Studies on children’s psychological adjustment to diabetes

Sammanfattning: Type I diabetes is a chronic disease that affects the daily life of the individual from diagnosis and for the rest of life. The patient is constantly reminded of the diabetes because of a daily, self-managed and demanding treatment. Good psychological adjustment to diabetes is important for psychological well-being and might influence the medical consequences of the disease. How the treatment is performed might affect both short-term as well as long-term outcome of the disease. It is also possible that psychological and behavioral factors early in the course diabetes of may predict the long-term outcome of the disease. The overall aim of this study was to investigate psychological adjustment to Type I diabetes in children and adolescents. The aims were addressed in two studies, one crosssectional (C-study) and one longitudinal, multi-center study (M-study). The M-study investigated a cohort children up to 15 years of age who were admitted to five pediatric clinics after onset of diabetes. Psychological data was collected at diagnosis, after nine months disease duration and after five years from onset (n=51). Medical data for diabetes outcome (mainly Haemoglobin bA1c) were collected at two years after diagnosis and in parallel with the followup assessment at five-year disease duration. The C-study was performed at one diabetes clinic of children nine to 18 years of age with varying length of diabetes duration (n=62). The objectives of performing two studies were to complement one another as well as to form a group of children sufficiently large to explore psychological adjustment to diabetes. The methods in the M-study were behavioral ratings and interviews of children performed by hospital staff and investigators, and psychological tests and questionnaires completed by the children. In the C-study, parents and children filled out questionnaires. Psychological adjustment to diabetes was studied by diabetes-specific emotional and behavioral adaptation, by the child's perception of family support and own competence in taking care of diabetes. Methods for studying diabetes-related psychological adjustment were developed for both studies. Affective reactions during the first weeks after diagnosis were predictive of difficulties in psychological adjustment to diabetes at five years of disease duration. Diabetes-related psychological adjustment in the children was associated to general psychological factors in both children and parent. Depressive symptoms in the child were associated with increased emotional and behavioral problems of adaptation as well as less support from the family. Metabolic control was more associated with diabetes-related behavioral adaptation than with general psychological functioning of the child. Children's metabolic control was more associated with family factors than with parents' psychological well-being. The level of later metabolic control was predicted by psychological factors assessed during first year after diagnosis and by level of early metabolic control. Also, it was found that physicians were not always aware of the children's emotional difficulties with the adaptation to diabetes. By identifying children who are at risk for developing problems or by early recognition of problems, it might be possible to reduce or prevent emotional suffering and future risk for diabetes complications.