Depression, anxiety, general parenting stress, and diabetes-specific parenting stress in parents of children with Type 1 Diabetes: an updated review; and, The experiences of young people with Type 1 Diabetes who Access Transition Services

Systematic Review: A previous review looked at the psychological experience of parents caring for a child with Type 1 Diabetes (T1D), however, there were some limitations of their review. This updated review used a more comprehensive search strategy to synthesise and quality review what is known about depression, anxiety, general parenting stress, and diabetes-specific parenting stress in parents who care for a child with T1D. Studies on parents caring for children with T1D included at least one measure of parental adjustment, stress, anxiety, or depression were included in this review. The following online databases were searched: CINAHL, Embase, Medline, PsycINFO, Prospero, and The Cochrane Database of Systematic Reviews. A total of 16 studies met criteria for this review. Evidence indicated prevalence of depression in parents of a child with T1D was 13%-49%. Parents of a child with Type 1 diabetes (T1D) had higher prevalence rates of depression and anxiety. The majority of studies in this review found no evidence that parents of children with Type 1 diabetes had higher rates of depression. Evidence indicated parents may be at a slightly increased risk of anxiety, with limited evidence that anxiety and depression were higher in mothers than fathers. Evidence and data for general and diabetes-related parenting stress was very limited, with parenting stress tending to be higher in parents of children with Type 1 diabetes compared to parents of healthy children. Additionally, they also experience specific diabetes-related parenting stress specific to their child’s diabetes. This indicates that these parents may have a slightly increased likelihood/vulnerability to poorer mental health. There was also some evidence of parental mental health being associated with diabetes outcomes, and that ethnicity and family income are associated with poorer outcomes. This review found an increased risk of these parents having poorer mental health. Evidence was limited and of variable quality, with issues regarding measures used, and completeness of the data collected and reported. Larger-scale and more diverse and representative samples are required in future research. Clinicians and health services need to be aware of the potential psychological impact for parents, and consider assessment/screening where appropriate. There is a need for evidence-based effective psychological interventions for parents, as there is growing evidence that poor parental mental health has a detrimental impact not just on parents but also on child mental health, and diabetes management and outcomes. Empirical Paper: There is a lack of qualitative research on young people with Type 1 diabetes (T1D) during transition from adolescence into adulthood. The aim of this project was to explore this, in the context of the specific developmental challenges and processes that occur during adolescence. A qualitative approach was used, with individual semi-structured interviews carried out with young people (N=8). Interviews were audio-recorded and transcribed, before being analysed using Thematic Analysis. Qualitative analysis identified the following 2 master themes: (1) My internal experience of transition, as someone with T1D, and (2) External factors and supports: what helps or hinders transition. Subthemes for (1) turning point to taking on ownership of my diabetes, loneliness/feeling different, daily hassles and consequences of managing blood glucose levels, and relationship between T1D and mental health. Subthemes for (2) were shift of support from family to peers, use of healthcare services, the role of technology, and supports at school/work. Some of the subthemes support existing research, whilst the subthemes regarding the relationship between T1D and mental health, and the role of technology were new findings having not previously been found in research on this topic with this specific age group. Themes reflected on developmental tasks of adolescence including identity, autonomy, and abstract thinking and decision-making. The findings are discussed in relation to the specific challenges of adolescence. Implications for clinical practice and research are also discussed, with suggestions made for future research and practice to try to address