All ETDs from UAB

Advisory Committee Chair

Marti Rice

Advisory Committee Members

Anne-Marie Kaulfers

John E Lochman

Shannon Morrison

Erica R Pryor

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

Introduction: Type 1 diabetes (T1D) is one of the most common diseases of childhood affecting over 167,000 children under the age of 20. Despite adequate insulin regimens and concurrent treatments, many children still have trouble achieving glycemic control as evidenced by elevated HbA1c levels. Previous research indicates that parent-child interactions and parental involvement in diabetic care influence glycemic control. However, these relationships may be impaired in mothers with depressive symptoms or in children who have high levels of depressive symptoms or perceived stress. Moreover, cortisol, a stress hormone, may mediate the proposed relationships. Therefore, the purpose of this study was to generate hypotheses on the relationships between maternal depressive symptoms, child depressive symptoms, child’s perceived stress, cortisol, and glycemic control in prepubertal school-aged children diagnosed with T1D. Methods: Recruitment occurred at a pediatric endocrinology clinic in the Southeast US using convenience sampling. Data collection occurred on the day of the child's routine endocrinology visit and included surveys completed by the mother and child, 2 salivary samples from the child collected 3 hours apart, and review of the medical record to obtain HbA1c, height, and weight. Results: Thirty children and their mothers were enrolled in the study. Ages of children ranged from 6.9 to 12.2 years. Most children were female (70%), Caucasian (76.7%), and socioeconomically diverse. HbA1c values ranged from 6.1% to 12.2%. Eighteen children showed normal declines in cortisol from morning to afternoon samples while twelve children had increases in cortisol. Using relevancy thresholds for effect sizes, several relationships between variables of interest may be clinically meaningful. Conclusions: Results from the pilot study have shown recruitment, participation, and data collection in this specific population is feasible in school age children. As a pilot study, conclusions about the relationships between variables of interest cannot be made at this time. However, examination of effect sizes between variables of interest supports the need for future research in a larger, more representative sample, including the continued assessment cortisol may have as a mediator between maternal depressive symptoms, child depressive symptoms, child’s perceived stress, and glycemic control.

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