Illness intrusiveness in parents and glycaemic control in youth with type 1 diabetes: intergenerational processes

Abstract

Background. Type 1 Diabetes (T1D) is a chronic condition accompanied by strict treatment guidelines impacting both the patient and the surrounding family. Although previous literature has examined specific associations linking parental and youth functioning, studies examining encompassing intergenerational models are scarce. The present multi-informant study investigated an intergenerational path-model linking illness intrusiveness in parents to patient glycaemic control. More specifically, parental functioning (illness intrusiveness and depressive symptoms) was expected to predict patient functioning (depressive symptoms, treatment adherence, and glycaemic control) through parenting practices (overprotection and psychological control). Methods. 316 patient-mother dyads and 277 patient-father dyads participated at the first wave of an ongoing longitudinal study (patients with T1D, aged 14-25, living at home). Parents reported on their experience of illness-intrusiveness, their depressive symptoms, and patient’s treatment adherence. Patients indicated their depressive symptoms and treatment adherence. Medical records provided HbA1c-values. Parenting practices, as operationalized by the dimensions of overprotection and psychological control, were assessed in both parents and patients. Findings. Structural equation modelling favoured our hypothesized path model to an alternative, child-driven model. An adequate fit was found for both patient-mother and patient-father dyads. Parental functioning predicted patient functioning with parenting practices as intervening mechanisms. Parental illness intrusiveness was associated with parental depressive symptoms, both predicting overprotection and psychological control. Psychological control in particular predicted patient depressive symptoms, treatment adherence, and glycaemic control. Discussion. These findings underscore the importance of the context when considering the functioning of youth with T1D. Longitudinal analyses are warranted to further investigate bidirectional or transactional pathways.