Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: Opportunities for education and counseling

Abstract

Objective

To examine demographic and clinical characteristics, such as pediatric parenting stress and self-efficacy for diabetes care, of parents of children newly diagnosed with type 1 diabetes that are associated with parental anxiety and depression.

Methods

102 parents reported on their levels of depression (CESD), state anxiety (STAI), pediatric parenting stress (PIP), and self-efficacy for diabetes care (SED) within 4 weeks of their child's diagnosis with type 1 diabetes. Data were analyzed using hierarchical multiple regression.

Results

Parents’ scores in the clinical range for depression and anxiety were associated with increased frequency and difficulty of pediatric parenting stress, and there was a trend for depression to be related to lower self-efficacy for diabetes care. The association of female gender with anxiety and depression was partially mediated by more frequent pediatric parenting stress.

Conclusion

Parents of children newly diagnosed with type 1 diabetes are at risk for experiencing anxiety and depression, related, in part, to their experiences of pediatric parenting stress.

Practice implications

Providers and educators should be aware of the risk for depression and anxiety in parents and should work to decrease pediatric parenting stress, increase self-efficacy, and refer parents who are experiencing significant anxiety or depression following their child's diagnosis to a mental health specialist.

Introduction

The diagnosis of diabetes in a child has often been described as a psychosocial stressor and key transition time in the lives of families [1]. Consequently, children and parents alike need not only to alter their family's lifestyle, but also adapt their worldview in order to accommodate pediatric chronic disease management [1], [2], [3]. The onset of type 1 diabetes typically occurs with little forewarning, necessitating families to make multiple life changes simultaneously and in a very short time frame. This, too, is known to produce stress in families and may contribute to individual members’ feelings of loss of normalcy and imbalance during this time [3], [4]. For parents of children who are newly diagnosed, managing these life changes can seem overwhelming and, for some, even insurmountable [5], [6], [7], [8].

Given the multiple medical and behavioral demands inherent in the contemporary management of type 1 diabetes (e.g., checking blood glucose levels, administering insulin injections, and being vigilant about eating and exercise), it is not surprising that parents of children newly diagnosed with diabetes experience a range of emotional responses, including anxiety, depression, and stress [9], [10]. Also, for parents of children newly diagnosed with diabetes, concerns about one's ability to manage diabetes are particularly prevalent during the early months after diagnosis [7], [11]. A prior longitudinal study noted that following a diagnosis of diabetes in a child, parents were apt to report subthreshold symptoms of mood disturbance and psychological distress [12]. In the majority of cases, these symptoms resolved after 6–7 months’ time, suggesting they largely constituted short-term stress reactions [10], [12]. However, a number of parents of children with type 1 diabetes continue to experience psychological symptoms, which show stability over the course of a year [13]. Further, parenting stress in mothers of children diagnosed with type 1 diabetes has been related to child depressive symptoms [14], indicating the influence of parental responses to child outcomes.

In a European study of parents of children newly diagnosed with type 1 diabetes, a significant portion of parents, 24% of mothers and 22% of fathers, reached a diagnostic threshold for current post-traumatic stress disorder (PTSD). Additionally, 51% of mothers and 41% of fathers experienced subthreshold PTSD [9]. When viewed from this perspective, one better appreciates the seriousness of the impact of the child's diagnosis on parent mental health and well being in the short term.

With respect to parents’ long-term adjustment to the diagnosis of type 1 diabetes in their children, relatively little data exist. One notable exception is a recent paper by Carpentier et al. [15] that reported on 5–6 year outcomes among parents of newly diagnosed children. The authors found that parents who were highly uncertain about their child's illness and outcomes at the time of the initial diagnosis were more likely to experience greater psychological distress at follow-up. This suggests that diabetes education and counseling efforts directed toward parents of newly diagnosed children might benefit from attending to parents’ feelings of uncertainty to boost their self-efficacy for diabetes management. Indeed, preliminary research in this area appears promising [16], though more information is needed on the specificity of parents’ stress.

For example, the concept of “pediatric parenting stress” has been put forth as describing the stress related to caring for a child with a chronic illness [17], [18]. This specificity is a relative improvement over notions of general and ubiquitous parenting stress and provides better insights into the exact illness-related stressors that affect outcomes. Similarly, parents’ feelings of self-efficacy may contribute to and/or affect the stress experience related to the child's illness [19]. In parents of children with asthma, lower parental self-efficacy has been associated with greater asthma-related morbidity [20]. Furthermore, parents of children with diabetes who have lower self-efficacy are more likely to experience pediatric parenting stress [21]. These findings suggest that greater attention to parents’ stress and self-efficacy is warranted.

In light of these issues, the current study focused on symptoms of anxiety and depression experienced by parents of children newly diagnosed. Specifically, the study sought to identify parents most and least likely to experience depression and anxiety following their child's diagnosis of type 1 diabetes, including an examination of demographic and clinical characteristics, self-efficacy, and pediatric parenting stress. It was hypothesized that parents of newly diagnosed children with lower self-efficacy and more intense and frequent pediatric parenting stress would be more likely to meet cutoff criteria for depression and anxiety.