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Journal of Pediatric Psychology Advance Access originally published online on December 1, 2005
Journal of Pediatric Psychology 2006 31(8):793-802; doi:10.1093/jpepsy/jsj090
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© The Author 2005. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Gender Differences in Adherence and Metabolic Control in Urban Youth with Poorly Controlled Type 1 Diabetes: The Mediating Role of Mental Health Symptoms

Sylvie Naar-King, PhD, April Idalski, MSW, Deborah Ellis, PhD, Maureen Frey, PhD, Thomas Templin, PhD, Phillippe B. Cunningham, PhD and Nedim Cakan, MD

Wayne State University

All correspondence concerning this article should be addressed to Sylvie Naar-King, PhD, Pediatric Prevention Research Center, University Health Center, 4201 St. Antoine, Detroit 48201, Michigan. E-mail: snaarkin{at}med.wayne.edu.

Received November 4, 2004; revisions received April 18, 2005, July 28, 2005, and October 8, 2005; accepted October 25, 2005

Objective To examine gender differences in adherence and metabolic control and test the mediating role of mental health symptoms in a sample of predominantly African-American, low-income youth with chronically poor metabolic control. Methods Baseline questionnaire data from an intervention study were collected from 119 youth and their primary caregiver. Results Boys had worse adherence than girls, but there were no gender differences in hemoglobin A1C (HbA1C). Boys had more externalizing symptoms, whereas girls had more anxiety; there were no gender differences in depression. Externalizing symptoms were associated with poor adherence and metabolic control. Although anxiety was correlated with poor adherence, this relationship was not significant in the invariate analysis. Results of structural equation modeling (SEM) suggested that externalizing symptoms mediated the relationship between gender and adherence. Conclusions Results suggest that gender differences in adherence may be attributed, in part, to gender differences in externalizing symptoms in urban youth with poor metabolic control. Interventions targeting these symptoms may be necessary to improve adherence and HbA1C in both boys and girls.

Key words: adherence; diabetes; gender; mental health; youth.


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