Journal of Pediatric Psychology Advance Access originally published online on May 4, 2006
Journal of Pediatric Psychology 2007 32(2):194-205; doi:10.1093/jpepsy/jsj116
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Family Mediators and Moderators of Treatment Outcomes Among Youths with Poorly Controlled Type 1 Diabetes: Results From a Randomized Controlled Trial
1 Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 2 Columbus Children’s Hospital, 3 School of Nursing, Wayne State University, 4 Carman and Ann Adams Department of Pediatrics, Wayne State University, 5 Department of Psychiatry, Medical University of South Carolina, and, 6 Department of Psychology, Central Michigan University
All correspondence concerning this article should be addressed Deborah A. Ellis, Department of Psychiatry and Behavioral Neurosciences, 9-B University Health Center 4201 St. Antoine Detroit, MI 48201. E-mail: dellis{at}med.wayne.edu.
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Abstract |
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Objective To determine whether multisystemic therapy (MST) improved family relationships among youths with poorly controlled type 1 diabetes and whether these changes mediated MST effects on health outcomes. The moderating effect of family demographics on study outcomes was also assessed. Methods A randomized controlled trial was conducted with 127 youths. Changes in general family relationships and caregiver support for diabetes care from baseline to treatment completion were assessed. Structural equation modeling (SEM) was used to test whether changes in family relations mediated improvements in frequency of blood glucose testing (BGT) and metabolic control. Results MST increased support for diabetes care from both primary and secondary caregivers in two-parent but not in single-parent families. However, MST had the strongest effects on BGT and metabolic control in single-parent families. SEM did not support family relations as the mediator of improved BGT or metabolic control. Rather, MST had a direct effect on BGT for all participants. BGT mediated improvements in metabolic control among single-parent families. Conclusions MST improved family relationships for youths with diabetes in two-parent but not in single-parent families. Objective outcomes related to diabetes were strongest for single-parent families. Other processes such as increased parental monitoring may have been responsible for improved health outcomes among these families.
Key words: diabetes; family functioning; multisystemic therapy.
Received April 28, 2005; revision received December 15, 2005; revision received March 11, 2006; accepted March 20, 2006
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