Longitudinal associations of maternal depressive symptoms, maternal involvement, and diabetes management across adolescence.

OBJECTIVE: To examine whether maternal depressive symptoms: (a) predicted the level of maternal involvement in diabetes management tasks across adolescence; and (b) moderated associations of involvement with adolescent adherence, metabolic control, and depression. METHODS: Eighty-two youth aged 10-15 years with type 1 diabetes and their mothers completed measures at baseline and 16 months later. Participants rated maternal involvement in diabetes tasks, adherence, and depressive symptoms; metabolic control was indexed from medical records. RESULTS: Maternal depressive symptoms were associated with higher involvement at baseline, and slower declines in involvement across time. At baseline, involvement was associated with lower adolescent depression and better metabolic control, but this association was stronger when mothers reported fewer depressive symptoms. Interactions of maternal depression with involvement across time suggested maternal involvement was associated with better subsequent adherence primarily when mothers reported fewer depressive symptoms. CONCLUSIONS: Mothers' depressive symptoms may undermine her care-giving effectiveness during adolescence.

Mother child appraised involvement in coping with diabetes stressors and emotional adjustment.

OBJECTIVE: To examine how children's and mother's appraisals of each other's involvement in coping with diabetes events are associated with emotional adjustment. METHODS: One hundred and twenty-seven children (ages 10-15 years) with type 1 diabetes and their mothers reported on their own emotional adjustment and how each other was involved in coping strategies surrounding diabetes stressful events. RESULTS: Appraisals that mothers and children were uninvolved with each other's stressors were associated with greater depressive symptoms and less positive mood; children's appraisals of mother's supportive involvement with children's less depressive symptoms, and appraisals of collaborative involvement with less depressive symptoms and more positive mood for both mothers and children. Appraised control was most detrimental for children for older females and for mothers of younger children. CONCLUSIONS: Collaborative involvement in coping efforts may be an important resource for addressing negative emotions that both children and mothers experience surrounding type 1 diabetes, especially across adolescence.

Children's appraisals of maternal involvement in coping with diabetes: enhancing our understanding of adherence, metabolic control, and quality of life across adolescence.

OBJECTIVE: To examine how children's appraisals of maternal involvement in coping with diabetes are associated with adherence, metabolic control, and quality of life across adolescence. METHODS: Children (N = 127, ages 10-15 years) with type 1 diabetes completed measures of adherence, quality of life, and appraisals of mothers' involvement in dealing with diabetes problems (i.e., mother appraised as uninvolved, controlling, or collaborative). Metabolic control was indexed through medical records. RESULTS: Regardless of age or sex of child, appraised maternal uninvolvement was associated with poorer adherence and quality of life, while appraised collaboration was associated with better adherence and metabolic control. There was evidence that the association between appraised collaboration and metabolic control was partially mediated by adherence. Appraised control was associated with poorer adherence among older, but not younger, children and with poorer quality of life among older females but not among older males or younger children of either sex. CONCLUSIONS: Maintaining maternal involvement in diabetes care is important across ages 10 to 15, but the optimal form of this involvement may need to be adjusted to be consistent with the child's level of development. The present findings suggest that better adherence is seen across age when mothers are viewed as collaborating with, as opposed to controlling, their child when dealing with diabetes problems.

The role of autonomy and pubertal status in understanding age differences in maternal involvement in diabetes responsibility across adolescence.

OBJECTIVE: To examine how autonomy and pubertal status explain age decreases in maternal involvement in type 1 diabetes management across adolescence, how they relate to metabolic control, and the reasons that guide declines in maternal involvement. METHODS: One hundred twenty-seven children ages 10-15 years with type 1 diabetes and their mothers participated. Data included maternal and child report of diabetes management, child report of autonomy level, maternal report of pubertal status, maternal reports of reasons for transfer of diabetes responsibility, and glycosylated hemoglobin (Hba(1c)) values. RESULTS: Autonomy and pubertal status partially mediated age effects on reports of maternal involvement. Mothers' reasons for transferring responsibility included responding to the child's competence, promoting competence and maturity in their child, and minimizing hassles and conflict. The transfer of diabetes responsibility from mother to child without sufficient autonomy and when pubertal status was low was related to higher Hba(1c) values. CONCLUSIONS: The importance of chronological age for changes in maternal involvement suggests the need to examine mothers' and adolescents' developmental expectations for diabetes management. The reasons for transferring responsibility from mother to child suggest many avenues for intervention.