Abstract
The aim of this thesis is to learn how pediatric psychological care for (Dutch) adolescents and their parents may be optimized. Psychological functioning in adolescents (specifically depression and behavior problems) and their parents (general and diabetes specific parenting stress) is studied while taking into account biological (gender, age, HbA1c) characteristics.
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How the adolescents internalize their experiences is studied by explicitly asking them to provide their representations about their life and if they are satisfied with the way they cope with diabetes. A systematic review of the literature is done to investigate the type and success rate of existing psychological interventions to support adolescents with T1DM and their parents. In the cross-sectional study 151 Dutch adolescents with T1DM (65 males and 86 females) and at least one of their parents (126 mothers and 103 fathers) participated.They were between 12 and 18 years of age, were in secondary school, had been diagnosed for diabetes for > 6 months, and did not have comorbid medical or psychiatric conditions. The comparison group consisted of 122 healthy peers and their parents (106 mothers and 55 fathers). We found that one in eight youth with T1DM met the clinical cut off for depression. However, the adolescents with T1DM did not differ from healthy peers in number of depressive complaints. Specifically the combination of depressive symptoms and rule breaking behavior was related to metabolic control. Surprisingly, adolescents with T1DM reported more thought problems than healthy peers, maybe due to subtle neuropsychological problems as a result of the disease. The adolescents with T1DM had a positive representation of their overall functioning. They rated their life with a mean of 7.4 on a 10 point scale, but they rated their life less positive in comparison to their healthy peers, who rated their life with an 8. Adolescents who rated their life with a 6 or lower, reported more depressive symptoms and more internalizing and externalizing behavior problems than adolescents who valued their life with a 7 or up. An important first impression of psychosocial functioning in adolescents with T1DM can be provided by the answer on the 10-point ‘Rate your life Scale’ regarding the evaluation of one’s life. The majority of adolescents also had a positive representation of their coping style: 71.9% of the adolescents valued their own coping ability as successful or very successful. Satisfaction with their own coping ability was related to both physical and psychological functioning. Adolescents who value their coping style as more satisfying, reported less depressive feelings and less (particularly internalizing) behavior problems and had a better metabolic control (lower HbA1c). Especially fathers of Dutch adolescents with T1DM reported significantly more parenting stress than fathers of healthy peers. Parents of Dutch adolescents with T1DM were especially worried when their child was experiencing depressive feelings; not when the physical functioning of the adolescent was worrisome. Also their worries concerned general parenting issues and to a much lesser degree diabetic related parenting issues. We found that one in eight youth with T1DM met the clinical cut off for depression. However, the adolescents with T1DM did not differ from healthy peers in number of depressive complaints. Specifically the combination of depressive symptoms and rule breaking behavior was related to metabolic control. Surprisingly, adolescents with T1DM reported more thought problems than healthy peers, maybe due to subtle neuropsychological problems as a result of the disease. The adolescents with T1DM had a positive representation of their overall functioning. They rated their life with a mean of 7.4 on a 10 point scale, but they rated their life less positive in comparison to their healthy peers, who rated their life with an 8. Adolescents who rated their life with a 6 or lower, reported more depressive symptoms and more internalizing and externalizing behavior problems than adolescents who valued their life with a 7 or up. An important first impression of psychosocial functioning in adolescents with T1DM can be provided by the answer on the 10-point ‘Rate your life Scale’ regarding the evaluation of one’s life. The majority of adolescents also had a positive representation of their coping style: 71.9% of the adolescents valued their own coping ability as successful or very successful. Satisfaction with their own coping ability was related to both physical and psychological functioning. Adolescents who value their coping style as more satisfying, reported less depressive feelings and less (particularly internalizing) behavior problems and had a better metabolic control (lower HbA1c). Especially fathers of Dutch adolescents with T1DM reported significantly more parenting stress than fathers of healthy peers. Parents of Dutch adolescents with T1DM were especially worried when their child was experiencing depressive feelings; not when the physical functioning of the adolescent was worrisome. Also their worries concerned general parenting issues and to a much lesser degree diabetic related parenting issues.
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