Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: I. The influence of patient coping and adjustment.
Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: I. The influence of patient coping and adjustment.
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患有胰岛素依赖型糖尿病的儿童和青少年在四年纵向随访中的依从性：I.患者应对和调整的影响。
DOI：
10.1093/jpepsy/15.4.511
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发表时间：
1990
影响因子：
3.6
通讯作者：
Stein,J
中科院分区：
文献类型：
--
作者：
Jacobson,AM;Hauser,ST;Lavori,P;Wolfsdorf,JI;Herskowitz,RD;Milley,JE;Bliss,R;Gelfand,E;Wertlieb,D;Stein,J
对一组青少年和儿童胰岛素依赖型糖尿病的发病队列进行了为期4年的研究。在研究开始时评估个体患者的心理社会和人口统计学因素，并用于检查随访期间的依从性。我们发现，在研究开始时对患者应对（防御水平、适应强度和控制点）和调整的初步评估可预测患者在4年研究期间对糖尿病治疗方案的依从性水平。心理社会变量预测依从性结果与患者年龄无关。这是发现的三个领域的坚持，即，饮食、胰岛素调整和代谢监测，以及来自单独依从性量表的复合指数。研究入组时的青春期前患者（9-12岁）比诊断时已处于青春期的患者（13-16岁）更依从。使用多元回归，三个因素（年龄、调整、自我防御水平）解释了依从性方差的47%。随访期间，没有任何因素可以预测依从性的变化。因此，诊断后不久评估的糖尿病儿童的心理社会特征预测了4年内的典型或平均依从性。识别这些特征可能有助于制定在疾病过程中早期进行干预的策略。
An onset cohort of adolescents and children with insulin-dependent diabetes mellitus was studied over a 4-year period. Individual patient psychosocial and demographic factors were assessed at study inception and used to examine aspects of adherence over the follow-up. We found that initial assessment of patient coping (defense level, adaptive strength, and locus of control) and adjustment at study inception were predictive of the level of patient adherence to diabetic regimen over the 4 years of study. Psychosocial variables predicted adherence outcomes independent of patient age. This was found for three domains of adherence, i.e., diet, insulin adjustment, and metabolic monitoring, and for the composite index derived from the separate adherence scales. Preadolescents (ages 9–12) at study entry were more adherent than patients who were already adolescent (ages 13–16) when diagnosed. Using multiple regression, three factors (age, adjustment, ego defense level) accounted for 47% of the variance in adherence. No factors were predictive of change in adherence during the follow-up. Thus, psychosocial characteristics of diabetic children assessed shortly after diagnosis predicted typical or average adherence over a 4-year period. Identification of such characteristics may be useful in developing strategies for intervention early in the course of illness.