Cognitive, behavioral and goal adjustment coping and depressive symptoms in young people with diabetes: a search for intervention targets for coping skills training

Bridging illness uncertainty and self-care: The role of cognitive emotion regulation in type 2 diabetes management

AIMS

This study assessed the mediating role of cognitive emotion regulation strategies in the relationship between illness uncertainty and diabetes health-promoting self-care behaviours.

METHODS

A cross-sectional study was conducted with 433 T2DM outpatients using the Mishel Uncertainty in Illness Scale, the Diabetes Health Promotion Self-Care Scale, and the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using SPSS (v.29) for descriptive and Pearson correlation tests, and Process Macro for SPSS (Model 4, v.4.2) for mediation analysis.

RESULTS

There is a statistically significant, weak negative relationship between illness uncertainty and diabetes health promotion self-care scores (r = -0.105, p = 0.029). CERQ showed a weak negative correlation with illness uncertainty scores, whereas the questionnaire demonstrated a statistically significant, moderate positive correlation with diabetes health-promoting self-care (p < 0.05). The relationship between illness uncertainty and diabetes health- promoting self-care was mediated by CERQ such as self-blame (β= 0.083, 95 % CI= 0.019 - 0.155), acceptance (β= -0.031, 95 % CI= -0.061 - -0.007), rumination (β= -0.107, 95 % CI= -0.179 - -0.048), and positive reappraisal (β= -0.043, 95 % CI= -0.091 - -0.001).

CONCLUSIONS

Illness uncertainty negatively impacts self-care behaviours in T2DM patients. CERQ, including self-blame, acceptance, rumination, and positive reappraisal, play a mediating role, highlighting their potential in interventions to improve self-care.

The relationship between acceptance, self-compassion and hope in infertile women: a structural equation analysis

OBJECTIVE

This study aimed to determine the relationship between psychological acceptance, self-compassion and hope in infertile women.

BACKGROUND

Infertility distress can make women more vulnerable than men. Acceptance, self-compassion and hope can help infertile women to alleviate their distresses and to peruse the medical treatments.

METHODS

This study was performed using a cross-sectional descriptive correlational design; A total of 346 women with primary infertility referred to infertility centres of Yazd, Isfahan and Kerman provinces, Iran, participated in the study by completing the self-compassion scale, hope scale and Acceptance and Action Questionnaire-II (AAQ-II). Data were analysed using structural equation analysis.

RESULTS

The results of structural equation analysis showed that the path coefficient of self-compassion on acceptance (r = .69, p < .01) and hope (r = .29, p < .05) in infertile women was direct and significant. Acceptance also had a direct effect on hope in infertile women (r = .31, p < .05) and played a significant mediating role in the relationship between self-compassion and hope in infertile women.

CONCLUSIONS

The findings suggest that self-compassion is likely to be an important strategic intervention alongside medical treatments for infertile women, because it leads to problem acceptance and then increases hope in them.

Virtual reality's impact on children with type 1 diabetes: a proof-of-concept randomized cross-over trial on anxiety, pain, adherence, and glycemic control

AIMS

 Assess the effectiveness of virtual reality (VR) technology, in reducing pain and anxiety, and improving adherence and glycemic control among children with type 1 diabetes (T1D).

METHODS

Children with T1D, managed with continuous glucose monitoring and insulin pumps, were recruited for a randomized cross-over trial. Children were randomized to one of two interventions for diabetes management: group 1 used VR glasses first and group 2 listened to vocal-guided affective imagery first (audio). After 1 month, the interventions were crossed over. The outcome measures included pain and anxiety assessment, adherence, glycemic control, and patient-reported outcome measures (PROMs) of VR satisfaction and effectiveness.

RESULTS

 Forty children, mean age 11.4 ± 1.8 years, were participated. During the VR part, the monthly mean pain score compared to the baseline improved in both groups by 30% (p = 0.03). A 14% reduction in the state anxiety score was observed from baseline to 1 month in both groups (p = 0.009). Glycemic control measures including time in range, time above range, and glucose management indicator improved in both groups during VR part (p < 0.004 for all), compared to audio part. After one month, the patient-reported outcome measure (PROM) of satisfaction and effectiveness was sixfold higher after 1 month in group 1 compared to group 2 (p = 0.002). Adherence improved for both groups.

CONCLUSIONS

VR was shown to be effective in reducing pain and anxiety, improving adherence, PROM, and glycemic control among children with T1D. We suggest incorporating VR technology in pediatric diabetes clinics to facilitate and improve coping and management of diabetes.

TRIAL REGISTRATION

Trial registration number and date of registration for prospectively registered trials:ClinicalTrials.gov Identifier: NCT05883267, May 10th, 2023.

Diabetes causal attributions: Pathways to stigma and health

This study investigates the relationships among causal attributions, internalized stigma, and self-blame, along with downstream health and life satisfaction consequences for individuals with type 1 and type 2 diabetes. Data were analyzed from the Diabetes, Identity, Attributions, and Health study. Participants diagnosed with either type 1 or type 2 diabetes (N=363) were included in the analysis. Results indicated that the relationship between causal attributions and stigmatization was moderated by diabetes type. Path analyses, one for each diabetes type, revealed overall patterns linking causal attributions to internalized stigma and to self-blame, which were linked to ratings of reduced self-care, increased symptoms, and reduced life satisfaction. However, the specific paths diverged by diabetes type in important ways. Whereas higher genetic causal attributions were associated with more self-blame and stigmatization for type 1 diabetes, these attributions were associated with less self-blame and stigmatization for type 2 diabetes. The current work demonstrates the importance of causal attributions to overall health and illustrates how even in conditions with genetic attributions that are similar in magnitude, affected individuals may attach very different meaning to those attributions.

Supporting the Management of Gestational Diabetes Mellitus With Comprehensive Self-Tracking: Mixed Methods Study of Wearable Sensors

BACKGROUND

Gestational diabetes mellitus (GDM) is an increasing health risk for pregnant women as well as their children. Telehealth interventions targeted at the management of GDM have been shown to be effective, but they still require health care professionals for providing guidance and feedback. Feedback from wearable sensors has been suggested to support the self-management of GDM, but it is unknown how self-tracking should be designed in clinical care.

OBJECTIVE

This study aimed to investigate how to support the self-management of GDM with self-tracking of continuous blood glucose and lifestyle factors without help from health care personnel. We examined comprehensive self-tracking from self-discovery (ie, learning associations between glucose levels and lifestyle) and user experience perspectives.

METHODS

We conducted a mixed methods study where women with GDM (N=10) used a continuous glucose monitor (CGM; Medtronic Guardian) and 3 physical activity sensors: activity bracelet (Garmin Vivosmart 3), hip-worn sensor (UKK Exsed), and electrocardiography sensor (Firstbeat 2) for a week. We collected data from the sensors, and after use, participants took part in semistructured interviews about the wearable sensors. Acceptability of the wearable sensors was evaluated with the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Moreover, maternal nutrition data were collected with a 3-day food diary, and self-reported physical activity data were collected with a logbook.

RESULTS

We found that the CGM was the most useful sensor for the self-discovery process, especially when learning associations between glucose and nutrition intake. We identified new challenges for using data from the CGM and physical activity sensors in supporting self-discovery in GDM. These challenges included (1) dispersion of glucose and physical activity data in separate applications, (2) absence of important trackable features like amount of light physical activity and physical activities other than walking, (3) discrepancy in the data between different wearable physical activity sensors and between CGMs and capillary glucose meters, and (4) discrepancy in perceived and measured quantification of physical activity. We found the body placement of sensors to be a key factor in measurement quality and preference, and ultimately a challenge for collecting data. For example, a wrist-worn sensor was used for longer compared with a hip-worn sensor. In general, there was a high acceptance for wearable sensors.

CONCLUSIONS

A mobile app that combines glucose, nutrition, and physical activity data in a single view is needed to support self-discovery. The design should support tracking features that are important for women with GDM (such as light physical activity), and data for each feature should originate from a single sensor to avoid discrepancy and redundancy. Future work with a larger sample should involve evaluation of the effects of such a mobile app on clinical outcomes.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03941652; https://clinicaltrials.gov/study/NCT03941652.

Effect of Sleep Quality on Anxiety and Depression Symptoms among College Students in China's Xizang Region: The Mediating Effect of Cognitive Emotion Regulation

BACKGROUND

While the exact mechanisms are not fully understood, there are significant links between sleep quality, anxiety, depressive symptoms, and cognitive emotion regulation. This research examines how sleep quality affects anxiety and depressive symptoms, as well as the potential of cognitive emotion regulation strategies (CERS) to moderate the impact of sleep quality on these symptoms.

METHODS

The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), the Cognitive Emotion Regulation Questionnaire (CERQ), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7) were all completed online by students from two colleges in China's Xizang region.

RESULTS

The study included 4325 subjects. The prevalence of poor sleep quality, anxiety symptoms, and depression symptoms was 45.69%, 36.81%, and 51.86%, respectively. We observed significant direct effects on poor sleep and severity of anxiety/depression: c'1 = 0.586 (0. 544-0.628), and c'2 = 0.728 (0.683-0.773). Adaptive CERS only had a mediating effect on the relationship between sleep quality and depression symptoms, with a1b3 = -0.005 (-0.011--0.001). The link between poor sleep quality and the intensity of anxiety and depression was significantly affected by the indirect effects of maladaptive CERS: effect a2b2 = 0.126 (0.106-0.147), and effect a2b4 = 0.145 (0.123-0.167).

CONCLUSIONS

Individuals who experience poor sleep quality are more likely to have increased levels of anxiety and depression. However, enhancing sleep quality led to a decrease in anxiety and depression levels. Adaptive CERS did not predict anxiety, but they did predict depression. Multiple maladaptive CERS could increase levels of anxiety and depression. To prevent mental stress, it is crucial to examine sleep problems among college students, understand their cognitive strategies, promote the adoption of adaptive CERS, and reduce the reliance on maladaptive CERS.

Coping with fibromyalgia during the COVID-19 pandemic: adjustment and wellbeing

OBJECTIVE

Fibromyalgia syndrome (FMS) is a chronic condition with symptoms known to be exacerbated by stress. Individuals with FMS may be experiencing particular distress under Covid-19 pandemic-related lifestyle restrictions. The present study examined wellbeing, perceived symptom change and coping in individuals with and without FMS during pandemic-related social lockdown in the UK.

DESIGN

Participants with a diagnosis of FMS (N = 390) and a general public sample with no FMS (N = 151) completed questionnaires at three time points.

MAIN OUTCOME MEASURES

BBC Wellbeing Scale, Cognitive-Emotional Regulation Questionnaire measure of coping, perception of extent to which symptoms have worsened or improved over time.

RESULTS

Contrary to expectations, FMS participants reported no worsening of symptoms and an increase in wellbeing over the study period. Non-FMS participants experienced worsening health symptoms and no change in wellbeing. Coping strategies involving positive reappraisal, refocussing and planning were positively associated with wellbeing in the FMS group.

CONCLUSION

The unpredictable symptom profile in FMS, and the regular readjustment this necessitates, may support a form of resilience which has been adaptive during the pandemic. The results have implications for supporting people with FMS, and potentially other chronic conditions, especially at times of stress.

The influence of weight on psychosocial well-being in diabetes

BACKGROUND

Individuals with diabetes experience a wide variety of psychosocial responses to their illness due, in part, to the nature of type 1 and type 2 diabetes. Variation in patient weight may play a central role in these differences, yet its influence on psychosocial variation is largely unknown. The current study investigates the relationship between patients' perceived weight status and aspects of psychosocial well-being among individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D).

METHODS

Individuals who were diagnosed with type 1 or type 2 diabetes were assessed via an online survey from the Diabetes, Identity, Attributions, and Health Study. Participants were categorized into a lower v. higher weight status group based on their self-reported perceived weight. Analyses of covariance were conducted to assess differences in measures of disease onset blame, diabetes stigma, and identity concerns among diabetes type and perceived weight status. Covariates included in our models were gender, age, education, and time since diagnosis. Bonferroni correction was used for post-hoc tests to assess any significant interactions found in our models.

RESULTS

Findings indicated that weight moderates multiple psychosocial outcomes pertinent to illness experience. Those with T2D and lower weight blamed themselves less for their disease onset, while those with higher weight felt blamed more for their disease onset by others, regardless of diabetes type. Individuals with T1D and higher weight were more frequently and more concerned about being mistaken for having the other disease type (i.e., T2D) compared to those with lower weight.

CONCLUSIONS

Weight is a key influence on the psychosocial outcomes for people with diabetes, but it operates differently in type 1 versus type 2 diabetes. By further examining the unique interaction between disease type and weight status we may be able to improve psychological well-being among affected individuals of all sizes.

The Predictive Role of Cognitive Emotion Regulation of Adolescents with Chronic Disease and Their Parents in Adolescents' Quality of Life: A Pilot Study

BACKGROUND

The purpose of this study was to investigate cognitive emotion regulation in adolescents with chronic illness and their parents.

METHODS

Eighty-five young people (mean = 15.86 years, standard deviation = ± 1.42, girls 65.88%) with chronic illnesses (inflammatory bowel disease n = 40 or type 1 diabetes n = 45), and their parents (mean = 46.06 years, 87.06% mother) completed the Cognitive Emotion Regulation Questionnaire (CERQ) for themselves and the Inventory of Quality of Life in Children and Adolescents (ILC) questionnaire adolescent and parent version. We conducted two hierarchical linear regression analyses with "enter" method. The CERQ scales and the diagnosis of chronic disease were chosen as independent variables, and the total ILC score in the first analysis and the ILC proxy score in the second analysis were chosen as dependent variables.

RESULTS

Among adolescents, cognitive emotion regulation strategies such as self-blame, positive reappraisal, and catastrophizing have been proven to be predictors of their own quality of life; however, parental self-blame was also found to be a predictor of adolescents' quality of life. Parental rumination and positive refocusing have been shown to be predictors of how parents rate their child's quality of life.

CONCLUSIONS

The present study sheds light on cognitive emotion regulation strategies in adolescents with chronic illness and their parents that have a significant impact on the development of young people's quality of life.

Predictors of problem-solving skills among emergency medical services staff in Iran: A cross-sectional correlational study

Background and aims

Pre-hospital emergency technicians face many problems in the workplace daily, so the ability to solve or overcome them in the workplace is essential. This article aimed to assess the predictors of problem-solving skills among emergency medical services staff in Iran.

Methods

This study was cross-sectional correlational research. Using convenience sampling methods, 140 emergency medical services (EMS) staff were enrolled in the study. Response time was assessed using ASAYAR software, problem-solving skills (PSS) were measured using the Hepner Petersen Problem Solving Questionnaire (PSI), and cognitive emotion regulation strategies were assessed using the Garnfsky Cognitive Emotion Regulation Questionnaire. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multiple linear regression analysis were applied using SPSS 14.0.

Results

The results of our study showed that the total mean score for problem-solving skills was 136.84 (14.65) (range, 175–107 points). Multiple linear regression indicated that refocusing on planning, positive evaluation, stress management courses, delays and their causes, positive refocusing, catastrophizing, and acceptance were effective predictors of problem-solving skills in emergency personnel, accounting for 54% of the total variances.

Conclusion

This study is one of the first studies in this field. Based on our findings, individuals who consider their emotions and feelings when solving problems are better able to use the process of thinking and problem-solving skills. Therefore, by training people in the field of emotional regulation skills, the skills to solve problems technicians can be increased.

Goal adjustment by people living with long-term conditions: A scoping review of literature published from January 2007 to June 2018

Long-term health conditions can limit achievement of personal goals. We aimed to map and synthesize definitions of goal adjustment, theoretical underpinnings, associations with recovery and supportive interventions for adults with long-term conditions. We searched multiple databases (January 2007-June 2018) and identified peer-reviewed research relating to goal adjustment. Data were charted, mapped and synthesized using content analysis and descriptive summaries. Two stakeholder consultations informed the review. Ninety-one articles were included. A range of long-term conditions were represented including cancer (22%), stroke (12%) and mixed neurological conditions (8%). Goal adjustment was one available option when faced with unattainable goals; other options were goal disengagement and goal re-engagement. Most studies were quantitative (58%), reporting mainly positive associations between goal adjustment, disengagement, reengagement and recovery. The Dual Process Model, Goal Adjustment Model and Self-Regulation Theory were most cited underpinning models/theory. Five interventions were identified; only one (self-system therapy) was evaluated in a randomized controlled trial. Our review provides original and significant insights into goal adjustment definitions, theoretical underpinnings and association with recovery. Effective interventions to support goal adjustment, disengagement and reengagement are lacking. This research-practice gap warrants attention to ensure people with long-term conditions are optimally supported when facing unattainable goals.

"The Relationships between Coping Mechanisms, Depression, Anxiety and Sleep Disorders in Cardiovascular Patients"

"Depression, anxiety and sleep disorders are psychological risk factors that could impact the quality of life in cardiovascular patients. In this study, a theoretical model on the complex relationships between coping mechanisms, depression, anxiety and sleep disorders was studied in a sample of 274 cardiovascular patients. The maladaptive cognitive-emotional coping strategies that appeared to be correlated with these negative emotional pathologies were self-blaming, ruminating and catastrophizing, and the adaptive ones were positive refocusing, refocusing on planning and positive reassessment. A theoretical model that explains these relationships at a process level appears to have statistical significance and to have adequate goodness of fit. In this model, there are statistically significant direct effects of maladaptive and adaptive coping mechanisms on depression and anxiety, a significant effect of anxiety on depression, as well as statistically significant positive effects of depression and anxiety on sleep disorders. The age has been controlled for in the model and the severity of the illness appears to have a moderating role in this context, with a stronger effect of anxiety on depression for patients with more severe illnesses. The practical implications of these results in psychological counselling addressed to cardiovascular patients are discussed."

The effectiveness of emotion cognitive reappraisal as measured by self-reported response and its link to EEG alpha asymmetry

Cognitive reappraisal is an important emotion regulation skill for psychological health and well-being, however, some people cannot use this strategy effectively. We investigated EEG alpha asymmetry by calculating lateral index (LI) when twenty-six healthy participants were instructed to complete the emotion cognitive reappraisal task of viewing neutral pictures, watching negative pictures and reappraising negative pictures. According to self-reported valence and arousal, the participants were divided into effective and ineffective groups. Habitual use of rumination was also assessed using the Cognitive Emotion Regulation Questionnaire (CERQ). EEG alpha asymmetry results demonstrated that, ineffective group showed greater relative right temporal activity than effective group in the early stage of reappraisal, indicating higher subjective arousal. Both groups showed greater relative left frontal alpha activity in the late stages of reappraisal compared with watching negative images, indicating the recruitment of corresponding functions in prefrontal regulatory circuitry during the effort of reappraisal. CERQ analysis results showed that, ineffective group got significantly higher score than effective group in habitual use of rumination. Partial correlation revealed that, in male participants, temporal LI change (negative-reappraisal minus negative-watch) was negatively correlated with self-reported arousal and habitual use of rumination. In addition, by using K-means cluster analysis, temporal LI combined with CERQ-rumination score achieved a classification accuracy of 84.6 %. These findings suggested that, EEG alpha asymmetry as well as the habitual use of rumination accounted for the reappraisal effectiveness.

COPD patient education and support - Achieving patient-centredness

BACKGROUND

The art of medicine is undergoing a dramatic shift in focus, evolving to focus on patient involvement as partners in care, transforming the traditional, prescriptive, reactive practice of healthcare into a proactive discipline. The personal and societal burden of chronic diseases is burgeoning and unsustainable in current systems, novel approaches are required to address this.

DISCUSSION

Although considerable progress has been made in the development of diagnostics, therapeutics and care guidelines for patients with chronic obstructive pulmonary disease (COPD), questions remain surrounding the implementation of best practice education and support. Current educational programmes, personal limitations and preferences and patient-clinician communication in modification of coping styles and behaviour are discussed. A novel holistic model, the Kaleidoscope Model of Care is proposed to address the barriers to optimal self-care behaviours.

CONCLUSION AND PRACTICE IMPLICATIONS

Holistic approaches are essential for optimal self-management and improved outcomes. Guidance on personalised goals for patients to help meeting their therapy priorities is needed to aid healthcare professionals (HCPs) and funders to minimise healthcare burden and costs. The novel KALMOD approach may optimise patient empowerment, exploring whole-life factors that impact COPD care and improve interactions between patients and HCPs for optimised outcomes.

Association of cognitive-emotional regulation strategies to depressive symptoms in type 2 diabetes patients

Aim. The present cross-sectional observational study aimed to investigate the relation between cognitive–emotional regulation strategies and depressive symptoms in type 2 diabetes patients in the context of sociodemographic and clinical factors, of diabetes distress, perception of illness consequences and previous depression.

Method. Multiple logistic regression was performed on the responses of 354 adults with type 2 diabetes (58.5% women; mean ± SD age: 61.14 ± 8.5 years; diabetes duration: 9.7 ± 6.4 years; BMI: 30.9 ± 5.3 kg/m2). Depressive symptoms were present in 16.9% and diabetes distress in 45.5%. Participants completed questionnaires on depression (BDI-II), cognitive-emotional regulation strategies (CERQ), diabetes distress (DDS), illness perceived consequences (IPQ-R).

Results. Of the cognitive–emotional strategies, lower positive reappraisal of diabetes (OR:0.49;CI:0.34-0.70) and increased catastrophizing (OR:2.08; CI:1.47-2.91) were found to increase the likelihood of experiencing depressive symptoms in the presence of higher diabetes distress (OR: 1.53; CI:1.07-2.19), increased negative perception of diabetes consequences (OR:2.02; CI:1.34-3.06) and the presence of previous depression (OR:4.18; CI:2.03-8.63).

Conclusion. To our knowledge, this is the first study to report on cognitive-emotional regulation strategies in type 2 diabetes and provides evidence for the beneficial influence of positive reappraisal and adverse effect of catastrophizing on depressive symptoms in the context of diabetes distress, perceived consequences of diabetes and previous history of depression.

Promoting Mental Health in Unaccompanied Refugee Minors: Recommendations for Primary Support Programs

During the last years, the number of refugees around the world increased to about 22.5 million. The mental health of refugees, especially of unaccompanied minors (70% between the ages of 16 and 18 years) who have been exposed to traumatic events (e.g., war), is generally impaired with symptoms of post-traumatic stress disorder, depression, and anxiety. Several studies revealed (1) a huge variation among the prevalence rates of these mental problems, and (2) that post-migration stressors (e.g., language barriers, cultural differences) might be at least as detrimental to mental health as the traumatic events in pre- and peri-flight. As psychotherapy is a limited resource that should be reserved for severe cases and as language trainings are often publicly offered for refugees, we recommend focusing on intercultural competence, emotion regulation, and goal setting and goal striving in primary support programs: Intercultural competence fosters adaptation by giving knowledge about cultural differences in values and norms. Emotion regulation regarding empathy, positive reappraisal, and cultural differences in emotion expression fosters both adaptation and mental health. Finally, supporting unaccompanied refugee minors in their goal setting and goal striving is necessary, as they carry many unrealistic wishes and unattainable goals, which can be threatening to their mental health. Building on these three psychological processes, we provide recommendations for primary support programs for unaccompanied refugee minors that are aged 16 to 18 years.

Maternal distress in the context of their child's type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8-15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.

Stress in Parents of a Child with Hemifacial Microsomia: The Role of Child Characteristics and Parental Coping Strategies

OBJECTIVE

Examine stress levels of parents of children with hemifacial microsomia (HFM) and the relationship of parental stress to child characteristics and cognitive coping strategies.

DESIGN

Prospective cross-sectional study.

PARTICIPANTS AND SETTING

Parents with a child (age 3-19 years) with HFM (N = 31) were recruited through the Department of Orthodontics and the Craniofacial Center, Sophia-Erasmus Medical Center, Rotterdam, The Netherlands. Intervention and Outcome Measures: The adapted and shortened Dutch version of the parental stress index (NOSI-K) was used to measure parental stress, and the cognitive emotion-regulation questionnaire was used to measure cognitive coping strategies. Pearson correlations and a multiple regression analysis were performed.

RESULTS

The hierarchical multiple regression analysis showed associations between increased parental stress and learning difficulties and use of acceptance as a coping strategy. This suggests that problems other than the characteristic visual appearance of the child's face in HFM have a greater influence on parental stress.

CONCLUSIONS

Learning difficulties of the child with HFM and parental acceptance affect stress in parents with a child with HFM the most and are important in the search for a targeted tailoring of intervention for parents with high levels of parental stress.