65–79. doi:10.1159/000271476.

    Article  Google Scholar 

  • Schwarzer, R., & Leppin, A. (1991). Social support and health: A theoretical and empirical overview. Journal of Social and Personal Relationships, 8, 99–127. doi:10.1177/0265407591081005.

    Article  Google Scholar 

  • Shor, E. L., & American Academy of Pediatrics Task Force on the Family. (2003). Family pediatrics: Report of the Task Force on the Family. Pediatrics, 111, 1541–1571.

    Google Scholar 

  • Small, S. A., Eastman, G., & Cornelius, S. (1988). Adolescent autonomy and parental stress. Journal of Youth and Adolescence, 17, 377–391. doi:10.1007/BF01537880.

    Article  PubMed  Google Scholar 

  • Soliday, E., Kool, E., & Lande, M. (2001). Family environment, child behavior, and medical indicators in children with kidney disease. Child Psychiatry and Human Development, 31, 279–295. doi:10.1023/A:1010282305881.

    Article  PubMed  Google Scholar 

  • Streisand, R., Braniecki, S., Tercyak, K. P., & Kazak, A. E. (2001). Childhood illness-related parenting stress: The pediatric inventory for parents. Journal of Pediatric Psychology, 26, 155–162. doi:10.1093/jpepsy/26.3.155.

    Article  PubMed  Google Scholar 

  • Streisand, R., Mackey, E., & Herge, W. (2010). Associations of parent coping, stress, and well-being in mothers of children with diabetes: Examination of data from a national sample. Maternal and Child Health Journal, 14, 612–617. doi:10.1007/s10995-009-0497-7.

    Article  PubMed  Google Scholar 

  • Streisand, R., Swift, E., Wickmark, T., Chen, R., & Holmes, C. (2005). Pediatric parenting stress among parents of children with type 1 diabetes: The role of self-efficacy, responsibility and fear. Journal of Pediatric Psychology, 30, 513–521. doi:10.1093/jpepsy/jsi076.

    Article  PubMed  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Allyn and Bacon.

    Google Scholar 

  • The European DISABKIDS Group. (2006). The DISABKIDS Questionnaires—Quality of Life questionnaires for children with chronic conditions. Lengerich: Pabst Science Publishers.

    Google Scholar 

  • Varni, J., Seid, M., & Kurtin, P. (1999). Pediatric health-related quality of life measurement technology: A guide for health care decisions makers. Journal of Clinical Outcomes Management, 6, 33–40.

    Google Scholar 

  • Weissberg-Benchell, J., Nansel, T., Holmbeck, G., Chen, R., Anderson, B., Wysocki, T., et al. (2009). Generic and diabetes-specific parent–child behaviors and quality of life among youth with type 1 diabetes. Journal of Pediatric Psychology, 34, 977–988. doi:10.1093/jpepsy/jsp003.

    Article  PubMed  Google Scholar 

  • Williams, L., Laffel, L., & Hood, K. (2009). Education and psychological aspects diabetes-specific family conflict and psychological distress in paediatric type 1 diabetes. Diabetic Medicine, 26, 908–914. doi:10.1111/j.1464-5491.2009.02794.x.

    Article  PubMed  Google Scholar 

  • Wysocki, T., Buckloh, L., & Greco, P. (2009). The psychological context of diabetes mellitus in youths. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 287–302). New York: The Guilford Press.

    Google Scholar 

  • Zigmond, A. P., & Snaith, R. P. (1983). The hospital and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi:10.1111/j.1600-0447.1983.tb09716.x.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study is part of the “Family dynamics in pediatric chronic health conditions” research project, integrated in the “Relationships, Development & Health” Research Group (PEst-OE/PSI/UI0192/2011). Helena Moreira was supported by a Post-doctoral scholarship (SFRH/BPD/70063/2010) from Portuguese Foundation for Science and Technology.

Author information

Authors and Affiliations

  1. Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal

    Helena Moreira, Roberta Frontini & Maria Cristina Canavarro

  2. Institute of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Monika Bullinger

Authors
  1. Helena Moreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberta Frontini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monika Bullinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Cristina Canavarro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helena Moreira.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moreira, H., Frontini, R., Bullinger, M. et al. Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment. J Child Fam Stud 23, 347–359 (2014). https://doi.org/10.1007/s10826-013-9758-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-013-9758-6

Keywords

Search

Navigation