Factores psicosociales y de adaptación en adolescentes con enfermedad endocrina crónica y sus familias

Resumen

Adolescence may be a complicated stage where mental health, well-being and self-esteem can be compromised. These difficulties could increase when coupled with a chronic, non-communicable disease such as type 1 diabetes mellitus (T1DM). The presence of a chronic physical illness affects the whole family system, so the nature and quality of the interactions between caregivers and the adolescent with T1DM1 may impact (facilitating or hindering) the adjustment to the illness of the whole family. Few studies have examined the relationships between the primary family caregiver-adolescent dyad. The overall aim of the present study was to analyse the main psychological, family and disease characteristics of adolescents with T1DM and their primary family caregivers. A total of 228 adolescents participated, 76 of whom had T1DM. Of these, 56.10 % were male and their ages ranged between 12 and 16 years (M = 13.57; T.D. = 1.09). As for primary family caregivers, 83.30 % were their mothers (the remaining were the fathers), aged between 31 and 57 (M = 45.01; SD = 5.14). The evaluation was cross-sectional, conducted between June 2015 and February 2020, and considered the following variables: self-esteem, well-being, psychopathology, adaptive response to T1DM, glycated hemoglobin (HbA1c), perceived threat of the disease and family lifestyles (for adolescents), family functioning, caregiving stress, emotional distress and adult attachment (for primary family caregivers). The main results showed that the most relevant variables for explaining psychological adjustment during adolescence are: self-esteem, peer bonds and family lifestyles, with no statistically significant role for the presence or absence of T1DM. These variables, together with the perceived threat of the disease, were important in understanding the adaptive response to T1DM found in the sample. Glycated haemoglobin (HbA1c) levels improved when there was a better adaptive response to T1DM, better self-esteem and a lower perceived threat of the disease. On the other hand, caregivers were found to be more stressed and emotionally affected than adolescents. Key predictors of anxious, depressive and stress symptoms in primary family caregivers were: insecure attachments, the presence of another child with a chronic non-communicable disease, and low income.Finally, in terms of dyad adjustment, the presence of emotional distress and insecure attachment in primary caregivers predicted worse emotional adjustment, a worse adaptive response to T1DM and worse HbA1c levels in adolescents. Inadequate HbA1c levels and the presence of psychopathology in adolescents predicted more emotional symptoms and stress in the primary family caregiver. In conclusion, it is essential to consider multiple variables in both adolescents with T1DM and their primary family caregivers to better understand the adjustment to the disease at this stage in both the family system and its members. It is important to promote self-esteem and emotional bonds in adolescents (with or without T1DMD), as well as positive family lifestyles, since these are fundamental aspects for the physical and emotional adjustment of the adolescent-caregiver dyad during this stage of the life cycle and in the face of the disease.