Author ORCID Identifier

https://orcid.org/0000-0002-5470-3882

Semester

Summer

Date of Graduation

2024

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Christina Duncan

Committee Member

Kevin Larkin

Committee Member

Melissa Olfert

Committee Member

Melissa Blank

Abstract

Background: Many adolescents with type 1 diabetes (T1D) find the transition from pediatric to adult healthcare stressful, reporting high levels of diabetes distress and burnout. Although promoting positive coping strategies (primary control, secondary control), and inhibiting negative coping (disengagement) improves health outcomes in youth of transition age, little research has examined how different types of coping relate to transition readiness in T1D. Additionally, it remains unknown what psychological factors predict disengagement coping in adolescents with T1D. Therefore, this study aimed to (1) examine which coping styles predict transition readiness in adolescents with T1D, (2) determine whether diabetes distress mediates the relation between disengagement coping and transition readiness, and (3) explore psychological predictors of disengagement coping.

Method: Sixty-eight families with a child with T1D and a caregiver were recruited during routine clinic appointments. Consent forms, assent forms, and surveys were completed electronically. Teens completed measures on (a) coping, (b) transition readiness, (c) diabetes distress, (d) hope, (e) diabetes self-efficacy, and (f) depressive symptoms. Caregivers completed forms on (a) demographics, (b) teen’s externalizing behaviors, and (c) their teen’s transition readiness. HbA1c level closest to time of consent to contact and time since diagnosis were extracted from the teen’s electronic medical record.

Results: Neither primary control, secondary control, or disengagement coping were significantly associated with transition readiness per parent and teen report. Similarly, there was no direct effect of disengagement on transition readiness in mediation models. Yet, there was a significant indirect effect of disengagement coping on transition readiness through higher levels of diabetes distress, (teen report: β = -.13; 95% standardized CI, LL = -.27, UL = -.02; parent report β = -.12; 95% standardized CI, LL = -.26, UL = -.02). The mediation model also illustrated that greater disengagement was associated with greater diabetes distress (teen report: β = .43, p < .001; β = .38, p < .01) and that diabetes distress was associated with worse transition readiness (teen report: β = -.30, p < .05; parent report β = -.29, p < .01). When examining psychosocial predictors of disengagement coping, we found that disease acceptance and diabetes distress explained 25% of the variance in disengagement coping, F(2, 57) = 9.37, p < .001; yet only diabetes distress was uniquely associated with disengagement coping (β = .33, p = .01)

Discussion: In this study it appears that coping style does not have a direct effect on transition readiness. However, disengagement coping is associated with relevant psychosocial concerns (e.g., diabetes distress) which in turn affect transition readiness. Likewise, it appears diabetes distress is a risk factor for disengaging from diabetes care. Thus, clinicians and researchers will want to screen teens for elevated diabetes distress to identify teens more at risk for disengaging from care, and perhaps lost to follow up, during the transition to adult care.

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