Abstract
The management of a child's type 1 diabetes (Insulin Dependent Diabetes Mellitus/T1D) is complex, demanding and enduring for a family. Fortunately, after the initial six months from diagnosis, most children and their families appear to successfully incorporate the treatment regimen into their daily lives. However, research studies conducted with multiple pediatric populations over the last fifteen to twenty years have demonstrated that routine measures assessing general psychosocial outcomes (e.g., anxiety, depression) are not capturing the potential posttraumatic stress responses that could develop in response to the assault to bodily integrity that can follow diagnosis of life-threatening medical condition. The symptoms, particularly the pattern of avoidance characteristic of posttraumatic stress, may interfere with a child and family's ability to adapt to the diagnosis and integrate its management into their daily routine. The principal aim for this longitudinal, pilot study is to evaluate the potential traumatic nature of the diagnosis and ongoing treatment of T1D in children and their parents, and track the trajectory of posttraumatic stress symptoms in families managing a new diagnosis of T1D. The secondary aim is to investigate the potential impact of these symptoms on self and family management of T1D, as well as on more long-term psychosocial functioning and health status. Our last aim is to explore how children and their families experience this diagnosis and its intense treatment. We plan to include 42 children newly diagnosed with T1D and their parents presenting to Yale New Haven Children's Hospital with the following criteria: a) English-speaking; b) between 8 to 17 years of age c) no other health problems other than the T1D; d) school grade appropriate to age within 1 year. They will be invited to participate once the child's diabetes has been stabilized and before they are discharged from the hospital. Instruments measuring acute- and post trauma symptoms, global trauma exposure, internalizing and externalizing behaviors, self and family management behaviors will be administered during the child's initial hospital admission, and subsequently at 3 and 6 months during routine follow up clinic appointments; medical outcome data (HbA1c, # hypoglycemic episodes, # hospitalizations) will also be collected at 3 and 6 months at these same appointments. A smaller subset of families will be asked to participate in a series of open-ended interviews to assess their experience with the diagnosis of T1D and its treatment. Analyses will include repeated measures ANCOVA and multiple linear regression for aims 1 and 2, and qualitative analyses for aim 3. The results of this study could significantly advance and enrich our understanding of a child and family's response to the diagnosis of T1D and the role they adopt in its management. Additionally, by tracking trauma symptoms longitudinally for a year from the time of diagnosis we can explore how these symptoms might also shape self- and family-management strategies as they develop. Determining that problems with self-management are associated with a pattern of avoidance characteristic of a trauma response could inform the development and delivery of psychosocial treatments better tailored to this constellation of symptoms, and more effective in equipping children and parents with healthy management strategies.
|
|
Principal Investigator
Jodie M. Ambrosino
Co-Investigator
Margaret Grey
William Tamborlane
Stuart A. Weinzimer
|
|
|
