Professional Documents
Culture Documents
Toronto, CA
September 3, 2014
Presentation Goals
1.
2.
Examined moderators
Year of publication
Age
Sex
Time since diagnosis
Glycemic control
Comparison group equivalence
Reynolds & Helgeson (2011) Annals of Behavioral Medicine
Variable
Mean ES
(fixed)
Significance
Homogeneity
Parent
Psychological distress
0.62
0.00
ns
Behavioral problems
0.25
0.00
ns
Internalizing problems
0.25
0.02
ns
Depressive symptoms
0.05
ns
ns
Depressive symptoms
0.26
0.00
Q=62.58, p<0.01
Depression (clinical)
0.40
0.00
Q=13.15, p=0.01
Anxiety
0.18
0.02
Q=15.77, p<0.01
Psychological distress
0.17
0.00
Q=14.09, p<0.05
Self-esteem
-0.09
ns
Q=32.05, p<0.01
Peer difficulties
-0.09
ns
Q=6.18, p<0.05
Psychopathology
0.04
ns
Q=8.77, p<0.05
Child
Beta
Significance
Depressive symptoms
-0.03
-0.33
p<0.01
Depression (clinical)
-0.04
-0.65
p<0.05
Anxiety
-0.02
-0.44
ns
Psychological distress
-0.02
-0.47
ns
Self-esteem
0.03
0.54
p<0.01
Peer difficulties
-0.19
-0.89
p<0.05
Beta
Significance
Depressive symptoms
-0.11
-0.37
p<0.01
Depression (clinical)
-0.06
-0.26
ns
Anxiety
-0.13
-0.84
p<0.01
Psychological distress
0.06
0.36
ns
Self-esteem
0.00
0.01
ns
Peer difficulties
0.58
0.89
p<0.05
Conclusions
Children with type 1 diabetes experience more
of a variety of psychosocial difficulties than
comparison groups
Effects are small to medium in size
Effects are smaller in more recent studies
Effects are smaller when there are better
comparison groups
Demographics
Diabetes (n= 132)
47%
49%
53
51
Race: White
93
91
Black
Asian
American Indian
95
95
Hispanic
Unknown
74
73
Age (years)
12.10 0.77
12.07 0.69
Social status*
41.97 11.05
46.40 13.31
Sex: Male
Female
Ethnicity: Non-Hispanic
Depressive symptoms
Anxiety
No group differences
Same for girls over time; decreased for boys
Anger
No group differences
Girls increase over time; boys same
No group differences
Increased over time
Self-Worth
No group differences
Declined over time, especially for girls
Helgeson, Snyder, et al. (2007) Journal of Pediatric Psychology
10
11
12
Depressive symptoms
Monitoring frequency
Child self-care
Glycemic control
13
Life Satisfaction
General Stress
.31***
-.70***
Diabetes-Specific Stress
.13***
-.32***
n.s.
.16*
Benefit Finding
14
Monitoring
Frequency
Child
Self-Care
Coeff
Coeff
Glycemic
Control
Coeff
Intercept
1.14*** (.45)
4.20*** (1.08)
4.28*** (.36)
9.10*** (1.08)
Social Status
-.00
(.00)
.02
(.01)
.00
(.00)
-.03**
(.01)
Parent Age
.00
(.00)
-.01
(.02)
-.01
(.01)+
.01
(.02)
Household Structure
.00
(.04)
-.62*
(.27)
-.14
(.09)
.44
(.27)
General Stress
.03*
(.02)
-.24+
(.11)
-.08*
(.04)
.26
(.10)
Diabetes-Specific Stress
.01
(.02)
.23*
(.11)
.11**
(.04)
.12
(.09)
Benefit Finding
-.01
(.01)
.06
(.09)
.01
(.03)
-.23**
(.07)
15
Conclusions
16
17
18.15 (.41)
18.02 (.49)
BMI*
25.68 (4.03)
24.12 (4.72)
Social status
(Hollingshead)*
42.61 (11.08)
46.58 (13.70)
47% (58)
46.3 (56)
66.7% (78)
68.9% (84)
Race White
92.3% (108)
93.4% (1114)
Age
Male
57.50%
Pump
Time since diagnosis (years)
HbA1c (%)
18
Time 2
Time 3
time
time x group
group
DM
DM
DM
Depr Symptoms
1.70
1.63
1.73
1.66
1.76
1.67
n.s.
n.s.
n.s.
Life satisfaction
5.20
5.50
4.86
5.53
5.21
5.49
n.s.
**
Bulimic symptom
1.56
1.43
1.54
1.41
1.61
1.47
n.s.
n.s.
Drive thinness
1.98
1.84
1.84
1.82
1.82
1.80
n.s.
n.s.
n.s.
Loneliness
1.72
1.60
1.74
1.64
1.79
1.64
n.s.
n.s.
Purpose in life
4.60
4.71
4.55
4.86
4.67
4.86
n.s.
**
Perceived stress
2.51
2.38
2.57
2.40
2.56
2.37
n.s.
n.s.
19
Life Satisfaction
6
5,8
5,6
5,4
5,2
Healthy
Diabetes
4,8
4,6
4,4
4,2
4
T1
20
T2
T3
Purpose in Life
6
5,8
5,6
5,4
5,2
Healthy
Diabetes
4,8
4,6
4,4
4,2
4
T1
21
T2
T3
Conclusions
No group differences on depression
Diabetes greater perceived stress than
controls trends for loneliness and bulimic
symptoms
Some group differences emerged with time:
life sat, purpose
22
Qualitative studies:
23
24
Interpersonal stress
Social competence
Failure to disclose DM
Avoid bullying
25
Self-Care
HbA1c
26
4 years of follow-up
Risk factors:
Resistance factors:
Parent relationships
Friend support
Helgeson et al. (2009) Journal of
Pediatric Psychology
27
Standard error
Age
.03
0.26
.92
Pubertal status
.15
0.08
.05
Method of delivery
-.69
0.14
0.00
Baseline BMI
.01
0.03
.88
-.02
0.01
.06
Sex
-1.23
0.56
.03
.02
0.01
.08
Self-care behavior
-.14
0.23
.55
-.13
0.07
.04
-.06
0.08
.43
.32
0.14
.02
Parent relationship
-.04
0.15
.77
.52
0.21
.01
Friend support
.26
0.10
.01
28
Standard error
Previous HbA1c
.70
0.04
0.00
Lag
.30
0.12
.02
Baseline BMI
.04
0.02
.01
Depressive symptoms
.78
0.43
.07
-.57
0.31
.07
Bulimic symptoms
.27
0.11
.02
Friend conflict
.35
0.14
.01
-.37
0.12
.002
29
Friend support
Friend conflict
Parent support
Parent control
30
Table 3 Multiple Regression Models: Social Environment Variables Predicting Health Behaviors
(Standardized Betas)
Depressive
Symptoms
Perceived
Stress
Bulimic
Drive for
Symptoms Thinness
HbA1C
.57**
.41***
.66***
.72***
.72***
.11
Delivery method
.03
Parent support
-.15**
-.20***
-.08
.01
.10
Parent control
.13**
.07
.05
-.02
-.12
Friend support
-.03
-.10+
-.00
-.01
.07
Friend conflict
.14**
.11*
.17***
.14***
.03
Time 1 DV
+p
< .10; *p < .05; **p < .01; ***p < .001; DV= dependent variable
31
32
Table 3 Logistic Regression Models: Social Environment Variables Predicting Health Behaviors
Smoking
Alcohol Use
Binge Alcohol
SE
OR
SE
OR
SE
OR
Time 1 DV
3.38**
*
.42
.29
1.72***
.34
5.59
1.68***
.39
5.38
Parent support
-.45*
.23
.64
-.03
.19
.97
-.21
.19
.81
Parent control
.48*
.22
1.61
.12
.18
1.13
-.03
.18
.97
Friend support
.18
.23
1.19
.32
.20
1.38
.24
.20
1.28
Friend conflict
.05
.33
1.05
1.27***
.32
3.55
.59*
.27
1.81
+p
< .10; *p < .05; **p < .01; ***p < .001; DV= dependent variable
33
34
Conclusions
35
Overall Conclusions
36
Acknowledgements
Co-Investigators/Collaborators
Collaborators
37
38
39
40
Table 4 Multiple Regression: Predicting Diabetes Outcomes (Standardized Betas, Change in R2 at Each Step, and Total R2)
Self-Care
HbA1c
T2
T3
T2
T3
n = 46
n = 50
n = 33
n = 37
R2
R2
R2
R2
Social Status
-.22
.04
-.23
.01
BMI
-.10
-.36**
.00
-.10
Sex
.01
.14
.01
.22
.04
.09
.02
.04
Friend Support
.07
-.29*
.04
-.06
Friend Conflict
.13
-.22
-.01
-.06
Romantic Support
.18
-.28+
.11
.17
Romantic Conflict
-.15
-.54**
.32
.36
Total R2
41
.06
.30
.11
.10
.10
.39
.13
.14
Effects of diabetes on
friendship
Effects of friendship on
health
Data from time 1 and
time 2 (2 years)
42
Support
Male DM
Male H
Female DM
Female H
3.5
3
T ime 1
43
T ime 2
beta
SE
.00
.00
Tanner stage
-.05
.05
-.02+
.01
-.20*
.10
group
-.09
.08
support
.12+
.07
negative relations
-.36***
Change in R 2 Cumulative R
.04
.04
.07
.11
.15
.53 ***
.05
.36
.36
-.00
.00
Tanner stage
-.01
.04
-.01
.01
.02
.38
-.18*
.08
group
-.03
.07
support
-.08
.06
negative relations
-.16**
.06
.03
.41
Step 2: sex
Step 3: sex
Note: SE = standard error of beta; + p < .10; * p < .05; ** p < .01; *** p < .001
44
beta
SE
-.02+
.01
Tanner stage
.20
.14
.03
.03
-.38
.28
support
.32+
.19
negative relations
.35*
Change in R2 Cumulative R2
.09
.09
.18
.05
.14
.67***
.08
.44
.44
-.02*
.01
Tanner stage
.22+
.12
.03
.02
.04
.48
.57*
.25
support
.19
.17
negative relations
.59***
.15
.07
.55
Step 2: sex
Step 3: sex
Note: SE = standard error of beta;+ p < .10; *p < .05; **p < .01; ***p < .001
45