Journal of Pediatric Psychology 15(4) pp. 527-542, 1990
© 1990 Society of Pediatric Psychology
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Adherence Among Children and Adolescents With Insulin-Dependent Diabetes Mellitus Over a Four-Year Longitudinal Follow-Up: II. Immediate and Long-Term Linkages With the Family Milieu1
Harvard Medical School, Tufts University, Private Practice
2All correspondence should be sent to Stuart Hauser, Massachusetts Mental Health Center, 74 Fenwood Road, Boston, Massachusetts 02115
Cross-sectional and longitudingal findings drawn from a 4-year longitudinal study of an onset cohort of preadolescents and early adolescents with insulin-dependent diabetes and their families are presented. Patient and parent perceptions of the familiy environment near the time of diagnosis are used to examine patterns of adherence in the first year of illness as well as over the four follow-up years. We found that family conflict, cohesion, and organization were strongly associated with independently rated first-year adherence levels. The strongest predictor of longer term adherence was family conflict, as experienced by the patients. In addition, parents'and youngsters' perceptions of family cohesion predicted improved adherence as well as overall higher levels of patient adherence. The findings are discussed with respect to the clinical implications of discovering those family characteristics that can, shortly after diagnosis, predict short- and long-term adherence. In addition, we present planned investigations intended to further clarify paths from family perceptions to individual diabetes behaviors.
Key words: diabetes; family environment; longitudinal; adherence.
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