The Contribution of Parent Psychosocial Functioning to Parental Monitoring, Youth Adherence, and Glycemic Control during Adolescence

Objective: Type 1 diabetes is one of the most common pediatric chronic illnesses. Adolescents are at risk for poorer adherence and in turn, poorer glycemic control; however, youth whose parents remain involved in diabetes care are in better control. A parent’s level of involvement is dependent in part upon his or her own social and emotional functioning. Much is known about the link between separate aspects of parent psychosocial functioning (e.g., depressive symptoms, parental stress) and parent involvement in diabetes care, adherence, and glycemic control. However, no study to our knowledge has examined these constructs simultaneously as they interrelate to one another and to youth diabetes status. Given the complexity of human behavior, use of multiple indicators of parent psychosocial status should provide a comprehensive portrayal of precursors to parental monitoring. Methods: The current study used structural equation modeling (SEM) in a sample of 257 parent-youth (aged 11-14) dyads (91% mothers) to examine comprehensive parent psychosocial functioning including parental distress, authoritative parenting, and parental self-efficacy for diabetes management as related to parental monitoring, youth adherence and glycemic control. Results: The SEM model fit the data well [χ2 (121) = 209.24, p \u3c .001, CFI = .93, TLI = .91, RMSEA = .06, SRMR = .08]. Overall, the model accounted for 30% of the variance in parental monitoring, 27% of the variance in adherence, and 22% of the variance in glycemic control. Specifically, lower levels of parental distress (i.e., depressive symptoms, parenting stress, and hypoglycemic fear) related to higher parental self-efficacy for diabetes management and more authoritative parenting, each of which in turn related to more parental monitoring. Further, higher parental self-efficacy related directly to better youth adherence. Conclusions: The current study shows interrelated paths of parent psychosocial functioning associated with parental monitoring of youth diabetes care and ultimately, youth adherence and glycemic control. Interventions that target diabetes adherence in adolescents with T1D should consider screening for and treatment of parental distress