The Association of Trait Mindfulness with Psychosocial and Bio-behavioral Variables among Adolescents with Type 1 Diabetes

Background: Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood. Adolescents with T1D are especially vulnerable to stress, diabetes distress, depression, and anxiety, which can lead to deteriorated diabetes self-management (DSM) and glycemic regulation. Protective factors have been identified to improve the well-being of adolescents with T1D by decreasing the risk of stress, depression, and anxiety which could improve DSM and glycemic regulation (A1c). Mindfulness, either as an individual trait or as a result of training, has been identified as a protective factor against stress and is associated with positive well-being in adults with diabetes. However, there has been limited investigation of mindfulness among adolescents with chronic disorders in general and among adolescents with T1D in particular. Objectives: 1) Describe trait mindfulness and mindfulness practices among adolescents with T1D; 2) Compare levels of trait mindfulness and mindfulness practices on adolescents’ demographics, clinical, and bio-behavioral variables; 3) Examine the association of trait mindfulness with psychosocial and bio-behavioral variables; 4) Examine which mindfulness facets (Observe, Describe, Act with Awareness, Nonjudgement; and Nonreactivity) are associated with psychosocial and bio-behavioral variables; 5) Explore the association between trait mindfulness and stigma toward chronic disorder; and 6) Explore the potential moderating and/or mediating role of shared responsibility on the relationship between trait mindfulness and bio-behavioral variables. Methods: This cross-sectional study recruited adolescents (age=12-18 years) with T1D at UPMC Children’s Hospital of Pittsburgh. Participants completed questions on a tablet computer including demographic data, measures on mindfulness, and psychosocial variables (stress, diabetes-specific stress, diabetes distress, depression, anxiety). For bio-behavioral variables (diabetes self-management and glycemic regulation) participants completed diabetes self-management measures on the tablet and A1c was obtained from medical records. Summary: Adolescents with higher levels of trait mindfulness and with more types of mindfulness practices had lower diabetes-specific stress, higher DSM, and lower A1c. Higher mindfulness as a unidimensional concept was significantly associated with better psychosocial variables and DSM. Mindfulness facets Act with Awareness, Nonjudgment, and Nonreactivity were associated with most psychosocial variables. Nonjudgement was associated with DSM and Nonreactivity was associated with A1c. It appears that mindfulness-based interventions could be tailored to target different mindfulness facets which may improve varied aspects of mental and physical health in adolescents with T1D. These findings provided better understanding of trait mindfulness among adolescents with T1D, which could be applied to establish a theory-based and developmentally-appropriate mindfulness-based intervention to improve psychological health, adherence to diabetes self-management, and glycemic regulation