Personal and family factors associated with quality of life in adolescents with diabetes

OBJECTIVE - Quality of life is an important criterion for assessing outcomes of treatment in chronic illness related to psychosocial well-being. The purpose of this study was to evaluate the factors that influence quality of life in adolescents with IDDM. RESEARCH DESIGN AND METHODS - Self-reports were obtained from 52 adolescents (age 13-20 years, mean 16.1 ± 1.9 [mean ± SD], diabetes duration 8.2 ± 3.4 years, 49% female) using the following scales: Diabetes Quality of Life for Youths, Children's Depression Inventory, Issues in Coping with Diabetes, Diabetes Family Behavior Scale, Family Adaptability and Cohesion, Self-Efficacy for Diabetes, and the Adolescent Coping Orientation. Metabolic control was measured by HbA(1c). RESULTS - Teenagers whose diabetes had the greater impact (R² = 0.48) and were less satisfied (R² = 0.45) felt that management was more difficult (r = 0.56) and that diabetes was more upsetting (r = 0.63). They also used fewer rebellion strategies for coping (r = -0.44), had lower diabetes self-efficacy (r = - 0.36). and had more depressive symptoms (r = 0.61). Higher impact was also associated with higher family warmth and caring (r = -0.54) and lower family adaptability (r = -0.42). Teenagers who were more worried (R² = 0.37) about their diabetes felt that management was more difficult (r = 0.40) and that diabetes was more upsetting (r = 0.58), and they used less rebellion (r = - 0.49) and more ventilation (r = 0.42) to cope, had lower diabetes (r = - 0.40) and medical (r = -0.30) self-efficacy, were more depressed (r = 0.55), and their families were less warm and caring (r = -0.33). HbA(1c) levels were not associated with quality of life or any other psychosocial factors except in teenagers who perceived their families as providing more guidance and control. These teenagers had lower HbA(1c) values than those whose families were less involved. CONCLUSIONS - Even teenagers who are successfully achieving HbA(1c) goals of therapy may perceive diabetes as having a negative impact on their lives, be depressed, and find diabetes difficult to manage. Diabetes treatment teams need to pay equal attention to the psychosocial needs of the quiet, nonrebellious teen with well-controlled diabetes from a supportive family as they do to the rebellious adolescent with poorly controlled diabetes.