Pediatric Medical Traumatic Stress in Youth with Type 1 Diabetes and Their Caregivers: A Longitudinal Assessment of Metabolic Control and Psychosocial Mediators
Date of Award
Doctor of Philosophy (PhD)
Jocelyn Carter, PhD
Kathryn Grant, PhD
This dissertation examines the role of pediatric medical traumatic stress (PMTS) in response to a type 1 diabetes (T1D) diagnosis for both parents and children and its influence on a child’s future metabolic control. PMTS is a term that represents a continuum of posttraumatic stress symptoms (i.e., intrusion, hyper-vigilance, and avoidance) that occur in response to a medical event that may or may not meet full clinical criteria for a Diagnostic Statistical Manual, Fifth Edition (DSM-5) diagnosis. This study examines a theoretical model (see Figure 1) and the interrelationships between a child and/or parent’s level of PMTS in response to a T1D diagnosis, a child’s metabolic control, as well as psychosocial variables including adherence to medical regimen, family functioning, and child and parent dispositional coping style. Cross-sectional, longitudinal, and mediational relationships of these variables were examined within an urban, diverse population of youth ages 8-18 and their parents. Results showed that children with higher levels of PMTS were more likely to have parents with higher levels of PMTS and had worse metabolic functioning. Avoidant and/or indirect coping styles were associated with more PMTS symptoms in both youth and their parents. Importantly, longitudinal results showed that higher youth-reported PMTS at baseline predicted poorer future metabolic control when controlling for covariates. This finding indicates that youth experience PMTS symptoms well beyond the initial diagnosis adjustment period that continue to influence their diabetes-related health in the future. While this pilot study found no significant effects of parent PMTS on future metabolic control or mediation of associated variables, future studies with larger sample sizes may find complex effects of adjustment responses as moderated by child age and/or gender. This study fills gaps in the literature by longitudinally examining youth and parent PMTS in a diverse, United States T1D population where most similar existing research is cross-sectional and completed within European-Caucasian populations. Further, this study supports that routine psychosocial screening, prevention, and intervention on sub-threshold posttraumatic symptoms related to T1D diagnosis is warranted in order to prevent declining metabolic control, even years after an initial traumatic diagnosis.
Karczewski, Sabrina Anne, "Pediatric Medical Traumatic Stress in Youth with Type 1 Diabetes and Their Caregivers: A Longitudinal Assessment of Metabolic Control and Psychosocial Mediators" (2015). College of Science and Health Theses and Dissertations. 119.