Adolescent Diabetic Control: Using the Process-Person-Context-Time Model

A Bioecosystem Theory of Negative Symptoms in Schizophrenia

Objective: Negative symptoms are a core feature of schizophrenia that has been linked to numerous poor clinical outcomes. Although person-level mechanisms have been identified for negative symptoms, psychosocial and pharmacological treatments targeting these mechanisms have been ineffective. The current theoretical paper proposes that limited treatment progress may result in part from a failure to identify and target environmental processes that cause and maintain negative symptoms. Methods: A novel theoretical model is outlined, called the bioecosystem theory of negative symptoms, that offers a conceptual framework for studying interactions among environmental systems and person-related biological and psychosocial factors. Results: Relying on Bronfenbrenner's developmental theory as an organizing framework, four interactive environmental systems are proposed to be critical for the genesis and maintenance of negative symptoms: (1) Microsystem: the immediate environment; (2) Mesosystem: the interactions among microsystems; (3) Exosystem: indirect environments that influence the individual through the microsystems; (4) Macrosystem: socio-cultural factors. The environmental factors within these systems are proposed to function as a network and have dynamic within-system interactions, as well as cross-system interactions that change over time and across phases of illness. Conclusions: Environmental contributions to negative symptoms have received minimal empirical attention, despite their potential to explain variance in negative symptom severity. The bioecosystem model of negative symptoms introduced here offers a novel conceptual framework for exploring environmental contributions to negative symptoms and their interaction with person-level biological and psychological factors. This theory may facilitate new avenues for identifying environmental treatment targets and novel systems-level interventions.

Parental resolution and the adolescent's health and adjustment: The case of adolescents with type 1 diabetes

This study examines the association between parents' resolution of their adolescent child's diagnosis of type 1 diabetes and the health and mental adjustment of the adolescents themselves. Parents of 75 adolescents with type 1 diabetes were interviewed using the Reaction to Diagnosis Interview. Parents and adolescents completed questionnaires regarding the child's physical health, self-management of the disease, and behavioral and emotional problems. Physicians reported adolescents' HbA1c levels. Results showed that adolescents whose fathers were resolved with the diagnosis exhibited better diabetes self-management and adolescents whose mothers were resolved with the diagnosis exhibited fewer internalizing and externalizing problems. The findings highlight the different role of mothers and fathers in the treatment of adolescents with diabetes and provide a basis for clinical intervention that focuses not only on adolescent health, but also on parental state of mind regarding the resolution with the disease.

Parents' sense of coherence and the adolescent's health and emotional and behavioral adjustment: the case of adolescents with diabetes

INTRODUCTION

This study examines parental sense of coherence (SOC) as a resource to health and well-being among adolescents with diabetes.

METHOD

Participants were recruited by the Juvenile Diabetes Research Foundation and a major pediatric diabetes clinic. Parents of 75 adolescents with type 1 diabetes completed the SOC Questionnaire. Parents and adolescents completed questionnaires regarding the child's physical health, disease self-management, and behavioral problems. Parents and physicians reported adolescent's HbA1c level.

RESULTS

Results showed that parents' SOC was positively correlated to adolescents' physical health and negatively to internalizing problems.

CONCLUSIONS

Findings highlight the place of parents in the wellness of adolescents with disease and provide a basis for interventions that enhance adolescents' health and psychological adjustment.