Elsevier

Journal of Adolescent Health

Volume 33, Issue 3, September 2003, Pages 180-188
Journal of Adolescent Health

International article
Coping with everyday stress and links to medical and psychosocial adaptation in diabetic adolescents

https://doi.org/10.1016/S1054-139X(02)00707-3Get rights and content

Abstract

Purpose

To study coping with everyday stressors in a longitudinal sample of 98 adolescents with insulin-dependent mellitus (type 1) diabetes.

Methods

The adolescents with type 1 diabetes were classified into three homogeneous groups of metabolic control by latent class analysis, based on annual tests of hemoglobin A1 values. Questionnaires assessing frequent minor stressors as well as ways of coping with these stressors were given annually over the course of 4 years. Latent class analysis revealed three distinctive groups of metabolic control over time. Adolescents who exhibited continuously poor, satisfactory, and good metabolic control. Eighty percent of the adolescents stayed in the group assigned to them over the 4-year period.

Results

Adolescents with stable good metabolic control were characterized by lower levels of minor stressors that decreased over time, but those with stable satisfactory and poor metabolic control experienced continuously higher stress levels. Adolescents with stably good metabolic control also employed less avoidant coping in dealing with minor stressors, compared with the two other groups.

Conclusions

Because of the danger of long-term complications, it is important to discriminate among different groups of metabolic control over time. Further, the impact of non-illness-related minor stressors on metabolic control should be considered for prevention purposes.

Section snippets

Sample

Subjects for the present study were participants in the German Longitudinal Study on Juvenile Diabetes [5]. The adolescents with IDDM were recruited from their regular source of pediatric health care services. The study received full Institutional Review Board approval. Eighty-eight percent of the families approached agreed to participate. All physical examinations were done in full accordance with the declaration of Helsinki [21]. Ninety-eight 14-year-old adolescents with diabetes (46 females

Results

Of the 81 possible cell combinations (i.e., 3 × 3 × 3 × 3), only 41 were realized; the remaining cells were empty. Because of the relatively sparse data, a bootstrap on 500 samples was conducted to generate meaningful support for the fit statistics [28]. All three fit statistics (i.e., likelihood ratio (LR), Chi-square, and Read Cressie) were significant (see Table 1). The excellent fit of the three-class latent class model suggested that there was no significant movement or transition among

Discussion

This study explores the links between medical adaptation and psychosocial adaptation in adolescents with diabetes with a focus on coping with non-illness-specific everyday stress. Up to 30% of those diabetic adolescents whose medical adaptation, measured via metabolic control, is poor over an extended period of time develop health damages such as retinopathy and nephropathy [30]. A first aim of this study was, therefore, to analyze whether adolescents with diabetes can be assigned to stable

Acknowledgements

The research was supported by the German Bundesministerium für Forschung und Technologie (No. 0706567). Our thanks to Anton K. Formann for his helpful comments on the latent class analyses.

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