Social support, chronic stress, and health outcomes in adolescents with diabetes.

Abstract

For those with Diabetes Mellitus (IDDM), the emotional, physical, and cognitive changes of adolescence are especially stressful and contribute to deterioration of metabolic control. Several psychosocial factors, such as social support and stress, have been linked to metabolic control. This cross-sectional study was to examine the relationship of support, chronic stress, and health outcomes (self-care compliance and metabolic control) in adolescents with diabetes. Social Support and Stressors of Youth with Diabetes (SSSYD) instrument was developed for this study to measure a teenager's perceptions of diabetes-related support and stress. The instrument provided a total support and stress scale with six subscale scores. The SSSYD appeared to have sufficient validity and reliability (Alpha's range 0.74 to 0.91). SSSYD was administered along with other self-administered questionnaires during the second wave of data collection in an ongoing project. Sixty-five adolescents with diabetes participating in the larger intervention study completed and returned these pre-mailed questionnaires. The sample was predominantly white, 30 females and 35 males, with a mean age of 15.9. Along with the intervention, participants received a free blood glucose (BG) monitoring device with memory (Glucometer M), and free blood tests. Metabolic control was measured by Glycosylated Hemoglobin (GHb) test of blood drawn in the diabetes clinic. Compliance was measured indirectly by self-report, and directly by the Glucometer M (total # of BG tests over 90 days, and the average # BG/day). The subjects were asked to perform glucose tests twice a day using their Glucometer M, and to attend diabetes clinic every three months for routine health-care and for group participation. Results indicated that teens reported receiving the greatest support from parents and friends. Overall, the sample reported receiving a moderate amount of support, but reported low levels of stress. Teens indicated needing the most support with glucose monitoring and diet. Emotional support was the type reported as most helpful. Teens receiving the group intervention during the first year reported significantly greater support. Results from multiple regression analysis did not show support as having any significant main or buffering effects on stress, or on any of the health-outcome measures. Support had an unexpected positive correlation with stress. Poor metabolic control was predicted by high levels of stress. Except for stress explaining 9% of the variance in control, and gender explaining 5% in compliance, much of the variance in health outcomes remained unexplained. Higher levels of stress were also associated with greater self-reported compliance. Significant findings may not have been detected due to the small sample size, which resulted in low statistical power. Therefore, caution should be used when interpreting these results.