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Journal of Pediatric Psychology Advance Access published online on December 1, 2005
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsj090
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Journal of Pediatric Psychology © 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
Received November 4, 2004
Revised October 8, 2005
Accepted October 25, 2005

Article

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 1 *, April Idalski MSW 1, Deborah Ellis PhD 1, Maureen Frey PhD 1, Thomas Templin PhD 1, Phillippe B. Cunningham PhD 1, and Nedim Cakan MD 1

1 Wayne State University

* To whom correspondence should be addressed.
Sylvie Naar-King, E-mail: snaarkin{at}med.wayne.edu


  Abstract

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.

Keywords: adherence; diabetes; gender; mental health; youth.
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