Malik Jamil A, Koot Hans M
Department of Developmental Psychology, VU University, Amsterdam, the Netherlands.
Diabetes Care. 2009 May;32(5):774-9. doi: 10.2337/dc08-1306. Epub 2009 Feb 5.
The aim of this study was to explain adjustment (diabetes-related quality of life, general well-being, and psychopathology) in adolescents with type 1 diabetes by testing the direct, mediating, and moderating effects of diabetes-specific and psychosocial factors, using an adapted version of the Disability-Stress-Coping model of Wallander and Varni.
A total of 437 adolescents (54.5% girls; age range 11-19 years) with type 1 diabetes (mean +/- SD diabetes duration 6.13 +/- 3.78 years) were recruited from 25 hospitals in the Netherlands. Questionnaires were completed by the adolescents and their family members. Metabolic control was assessed by measuring A1C in all participants in one laboratory.
Diabetes stress mediated between A1C and adjustment, after controlling for protective factors, and explained an additional 16% variance in quality of life and a 15% variance in general well-being, whereas a 19% additional variance in psychopathology was explained by both diabetes-related and general stress. No moderating effects were identified after controlling for the main effects of all risk and protective factors in the model.
Both diabetes-related and general stress are critical predictors of the adjustment of adolescents with type 1 diabetes. Protective factors such as self-worth and social support may mediate the effects of generic stress and thus should be encouraged. Diabetes-related stress has the potential to displace the effects of protective factors and thus may play a critical role in the development of maladjustment in adolescents with type 1 diabetes.
本研究旨在通过使用Wallander和Varni的残疾-压力-应对模型的改编版本，测试糖尿病特异性因素和心理社会因素的直接、中介和调节作用，来解释1型糖尿病青少年的适应情况（与糖尿病相关的生活质量、总体幸福感和精神病理学）。
从荷兰的25家医院招募了总共437名1型糖尿病青少年（54.5%为女孩；年龄范围11 - 19岁）（平均±标准差糖尿病病程6.13±3.78年）。青少年及其家庭成员完成问卷调查。在一个实验室对所有参与者测量糖化血红蛋白（A1C）来评估代谢控制情况。
在控制了保护因素后，糖尿病压力在A1C和适应之间起中介作用，并解释了生活质量中额外16%的变异和总体幸福感中15%的变异，而糖尿病相关压力和一般压力共同解释了精神病理学中额外19%的变异。在控制了模型中所有风险和保护因素的主要影响后，未发现调节作用。
糖尿病相关压力和一般压力都是1型糖尿病青少年适应情况的关键预测因素。自我价值和社会支持等保护因素可能会介导一般压力的影响，因此应该得到鼓励。糖尿病相关压力有可能取代保护因素的作用，因此可能在1型糖尿病青少年适应不良的发展中起关键作用。
