Avoidant coping and diabetes-related distress: Pathways to adolescents' Type 1 diabetes outcomes.
Avoidant coping and diabetes-related distress: Pathways to adolescents' Type 1 diabetes outcomes.
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DOI：
10.1037/hea0000445
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Hood KK
中科院分区：
文献类型：
--
作者：
Iturralde E;Weissberg-Benchell J;Hood KK
1型糖尿病（T1D）青少年容易受到糖尿病相关的困扰，并且经常难以完成将血糖值维持在目标范围内所需的自我管理任务。患有T1D的青少年处理问题的一种方式是通过回避应对。本研究探讨了回避型应对方式与糖尿病结局之间的跨时间关联，并测试了糖尿病相关痛苦可能的中介作用。对T1D青少年（N = 264）在1年内进行了4次评估，以测量回避型应对方式、糖尿病相关痛苦、依从性（基于血糖仪数据和自我报告）和血糖控制（血红蛋白A1c）。使用滞后自回归路径模型，利用所有结构的重复测量，测试了一段时间内的中介效应和直接效应。在所有3种糖尿病结局中均发现了假设的中介效应。回避型应对方式水平越高，在随后的时间点糖尿病相关的痛苦越大，这反过来又与下一次评估时血糖检查次数较少、自我护理行为频率较低和血糖控制较差（A1c较高）相关。在糖尿病的背景下，回避型应对方式可能会导致更大的糖尿病特异性痛苦，然后随着时间的推移，自我管理和血糖控制恶化。适应不良的应对方式是可以改变的因素，在进一步的困难发生之前提供了一个干预的切入点。
Adolescents with Type 1 diabetes (T1D) are vulnerable to diabetes-related distress and often struggle to complete self-management tasks needed to maintain blood glucose values in target range. One way that youth with T1D handle problems is through avoidant coping. The current study examined cross-time associations between avoidant coping style and diabetes outcomes and tested the possible mediating role of diabetes-related distress. Adolescents with T1D (N = 264) were assessed 4 times over 1 year to measure avoidant coping style, diabetes-related distress, adherence (on the basis of glucometer data and self-report), and glycemic control (hemoglobin A1c). Mediation and direct effects were tested across time using time-lagged autoregressive path models, making use of the repeated measurement of all constructs. The hypothesized mediation effect was found for all 3 diabetes outcomes. Higher levels of avoidant coping style were associated with greater diabetes-related distress at the subsequent time point, which was related in turn to fewer blood glucose checks, less frequent self-care behaviors, and poorer glycemic control (higher A1c) at the next assessment. In the context of diabetes, an avoidant coping style may contribute to greater diabetes-specific distress followed by deterioration in self-management and glycemic control over time. Maladaptive coping styles are modifiable factors that offer an entry point into intervention before further difficulties can take hold.
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