Family and Child Characteristics Associated with Coping, Psychological Adjustment and Metabolic ...

201 Pages·2012·2.56 MB·English

Family and Child Characteristics Associated with Coping, Psychological Adjustment and
Metabolic Control in Children and Adolescents with Type 1 Diabetes

by

Michelle Celine Wesley

A Thesis
presented to
The University of Guelph

In partial fulfilment of the requirements
for the degree of
Doctorate of Philosophy
in
Psychology

Guelph, Ontario, Canada

© Michelle C. Wesley, April, 2012
ABSTRACT

FAMILY AND CHILD CHARACTERISTICS ASSOCIATED WITH COPING,
PSYCHOLOGICAL ADJUSTMENT AND METABOLIC CONTROL IN
CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES

Michelle C. Wesley Advisors:
University of Guelph, 2012 Dr. Michèle Preyde
Dr. Michael P. Grand

This thesis is an investigation of the factors that impact psychological adjustment
and metabolic control in children and adolescents with type 1 diabetes. Studies suggest that
aspects of the family environment (stressful life events, family functioning and parent
mental health) and child characteristics such as age, sex, executive functioning and hopeful
thinking impact psychological adjustment and metabolic control. There is also evidence
that coping processes mediate these associations. The purpose of this study was to 1)
explore and identify developmental differences in coping processes in a sample of children
with T1D, 2) identify the family system characteristics that are associated with child
coping processes and psychological adjustment, and 3) identify the family and child
characteristics that impact metabolic control. Survey data were collected through
convenience sampling from an outpatient hospital clinic. Children aged 8 to 17 completed
self-reports of hopeful thinking and illness-related coping style. Caregivers provided
demographic information and completed questionnaires on their child’s physical health,
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stressful life events, mental health, family functioning, as well as the child’s initiative,
emotional control, and psychological adjustment. Ratings of child metabolic control
(HbA ) were also retrieved from hospital patient records. A predictive model examining
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direct and indirect contributions of the family environment and coping variables toward
child adjustment and metabolic control was tested. Age and sex differences in children’s
coping style were identified. Family functioning and parent mental health were found to
predict child psychological adjustment. Coping processes, including avoidant coping,
coping efficacy and executive functioning mediated relations between family functioning
and child adjustment. Results provided partial support for a mediational model of family
system characteristics that influence psychological adjustment in the sample. Family
functioning and parent mental health had a direct impact on children’s psychological
adjustment, as well as indirect effects on adjustment through coping processes (i.e., coping
style, coping efficacy, initiative and emotional control). Child age was found to moderate
some paths in the proposed model. Clinical and research implications are discussed.
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ACKNOWLEDGEMENTS

I would like to thank my research advisor, Dr. Michele Preyde who helped me turn
the study of my dreams into a reality. Thank you for your guidance and support throughout
my doctoral research pursuits and excellent feedback that you have given me. I am also
indebted to my advisor, Dr. Michael Grand. Your support, guidance and encouragement
helped me develop not only as a doctoral student, but also as a person. I also would like to
thank Dr. Heidi Bailey, for her helpful suggestions and statistical guidance, as well as other
members of my dissertation defense committee, Drs. Wysocki, McMurty and Meegan for
their insightful comments and suggestions. I would also like to thank my two very hard-
working and dedicated volunteer research assistants, Sara-Marie Skovbjerg and Russell
Barker.
I would be remiss if I did not extend my utmost appreciation to the McMaster
Children’s Hospital and Hamilton Health Sciences Centre. I would like to thank my site-
investigators, Drs. Erin Warriner, Karen McAssey, Jack Holland and John VanDerMeulen
for their knowledge, time and support during the proposal and data-collection phases of my
study, as well as the other amazing members of the Diabetes Clinic. I am so grateful to
have known your wonderful team and witnessed the fabulous work that you do every day.
I would also like to extend a note of gratitude to the families who agreed to participate in
my study.
I am ever so grateful for my family, friends, colleagues and many others who
supported and encouraged me through the hurdles and challenges of graduate school. My
parents, Dennis and Madeleine, and my sister Pam helped my find the courage and inner
fortitude needed to pursue my dreams and keep perspective on the things that matter in life.
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I also extend a heartfelt thanks to my loving partner, Michael Warnock, for his unwavering
support and encouragement. I am so grateful to have you in my life. I am also deeply
appreciative for my friends and colleagues who were always there for me when I needed
them, helped me stay grounded and were a source of inspiration, joy and laughter in my
life. In particular, I would like to thank my friends and classmates: Amber, Cailey, Nora,
Diana and Betty. I would also like to extend my gratitude to the staff at the many cafés and
restaurants that welcomed me and other “computer people” into their businesses.
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TABLE OF CONTENTS
Introduction ............................................................................................................................ 1
What is Type 1 Diabetes? ........................................................................................... 2
Supporting Children with Type 1 Diabetes ................................................................ 5
Developmental Factors Influencing Adjustment and Metabolic Control in
Children and Adolescents with Type-1 Diabetes ....................................................... 6
Family System Influences on Adjustment and Metabolic Control ............................ 8
Development of Coping Processes ........................................................................... 12
Coping with Diabetes ............................................................................................... 17
The Mediating Role of Child Coping Processes ...................................................... 21
Models of Coping and Adaptation ........................................................................... 22
Goals and Research Strategy ............................................................................................ 26
Method ............................................................................................................................. 30
Participants ............................................................................................................... 30
Sample ...................................................................................................................... 32
Procedure .................................................................................................................. 33
Measures ................................................................................................................... 36
Results .............................................................................................................................. 45
Data Analysis ........................................................................................................... 45
Developmental Differences in Child Coping Processes and Adjustment ................ 47
Associations Between Family System Variables and Other Famly Characteristics 54
Family System Predictors of Child Coping Processes ............................................. 55
Child and Family Predictors of Child Metabolic Control ........................................ 60
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Tests of Mediation .................................................................................................... 62
Structural Equation Modeling .................................................................................. 67
Discussion ........................................................................................................................ 73
Clinical Implications ................................................................................................ 81
Research Implications .............................................................................................. 86
Generalizability and Limitations .............................................................................. 89
Conclusion ................................................................................................................ 96
References ........................................................................................................................ 98
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LIST OF TABLES

Table 1. Demographic Characteristics for Full Sample and T1/T2 Subsamples..............130
Table 2. Scale Internal Consistency Reliability Estimates (Cronbach’s alpha)................132
Table 3. Original Children’s Coping Strategies Checklist Items......................................133
Table 4. Descriptive Statistics of Child Characteristics....................................................135
Table 5. Child Executive Functioning and Adjustment Problem Scores by Level of
Clinical Significance .........................................................................................136
Table 6. Descriptive Statistics of Family Environment Characteristics............................137
Table 7. Converted Parent Mental Health, Child Executive Functioning and Adjustment
Scores.................................................................................................................138
Table 8. Correlation Matrix of Associations between Child Hope Scale Items and Coping
Expectations Items (CCSC) ..............................................................................139
Table 9. Child Coping Styles by Child Age....................................................................140
Table 10. Tests of Mean Differences for Child Coping Style by Sex...............................141
Table 11. Mean and Standard Deviations of Child Coping Style by Child Gender
and Age..............................................................................................................142
Table 12. Correlation Matrix of Associations between Child Characteristics, Coping Style,
Executive Functioning, Adjustment and Metabolic Control ............................143
Table 13. Linear Regression Analysis of Child Coping Style to Adjustment
Problems............................................................................................................144
Table 14. Correlation Matrix of Associations between Family Environment and System
Characteristics and Metabolic Control...............................................................145
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Table 15. Correlation Matrix of Associations between Family Environment and Child
Coping Style and Efficacy.................................................................................146
Table 16. Linear Regression Analysis of Family Stress, Family Functioning and Parent
Mental Health to Child Avoidant Coping Style ...............................................147
Table 17. Linear Regression Analysis of Family Stress, Family Functioning and Parent
Mental Health to Child Adjustment (CBCL Total Problem t-scores) ..............148
Table 18. Partial Correlations Between Family Environment and Child Outcome Variables
(Age and Income Controlled) ...........................................................................149
Table 19. Comparison of Model Fit Statistics for Structural Equation Modeling
Analyses.............................................................................................................150
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LIST OF FIGURES

Figure 1. Theoretical model of familial and child characteristics associated with
psychological adjustment and metabolic control in children and youth with type
1 diabetes ..........................................................................................................151
Figure 2. Conceptual transactional stress and coping model for chronic childhood
illness.................................................................................................................152
Figure 3. Childhood adaptation model to chronic illness: Diabetes mellitus...................153
Figure 4. Tripartite model of children’s emotion regulation and adjustment ..................154
Figure 5. Standardized Beta Coefficients ($) derived using linear regression testing for
mediading effects on psychological adjustment (CBCL Total) and metabolic
control (HbA )..................................................................................................155
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Figure 6. Standardized estimates of full structural model predicting child adjustment from
family system characteristics and coping processes in the full sample.............156
Figure 7. Standardized estimates of trimmed structural model predicting child adjustment
from family system characteristics and coping processes in the full sample....157
Figure 8. Standardized estimates of the unconstrained trimmed model predicting child
adjustment from family system characteristics and coping processes in children
with type 1 diabetes ..........................................................................................158
Figure 9. Standardized estimates of unconstrained trimmed model predicting child
adjustment from family system characteristics and coping processes in
adolescents with type 1 diabetes .......................................................................159