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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 1  |  Page : 66-70

Effect of caring for children with type I diabetes on parent’s life


1 Department of Psychiatry, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
2 Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

Date of Submission07-Jan-2020
Date of Decision16-Jan-2020
Date of Acceptance20-Jan-2020
Date of Web Publication20-Apr-2020

Correspondence Address:
Shaimaa M Arafa
MD Psychiatry, 161 B Gardinia, Alahram Garden, Giza Governatev, 12556
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_4_20

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  Abstract 


Introduction Type 1 diabetes mellitus is one of the commonest chronic health conditions in children. The risk of complications in diabetes is common, so parents live with constant worry about their child’s health. The condition requires also a higher degree of behavioral regulation than normal children of the similar age. The children naturally must rely on their parents for instruction, support, and daily help. Therefore, type 1 diabetes mellitus is ‘a family condition’ challenging the patient’s social and familial circle.
Objective The aim was to assess parental stress and quality of life (QOL) in parents of diabetic children.
Participants and methods A case–control study was done on 100 parents, recruited from endocrine department and clinic at Al Zahra University Hospital, who were classified in two groups: group I included 50 parents of diabetic children and group II included 50 control parents of nondiabetic children. They were subjected to the following: sociodemographic data, parent stress index questionnaire, and QOL questionnaire.
Results Stress is significant among parents of diabetic children, with significant statistical relation between both groups regarding depression, attachment, sense of competence, role restriction, and social isolation. A significant statistical relation was also found regarding duration of diabetes and child age. QOL was also significantly diminished in parents of diabetic children.
Conclusion Parents of diabetic children are at increased risk for stress, which in turn affects their QOL.

Keywords: diabetic children, parental stress, quality of life


How to cite this article:
Arafa SM, Alwakeel ME. Effect of caring for children with type I diabetes on parent’s life. Sci J Al-Azhar Med Fac Girls 2020;4:66-70

How to cite this URL:
Arafa SM, Alwakeel ME. Effect of caring for children with type I diabetes on parent’s life. Sci J Al-Azhar Med Fac Girls [serial online] 2020 [cited 2020 May 30];4:66-70. Available from: http://www.sjamf.eg.net/text.asp?2020/4/1/66/282864




  Introduction Top


Type 1 diabetes is one of the commonest chronic childhood diseases [1]. It can be diagnosed at any age; peaks in onset occur between 5 and 7 years of age and near puberty. Type 1 diabetes mellitus (T1DM) accounts for ∼10% of all diabetes cases, and the incidence rate of childhood T1DM has risen worldwide by ∼2.8%–4.0% each year in the past decades [2]. Approximately 0.25%, that is, around 208 000, of children and adolescents in the world are affected by it [3]. The rise in prevalence and earlier onset of T1DM leads to longer chronic conditions and a heavier burden on caregivers [4]. However, there are few epidemiological studies concerned with T1DM in Egypt owing to lack of diabetes registries and suboptimal identification of new cases [5]. T1DM is a complex condition that requires skilled medical and psychosocial management [6]. A diagnosis of a child with T1D is a challenge for the family. Parents of diabetic children face challenges related to the diagnostic presentation, which is often severe [7]. Management of T1DM is complex and requires frequent monitoring of blood glucose levels, control of food intake, frequent insulin administration, modifying insulin dose to match diet, and activity levels [8]. Continued involvement of parents in treatment is associated with better health and psychosocial outcomes in diabetic children; however, this mode of intensive therapy puts big burden on parents [9]. WHO defined quality of life (QOL) as the individual’s ‘perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns’ [10]. Health-related quality of life (HRQoL) includes positive and negative aspects of an individual’s well-being, including their physical, social, and emotional well-being [11]. In child health care, the child and parent’s participation as well as their satisfaction with the care is essential [12]. Better satisfaction with health care yields an improved effect of treatment, and this leads to better health outcomes [13]. Parental satisfaction with care is owing to various factors, including feeling secure with the staff, receiving support, and being involved in their child’s care [14]. Parental QOL is affected by the burden of their diabetic child [15]. So it is important to include periodic assessment of HRQOL as a routine in diabetes care [16].


  Objective Top


This aim is to assess parental stress and QOL in parents of diabetic children.


  Participants and methods Top


Participants

A case–control study was done on 100 parents, who were classified in two groups: group I included 50 parents of diabetic children, and group II included 50 parents of nondiabetic children, who were randomly recruited from Endocrine Departments and Clinics at Al Zahraa University Hospital. After approval of the Medical Ethics Committee and written informed consent from the patients, the study was carried out. Inclusion criteria were parents of diabetic children’s diagnosed by professional endocrinologist as fasting plasma glucose greater than or equal to 126 mg/dl or 2 h postprandial sugar greater than or equal to 200 mg/dl or HbA1c greater than or equal to 6.5% according to American Diabetes Association (2018), age of parents from 25 to 50 years, age of child from 2 to 12 years, children of both sexes, and children with average IQ. Parents or children who did not fulfil the aforementioned criteria were excluded .

Methods

Parents were subjected to the following: first, sociodemographic data including age, sex, occupation, marital state, and residence; second, parent stress index questionnaire, which contains three domains: the ‘child characteristics’ domain, the ‘parent characteristics’ domain, and the ‘situational life stress’ domain [17]; and third, Lehman Quality of Life Interview (LQLI), which is a 33-item instrument. Each items is measured on a 1–7-point ‘feeling’ scale, where 1 indicates ‘terrible’ and 7 indicates ‘delighted.’

Statistical methods

The results were analyzed using the Statistical Package for the social sciences (SPSS) computer software program, version 10.1 (SPSS Inc., Chicago, Illinois, USA). Qualitative data were presented as mean SD for normal distributed data and as medians and percentiles for skewed data. Qualitative data were presented in the form of frequencies and percentages. For qualitative data, differences among groups were tested using the Pearson’s χ2-test. To study the relationship between two variable, Pearson’s and/or spearman’s correlation coefficients were calculated. All tests were tailed and considered statistically significant at P less than 0.05.


  Results Top


[Table 1] shows insignificance regarding parent sex, occupation, residence, education, and number of children.
Table 1 Sociodemographic data of parents

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[Table 2] shows insignificant statistical relation regarding sex, birth order, and illness duration of children.
Table 2 Sociodemographic data of children

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[Table 3] shows significant relation between both groups regarding depression, attachment, sense of competence, role restriction, and social isolation.
Table 3 Comparison between studied groups regarding parent stress index

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[Table 4] shows significant relation regarding QOL.
Table 4 Comparison between studied groups regarding quality of life

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[Table 5] shows significant relation regarding depression, social isolation, sense of competence, role restriction, and attachment.
Table 5 Relation between depression (present, absent) and parent stress index in parents’ of diabetic children

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[Table 6] shows a significant relation between depression and QOL regarding safety, finance, social relation, daily activity, and leisure activity.
Table 6 Relation between depression (present, absent) and quality of life in parents of diabetic children

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[Table 7] shows a significant relation between child age and parent stress index regarding parent’s health and relation of the spouse, whereas it was insignificant between child age and QOL.
Table 7 Correlation of child age with parent stress index, and quality of life in parents diabetic children

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[Table 8] shows significant relation between duration of the illness and QOL (safety and health), whereas it was insignificant regarding parent stress index.
Table 8 Correlation of illness duration with parent stress index, and quality of life in parents of diabetic children

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  Discussion Top


The diagnosis of a child with chronic illness, such as type 1 diabetes, leads to family disturbance and stress. If parents cannot effectively cope with their stress, they often have difficulty managing their child’s illness, leading to poorer outcomes for the child [18].

For diabetic children, parents are responsible for daily management of T1DM, which requires a change to many well-established family routines [19]. This responsibility can contribute to parental distress and diminished QOL [20].

Sociodemographic data

Most parents were married and were matched regarding parent sex, education, residence, occupation, and number of children. Parents live with constant worry about hypoglycemia or hyperglycemia, heightened feelings of responsibility for their child’s health, and the desire to promote optimal growth and development [13]. Mothers of younger children may have particularly high levels of worry because their children do not have the cognitive ability to recognize and respond to symptoms of hypoglycemia [21].

Parent stress index

Parents of diabetic children express high stress levels as they have to cope with multiple demands in everyday life [22]. Parenting stress arises when the parent’s expectations about the resources needed to meet the demands of parenting are not matched by available resources [23]. The current study revealed a significant relation regarding parent stress index items (depression, attachment, sense of competence, role restriction, and social isolation), whereas it was insignificant regarding relation of spouse and parents’ health [24]. Parents may feel overwhelmed by the demands of taking care of a diabetic child while juggling the eating patterns and activities of other family members [25]. A correlation was done between parent stress index and parent variables (age, sex, and education) and child variables (duration of illness), and no significant statistical relation was found. In this study, a significant relation was found regarding duration of diabetes and child age; the younger the age of child, the higher the level of stress in parents of diabetic child, which is consistent with American Diabetes Association standards [24]. It was also found that parents’ stress related to caring for a child with diabetes has been linked to increased parent anxiety, decreased hope, and reduced feelings of self-efficacy [26].

Quality of life

Success is measured by social and mental well-being as well as by standard of living and QOL, of the family as a whole and of each member [27]. The concept of QOL has gained currency over the past decade as a way of assessing the global outcome of a variety of medical condition, including psychiatric disorder [28].

In this study, there were significant relation regarding QOL items (satisfaction with living situation, general life satisfaction, leisure activity, daily activity, social relation, family relation, finance, safety, and health). This was consistent with the study done by Mitchell et al. [29].

Similarly, using Parent Diabetes Quality of Life Questionnaire (PDQOL), it was found that parents reported diminished T1D-related QOL [30], which was also similar with Lancon et al. [31]. Similar result was also found by Bhadada et al. [32], using WHOQOL- Brief; the caregivers of diabetic children were not satisfied with any item of the questionnaire. This also was consistent with the study done by Faulkner et al. [19].

A correlation was done between QOL and child age, parent sex, and parent occupation, and the study showed that there was an insignificant relation, which was consistent with the study done by Whittemore et al. [22].

In this study, a significant relation were found between QOL, education, and duration of the illness. There was also a significant correlation between depression and QOL items, regarding safety, finance, social relation, daily activity, and leisure activity, whereas it was insignificant regarding general life satisfaction, family relation, living situation, and health. There was also an insignificant statistical correlation between QOL and presence of anxiety, and this was consistent with the study of Linda et al. [33].


  Conclusion Top


Stress is more in parents of diabetic children, which may cause many problems in families and diminish their QOL.

Recommendation

It is important for future researchers to assess those parents who are not adequately coping with their diabetic children to improve the health of this at-risk population and promote the best QOL for families of diabetic children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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