Parent-adolescent conflict, treatment adherence and glycemic control in Type 1 diabetes: The importance of adolescent externalising symptoms

• Published in: Psychology & health 2013-09, Vol.28 (9), p.1082-1097
• Main Authors: Luyckx, Koen, Seiffge-Krenke, Inge, Missotten, Lies, Rassart, Jessica, Casteels, Kristina, Goethals, Eveline
• Format: Article
• Language: English
• Subjects: adolescence; Adolescent; Adolescent Behavior - psychology; Child; Conflict (Psychology); Diabetes; Diabetes Mellitus, Type 1 - prevention & control; Drug therapy; externalising symptoms; Female; Glycated Hemoglobin A - analysis; glycemic control; Humans; Longitudinal Studies; Male; Models, Psychological; parent-adolescent conflict; Parent-Child Relations; Patient Compliance - statistics & numerical data; Self Care - psychology; Time Factors
• ISSN: 0887-0446; 1476-8321
• DOI: 10.1080/08870446.2013.782405

Parent-adolescent conflict has been demonstrated to relate to treatment adherence and glycemic control in adolescents with Type 1 diabetes. The present longitudinal study investigated how these variables were interrelated over time, and examined whether externalising and internalising symptoms function as mediating variables. A total of 109 adolescents with diabetes participated at four annual time points and completed measures on conflict with parents, internalising and externalising symptoms. Information on treatment non-adherence and glycemic control was obtained from treating physicians. Cross-lagged analyses from a structural equation modelling approach indicated that father-adolescent but not mother-adolescent conflict positively influenced treatment non-adherence over time, which, in turn, was associated with higher glycosylated haemoglobin-values. Further, externalising but not internalising symptoms were found to mediate the pathway from father-adolescent conflict to treatment adherence over time. Finally, mother-adolescent conflict was found to relate indirectly to treatment non-adherence through its relationship with externalising symptoms. Hence, the present longitudinal study provides evidence that externalising symptoms represent an important mechanism through which earlier experiences of parent-adolescent conflict may influence later treatment non-adherence and poorer glycemic control. Implications and suggestions for future research are outlined.