Secrecy From Parents and Type 1 Diabetes Management in Late Adolescence

Nondisclosure of Type 1 Diabetes in Adolescence: A Single-Center Experience

Objective

The aim of this study was to assess the extent of nondisclosure of type 1 diabetes in adolescents and investigate its association with several psychosocial parameters and clinical outcomes.

Research design and methods

This was a cross-sectional study based on data collected from 69 adolescents with type 1 diabetes who were 12-18 years of age and followed at our diabetes clinic. The degree of disclosure, demographics, diabetes management, and psychosocial issues were assessed via questionnaires. Clinical parameters were derived from medical records. Associations between nondisclosure status and clinical and psychosocial study variables were assessed.

Results

Fifty-three participants (77%) reported some extent of nondisclosure. Nondisclosure was associated with low self-esteem, reduced friend support, and increased diabetes-related worries. Nondisclosure was also found to be associated with diminished self-care behaviors related to insulin administration and with elevated A1C.

Conclusion

Our results demonstrate that nondisclosure of type 1 diabetes in adolescents may be more common than initially recognized and is likely associated with unfavorable psychological outcomes and reduced self-care and diabetes management. Our results emphasize the importance of social interactions and disclosure in adolescents and may serve as a potential stepping stone to address other social barriers hindering diabetes management.

Neighborhood disadvantage, parent-adolescent relationship quality, and type 1 diabetes in late adolescents transitioning to early emerging adulthood

OBJECTIVE

We examined whether neighborhood disadvantage predicted subsequent levels, and longitudinal trajectories, of type 1 diabetes (T1D) outcomes among late adolescents transitioning into early emerging adulthood. We also examined whether such associations occur indirectly through parent-adolescent relationship quality.

RESEARCH DESIGN & METHODS

Seniors in high school with T1D (N = 236; mean age 17.76 ± 0.39 years; 61% female; 73.7% non-Latino White) completed selfreport measures of relationship quality with mothers and fathers, and adherence to their diabetes regimen; glycemic control was measured using HbA1c assay kits. Both T1D outcomes (i.e. adherence, HbA1c) were assessed annually across three time points (two years). Census tract indicators of neighborhood disadvantage (e.g., % unemployed) were culled from participant addresses at baseline linked to American Community Survey data. Structural Equation Modeling was used to estimate direct and indirect links between neighborhood disadvantage, relationship quality, and both subsequent levels (i.e., intercepts centered at Time 2), and trajectories of T1D outcomes (i.e., slopes across three time points).

RESULTS

All models showed excellent fit to the data. Greater neighborhood disadvantage associated with lower relationship quality with both parents. Lower relationship quality with fathers (but not with mothers) measured at Time 1 predicted poorer levels of adherence and HbA1c at Time 2, and formed an indirect path linking neighborhood disadvantage to each Time 2 outcome. Neighborhood disadvantage and parent-adolescent relationship quality during high school did not predict longitudinal trajectories of T1D outcomes across all three time points.

CONCLUSIONS

Parent-adolescent relationship quality (especially with fathers) remains important for T1D outcomes among late adolescents on the cusp of emerging adulthood, but may be at risk among those living within a socioeconomically-disadvantaged neighborhood.

Self- and Social-Regulation in Type 1 Diabetes Management During Late Adolescence and Emerging Adulthood

PURPOSE OF REVIEW

This paper aims to examine how self-regulation (i.e., cognition, emotion) and social-regulation (i.e., parents, friends, romantic partners) are interrelated risk and protective factors for type 1 diabetes management during late adolescence and emerging adulthood.

RECENT FINDINGS

Problems in cognitive (e.g., executive function) and emotional (e.g., depressive symptoms) self-regulation are associated with poorer management, both at the between- and within-person levels. Better management occurs when parents are supportive and when individuals actively regulate the involvement of others (e.g., seek help, minimize interference). Friends both help and hinder self-regulation, while research on romantic partners is limited. Facets of self- and social-regulation are important risk and protective factors for diabetes management during emerging adulthood. At this time when relationships are changing, the social context of diabetes may need to be regulated to support diabetes management. Interventions targeting those with self-regulation problems and facilitating self- and social-regulation in daily life may be useful.

Adolescent Information Management and Parental Knowledge in Non-Latino White and Latino Youth Managing Type 1 Diabetes

Objectives

The objective of this study is to examine associations between adolescents' regulation of information about their type 1 diabetes (adolescent disclosure, secrecy), parental knowledge about their adolescent's diabetes management, diabetes outcomes (adherence, HbA1c), and depressive symptoms in Non-Latino White and Latino families.

Methods

In all, 118 adolescents (56 = Latino, 62 = Non-Latino White) completed surveys of disclosure to and secrecy from parents, parental knowledge of adolescent diabetes management, adherence, and depressive symptoms, and mothers completed measures of maternal knowledge and adolescent adherence. Glycemic control was extracted from medical records. Adolescents also completed structured interviews about parental knowledge about their diabetes-related problems.

Results

Interviews revealed that adolescent disclosure is the primary method by which parents gain knowledge about adolescent diabetes management problems. Adolescent disclosure to and secrecy from parents were uniquely associated with diabetes management and depressive symptoms independent of parental knowledge across ethnic groups; maternal reports of knowledge about her adolescent's diabetes care activities were associated with diabetes management independent of adolescent disclosure and secrecy.

Conclusions

Adolescent information management strategies are a primary means by which parents gain knowledge about diabetes, which may facilitate more effective management.

Reasons for Open and Closed Attitudes Regarding Type 1 Diabetes

Thirty-one adults with type 1 diabetes participated in this qualitative study to explore reasons why they were willing (had an open attitude) or unwilling (had a closed attitude) to disclose diabetes-related information to others. Participants (61.3% female, mean age 38.48 years, mean duration of diabetes 21.94 years, 100% white) answered open-ended questions about living with type 1 diabetes. Interviews were transcribed verbatim and coded to identify major patterns that emerged in the data. Reasons for open attitudes included support from others, confidence and feeling comfortable, feeling normal despite diabetes, seeking to educate, and feeling that it was not a major concern to share information with others. Reasons for closed attitudes included fear of discrimination, misunderstanding from others, embarrassment and shame, and feeling that it was not a major concern to share information. A higher number of participants reported open attitudes after diagnosis than at initial diagnosis; a lower number of participants reported closed attitudes after diagnosis than at initial diagnosis. Professionals should consider effective forms of type 1 diabetes-related education to reduce diabetes misconceptions and discrimination against diagnosed individuals. This may help individuals feel more open and willing to adhere to and seek assistance with their diabetes-related self-care.

Integrated Primary Medical-Behavioral Health Care for Adolescent and Young Adult Depression: Predictors of Service Use in the Youth Partners in Care Trial

Objectives

Depression, a chronic and disabling condition, frequently has its first onset during adolescence, underscoring the value of early effective treatment and prevention. Integrated medical-behavioral health care provides one strategy for improving treatment access for adolescents and young adults (AYA).

Methods

This study examined predictors of accessing treatment in a multisite randomized controlled trial evaluating an integrated collaborative care intervention aimed at improving access to evidence-based depression treatment through primary health care, compared with usual care.

Results

The integrated care intervention was able to overcome barriers to care associated with an initial reluctance to pursue active treatment and older age. Service use was low in both conditions among less acculturated/non-English-speaking families.

Conclusions

Results support the value of integrated medical-behavioral health care for improving rates of care. Findings highlight mechanisms by which integrated care may lead to improved rates of care and outcomes for AYA, an underserved and understudied group.

Relation of parent knowledge to glycemic control among emerging adults with type 1 diabetes: a mediational model

The study goal was to examine the links of parent knowledge of children's behavior to diabetes outcomes and to test a mediational model that focused on psychological distress and self-care behavior. We recruited 132 adolescents (average age 12) and followed them to average age 23. At age 23 (n = 107), we conducted in-person interviews with these emerging adults to measure parent knowledge, psychological distress, self-care behavior and glycemic control. We used structural equation modeling to test our hypotheses with these cross-sectional data. Higher levels of parent knowledge were linked to better glycemic control, and this path was mediated by reduced psychological distress and enhanced self-care behavior. Parents remain an important influence in the lives of emerging adults with type 1 diabetes. When emerging adults have a relationship with their parents in which they share general information, psychological distress may be reduced which then facilitates self-care and, ultimately, glycemic control.

Youth secrets are associated with poorer sleep and asthma symptoms via negative affect

OBJECTIVE

Among older children and adolescents, keeping secrets from parents is consistently associated with lower levels of psychological well-being. Further, concealing one's thoughts and emotions has been associated with poor physical health outcomes in adults. However, it remains an open question whether secret-keeping is associated with poorer health and health-related behaviors (such as sleep) among youth and, if those hypothesized links exist, what the psychological mechanisms might be. We investigated the associations among youth secrecy towards parents, daily asthma symptoms and daily sleep behaviors in a sample of low-income youth with asthma aged 10-17 and tested negative affect as a possible mediator of these associations.

METHODS

One hundred and seventy two youths reported the extent to which they kept secrets towards parents over a period of four days. Asthma symptoms, nighttime awakenings, sleep onset latency, and subjective sleep quality were assessed with daily diaries completed by youths.

RESULTS

More frequent secret-keeping was associated with more severe asthma symptoms, lower ratings of sleep quality and greater number of nighttime awakenings. Secrecy was also associated with increased negative affect, which accounted for the associations between secrecy and number of awakenings and daytime asthma symptoms. These findings remained significant after controlling for youth age and other relevant demographic factors.

CONCLUSIONS

Our findings suggest that secrecy towards parents can have consequential health outcomes for youth with asthma and point to the importance of investigating affective processes as mediators of the influence of secret-keeping on youth health.

Adolescent Disclosure to Parents and Daily Management of Type 1 Diabetes

Objective

To examine how adolescents’ daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management.

Methods

A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters.

Results

Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents’ perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence).

Conclusions

Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.