Carman and Ann Adams Department of Pediatrics, Pediatric Prevention Research Center, Wayne State University, 4707 St. Antoine Street, Detroit, MI, USA.
J Dev Behav Pediatr. 2012 May;33(4):343-51. doi: 10.1097/DBP.0b013e31824eaac8.
This study examined a multivariate model of the relationship between caregiver strain and adolescent diabetes illness outcomes in a sample of caregivers of adolescents in chronically poor metabolic control (hemoglobin A1c ≥8.0% at enrollment and for previous 12 mo). Caregiver mental health symptoms were hypothesized to mediate the relationship between caregiver strain and adolescent illness management behavior and metabolic control. Caregivers' perceptions of social support and their level of responsibility for diabetes care tasks were hypothesized to be directly related to caregiver strain and indirectly to caregiver mental health symptoms.
One hundred forty-six caregiver-adolescent dyads completed baseline measures of caregiver strain, responsibility for diabetes care, social support, mental health symptoms, and illness management behavior. Adolescent metabolic control was also assessed.
Findings from structural equation modeling suggested that caregiver strain was directly and positively associated with caregiver mental health symptoms which mediated the relationship to adolescent diabetes management behavior and metabolic control. Caregivers' responsibility for diabetes care tasks was directly related to caregiver strain and indirectly to caregiver mental health, but caregivers' perception of social support was not.
These findings suggest that caregiver strain is an important dimension of the caregiving context of diabetes. Clinicians and researchers should consider how caregiving strain, responsibility for illness management, and mental health symptoms might be impacting children's diabetes care behavior and diabetes health when working with and designing interventions for adolescents with diabetes.
本研究在一组代谢控制长期较差（在入组时和前 12 个月内血红蛋白 A1c≥8.0%）的青少年糖尿病患者的照顾者中，考察了照顾者压力与青少年糖尿病疾病结果之间的多变量模型。假设照顾者的心理健康症状在照顾者压力与青少年疾病管理行为和代谢控制之间起中介作用。假设照顾者对社会支持的感知及其对糖尿病护理任务的责任与照顾者压力直接相关，并间接地与照顾者心理健康症状相关。
146 对照顾者-青少年二人组完成了基线的照顾者压力、糖尿病护理责任、社会支持、心理健康症状和疾病管理行为的测量。还评估了青少年的代谢控制情况。
结构方程模型的结果表明，照顾者压力与照顾者心理健康症状直接且呈正相关，而心理健康症状则对青少年糖尿病管理行为和代谢控制起中介作用。照顾者对糖尿病护理任务的责任与照顾者压力直接相关，与照顾者心理健康间接相关，但照顾者对社会支持的感知则没有。
这些发现表明，照顾者压力是糖尿病照护环境的一个重要方面。临床医生和研究人员在与青少年糖尿病患者一起工作或为其设计干预措施时，应该考虑照护压力、疾病管理责任和心理健康症状如何影响儿童的糖尿病护理行为和糖尿病健康。
