An investigation of the psychosocial correlates to optimal health management in young people with type 1 diabetes

Type 1 diabetes (T1D) presents considerable challenges to affected children and their families. Medical complications arising from poorly managed T1D may be present from a young age, and worsen over time. It is imperative that illness management is as optimal as possible from a young age, in order to establish a pattern of positive health management lasting into adulthood. Studies of adults and adolescents also demonstrate psychological complications associated with T1D, with implications for medical outcomes. However, these relationships remain relatively underexplored in Australian children. Investigating psychological wellbeing in children engaged with current treatment options is also needed, as the greater flexibility offered by contemporary treatment regimens may be less psychologically demanding. The aim of the current study was to investigate the role of specific psychosocial factors as barriers to optimal illness management in children and adolescents with T1D. As psychosocial wellbeing has previously been reliably linked to illness management in studies of adults and adolescents with T1D, psychosocial outcomes were also of interest. Eighty child and adolescent participants were recruited from a paediatric outpatient diabetes clinic at an Australian hospital. Participants were aged between 7 and 15 years, and held a diagnosis of T1D for at least twelve months. Participants completed written measures which assessed depressive and anxiety symptoms, family functioning, self-efficacy, coping and T1D knowledge. In order to assess illness functioning, T1D outcomes were determined by HbA1c level, and the number of school days missed. Discriminant function analysis was used to explore differences between groups of children and adolescents on several outcomes. Significant differences between groups on the basis of depressive symptoms, coping, family functioning and school days missed were identified. Glycaemic control was not significantly associated with psychosocial wellbeing. The results are discussed individually with a view to identifying markers of problems in psychosocial and illness functioning in Australian children and adolescents with T1D. The findings highlight the importance of specific individual and family factors in the psychosocial wellbeing and illness functioning in this group. This information may assist in the refinement of existing clinical interventions which aim to improve psychosocial and illness outcomes in young people with T1D.