PSYCH  Vol.6 No.8 , June 2015
Stress Management in Parents of Children with Diabetes Type 1: A Randomized Controlled Trial
ABSTRACT
Parents of children with diabetes type 1 (DT1) usually mention high stress levels as they have to cope with multiple demands in everyday life. Simple stress management techniques can be administered in everyday life and thus may hold some benefit for parents with diabetic children. The purpose of this study was to assess to evaluate the effectiveness of a stress management program (relaxation breathing and progressive muscle relaxation/RB-PMR) in reducing symptoms of stress. Self-reported validated measures were used to evaluate perceived stress, health locus of control, daily routine, anxiety and depression. This is a pilot, randomized controlled trial. A total of 54 parents were randomly assigned to the intervention group (n = 28) and control group (n = 26). In parents in the intervention group perceived stress, symptoms of depression and anxiety were significantly decreased after 8 weeks of the relaxation program (0.017, 0.044 and 0.006). RB-PMR practice was associated with changes in physical and psychological symptoms of parents with children with DT1. Future studies should extend by incorporating more objective clinical and laboratory outcomes.

Cite this paper
Pateraki, N. , Mantzourani, E. , Darvyri, P. , Alexopoulos, E. , Varvogli, L. , Mamoulakis, D. , Christina, D. and Chrousos, G. (2015) Stress Management in Parents of Children with Diabetes Type 1: A Randomized Controlled Trial. Psychology, 6, 1040-1050. doi: 10.4236/psych.2015.68101.
References
[1]   Abidin, R. (1995). Parenting Stress Index (3rd ed.). Odessa, FL: Psychological Assessment Resources, Inc.

[2]   Andreou, E., Alexopoulos, E. C., Lionis, C., Varvogli, L., Gnardellis, C., et al. (2011). Perceived Stress Scale: Reliability and Validity Study in Greece. International Journal of Environmental Research, 8, 3287-3298. http://dx.doi.org/10.3390/ijerph8083287

[3]   Barakat, L. P., Patterson, C., Weinberger, B., Simon, K., Gonzalez, E. R., & Dampier, C. (2007). A Prospective Study of the Role of Coping and Family Functioning in Health Outcomes for Adolescents with Sickle Cell Disease. Journal of Pediatric Hematology Oncology, 29, 752.
http://dx.doi.org/10.1097/MPH.0b013e318157fdac

[4]   Baughcum, A. E., Johnson, S. B., Carmichael, S. K., Lewin, A. B., She, J.-X., & Schatz, D. A. (2005). Maternal Efforts to Prevent Type 1 Diabetes in At-Risk Children. Diabetes Care, 28, 916-921.

[5]   Chrousos, G. P. (2009). Stress and Disorders of the Stress System. Nature Reviews Endocrinology, 5, 374-381. http://dx.doi.org/10.1038/nrendo.2009.106

[6]   Cohen, S., & Kessler, R. C. (1997). Measuring Stress. Oxford: Oxford University Press.

[7]   Colletti, J. M., Wolfe-Christensen, C., Carpentier, M. Y., Page, M. C., McNall-Knapp, R. Y., Meyer, W. H., & Mullins, L. L. (2008). The Relationship of Parental Overprotection, Perceived Vulnerability, and Parenting Stress to Behavioral, Emotional, and Social Adjustment in Children with Cancer. Pediatric Blood & Cancer, 51, 269-274. http://dx.doi.org/10.1002/pbc.21577

[8]   Cummings, E. M., Greene, A. L., & Karraker, K. H. (1991). Life-Span Developmental Psychology: Perspectives on Stress and Coping (p. 92). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

[9]   Daneman, D. (2005). Early Diabetes-Related Complications in Adolescents. Hormone Research, 63, 75-85.

[10]   Dykens, E. M., Fisher, M. H., Taylor, J. L., Lambert, W., & Miodrag, N. (2014). Reducing Distress in Mothers of Children with Autism and other Disabilities: A Randomized Trial. Pediatrics, 134, e454-e463. http://dx.doi.org/10.1542/peds.2013-3164

[11]   Esterling, B. A., Kiecolt-Glaser, J. K., & Glaser, R. (1996). Psychosocial Modulation for Cytokine-Induced Natural Killer Cell Activity in Older Adults. Psychosomatic Medicine, 58, 264-272.
http://dx.doi.org/10.1097/00006842-199605000-00010

[12]   Hilliard, M. E., Monaghan, M., Cogen, F. R., & Streisand, R. (2010). Parent Stress and Child Behavior among Young Children with Type 1 Diabetes. Child: Care, Health and Development, 37, 224-232.
http://dx.doi.org/10.1111/j.1365-2214.2010.01162.x

[13]   Jaser, S. S., & Grey, M. (2010). A Pilot Study of Observed Parenting and Adjustment in Adolescents with Type 1 Diabetes and Their Mothers. Journal of Pediatric Psychology, 35, 738-747.
http://dx.doi.org/10.1093/jpepsy/jsp098

[14]   Kiecolt-Glaser, J. K., Marucha, P. T., Malarkey, W. B., Mercado, A. M., & Glaser, R. (1995). Slowing of Wound Healing by Psychological Stress. The Lancet, 346, 1194-1196. http://dx.doi.org/10.1016/S0140-6736(95)92899-5

[15]   Kunz-Ebrecht, S. R., Kirschbaum, C., Marmot, M., & Steptoe, A. (2004). Differences in Cortisol Awakening Response on Workdays and Weekends in Women and Men from the Whitehall II Cohort. Psychoneuroendocrinology, 29, 516-528.

[16]   LeRoy, A. (2013). Exhaustion, Anger of Caregiving Get a Name. Turner Broadcasting System, Inc.

[17]   Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation of Australia.

[18]   McEwen, B. S. (1998). Stress, Adaptation, and Disease: Allostasis and Allostatic Load. Annals of the New York Academy of Sciences, 840, 33-44. http://dx.doi.org/10.1111/j.1749-6632.1998.tb09546.x

[19]   Mullins, L. L., Fuemmeler, B. F., Hoff, A., Chaney, J. M., Van Pelt, J., & Ewing, C. A. (2004). The Relationship of Parental Overprotection and Perceived Child Vulnerability to Depressive Symptomatology in Children with Type 1 Diabetes Mellitus: The Moderating Influence of Parenting Stress. Children’s Health Care, 33, 21-34. http://dx.doi.org/10.1207/s15326888chc3301_2

[20]   Mullins, L. L., Wolfe-Christensen, C., Pai, A. L. H., Carpentier, M. Y., Gillaspy, S., Cheek, J., & Page, M. (2007). The Relationship of Parental Overprotection, Perceived Child Vulnerability, and Parenting Stress to Uncertainty in Youth with Chronic Illness. Journal of Pediatric Psychology, 32, 973-982.
http://dx.doi.org/10.1093/jpepsy/jsm044

[21]   Nicholson, T. R., Taylor, J. P., Gosden, C., Trigwell, P., & Ismail, K. (2009). National Guidelines for Psychological Care in Diabetes: How Mindful Have We Been? Diabetic Medicine, 26, 447-450.
http://dx.doi.org/10.1111/j.1464-5491.2009.02701.x

[22]   Pires da Rocha, M. C., Figueiredo De Martino, M. M., Grassi-Kassisse, D. M., & Luiz de Souza, A. (2013). Stress among Nurses: An Examination of Salivary Cortisol Levels on Work and Day Off. Revista da Escola de Enfermagem USP, 47, 1187-1194. http://dx.doi.org/10.1590/S0080-623420130000500025

[23]   Powers, S. W., Byars, K. C., Mitchel, M. J., Patton, S. R., Standiford, D. A., & Dolan, L. M. (2002). Parent Report of Mealtime Behavior and Parenting Stress in Young Children with Type 1 Diabetes and in Healthy Control Subjects. Diabetes Care, 25, 313-318.

[24]   Schulz, R., & Beach, S. R. (1999). Caregiving as a Risk Factor for Mortality. The Journal of the American Medical Association, 282, 2215-2219. http://dx.doi.org/10.1001/jama.282.23.2215

[25]   Streisand, R., Braniecki, S., Tercyak, K. P., & Kazak, A. E. (2001). Childhood Illness-Related Parenting Stress: The Pediatric Inventory for Parents. Journal of Pediatric Psychology, 26, 155-162.
http://dx.doi.org/10.1093/jpepsy/26.3.155

[26]   Streisand, R., Swift, E., Wickmark, T., Chen, R., & Holmes, C. S. (2005). Pediatric Parenting Stress among Parents of Children with Type 1 Diabetes: The Role of Self-Efficacy, Responsibility and Fear. Journal of Pediatric Psychology, 30, 513-521. http://dx.doi.org/10.1093/jpepsy/jsi076

[27]   Sulkers, E., Tissing, W. J. E., Brinksma, A., et al. (2014). Providing Care to a Child with Cancer: A Longitudinal Study on the Course, Predictors and Impact of Caregiving Stress during the First Year after Diagnosis. Psycho-Oncology, 24, 318- 324.

[28]   Sullivan-Bolyai, S., Knafl, K., Tamborlane, W., & Grey, M. (2004). Parent’s Reflections on Managing Their Children Diabetes with Insulin Pumps. Journal of Nursing Scholarship, 36, 316-323.
http://dx.doi.org/10.1111/j.1547-5069.2004.04058.x

[29]   Thompson, R. J., & Gustafson, K. E. (1996). Adaptation to Chronic Childhood Illness. Washington DC: American Psychological Association. http://dx.doi.org/10.1037/10188-000

[30]   Thompson, R. J., Gil, K. M., Burbach, D. J., Keith, B. R., & Kinney, T. R. (1993). Psychological Adjustment of Mothers of Children and Adolescents with Sickle Cell Disease: The Role of Stress, Coping Methods, and Family Functioning. Journal of Pediatric Psychology, 18, 549-559. http://dx.doi.org/10.1093/jpepsy/18.5.549

[31]   Thompson, R. J., Gustafson, K. E., Hamlett, K. W., & Spock, A. (1992). Psychological Adjustment of Children with Cystic Fibrosis: The Role of Child Cognitive Processes and Maternal Adjustment. Journal of Pediatric Psychology, 17, 741-755. http://dx.doi.org/10.1093/jpepsy/17.6.741

[32]   Tsiouli, E., Alexopoulos, E. C., Stefanaki, C., Darviri, C., & Chrousos, G. P. (2013). Effects of Diabetes-Related Family Stress on Glycemic Control in Young Patients with Type 1 Diabetes: Systematic Review. Canadian Family Physician, 59, 143-149.

[33]   Vehik, K., & Dabelea, D. (2010). The Changing Epidemiology of Type 1 Diabetes: Why Is It Going through the Roof? Diabetes/Metabolism Research and Reviews, 27, 3-13.

[34]   Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control Scale. Health Education Monographs, 6, 160-170.
http://dx.doi.org/10.1177/109019817800600107

[35]   Warram, J. H. (2012). Genetics and Diabetes. Boston, MA: Joslin Diabetes Center and Joslin Clinic.

[36]   Weinger, K., & Jacobson, A. M. (2001). Psychosocial and Quality of Life Correlates of Glycemic Control during Intensive Treatment of Type 1 Diabetes. Patient Education and Counseling, 42, 123-131.
http://dx.doi.org/10.1016/s0738-3991(00)00098-7

[37]   Wennick, A., & Hallstrom, I. (2006). Swedish Familie’s Lived Experience When a Child Is First Diagnosed as Having Insulin-Dependent Diabetes Mellitus. Journal of Family Nursing, 12, 368-389.

[38]   Worral-Davies, A., Owens, D., Holland, P., & Haigh, D. (2001). The Effect of Parental Expressed Emotion on Glycaemic Control in Children with Type 1 Diabetes. Parental Expressed Emotion and Glycaemic Control in Children. Journal of Psychosomatic Research, 52, 107-113.

 
 
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