Perceived Family Stress Predicts Poor Metabolic Control in Pediatric Patients with Type 1 Diabetes: A Novel Triadic Approach

Abstract

Objective. Poor metabolic control and low treatment adherence remain major issues for many pediatric patients with type 1 diabetes. Important risk factors for both include psychosocial variables such as stress. To date, stress in type 1 diabetes patients and their parents has been investigated at an individual level. The present study tested the hypothesis that patients’, mothers’, and fathers’ perceived stress is positively related to each other and therefore is a factor common to the family. This factor was then hypothesized to be related to patients’ poorer treatment adherence behavior and metabolic control. Research Design and Methods. This cross-sectional study at the University Children’s Hospital Zurich included 190 type 1 diabetes patients (age: 7–18 years; illness duration: ≥1 year) and their families. The Perceived Stress Scale was used to measure the self-reported stress of patients, mothers, and fathers. Patients’ treatment adherence was rated by their endocrinologists. HbA1c served as indicator of metabolic control. A structural equation model (SEM) was conducted for analysis. Results. The SEM showed adequate model fit. Patients’ ( $\beta =.567$ , $p\le .001$ ), mother’s ( $\beta =.621$ , $p\le .001$ ), and father’s ( $\beta =.585$ , $p\le .001$ ) perceived stress loaded all on a single factor, perceived family stress. This factor was significantly associated with treatment adherence ( $\beta =-.384$ , $p\le .001$ ) and with HbA1c ( $\beta =.210$ , $p=.012$ ) of patients. Conclusions. Results confirmed perceived family stress to be a common family construct. Because perceived family stress might have a negative impact on patients’ treatment adherence and HbA1c, subjective stress appraisals of patients and both parents should be considered when counseling children and adolescents with type 1 diabetes.