Rogers v. Robson: Increased Malpractice Liability for Insurance Defense Counsel, 14 J. Marshall L. Rev. 589 (1981)

Poster Presentationstatus: publishe

Chronic illness as a 'family disease': The need for appropriate scientific methods for dyadic research

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Veerkracht bij ouders van een kind met kanker: Stabiliteit en/of flexibiliteit?

Hogere overlevingskansen in de pediatrische oncologie dragen bij tot een toenemende interesse in psychosociale factoren van patiënten en hun omgeving. Eén van de centrale concepten hierbij is veerkracht, een steeds belangrijker begrip binnen het domein van de pediatrische psychologie. Veerkracht wordt algemeen omschreven als de mogelijkheid om aan stress en negatieve gebeurtenissen te weerstaan. Echter, een grote ambiguïteit in definiëring en operationalisering bemoeilijken een consensus in de bestaande literatuur. Er wordt onder andere verwezen naar veerkracht als een beperkt flexibele karaktertrek, maar anderzijds wordt veerkracht ook gezien als een dynamisch ontwikkelingsproces. Een longitudinale studie bij ouders van kinderen met kanker werd opgezet om de evolutie van veerkracht te onderzoeken tijdens het ziekteproces. 65 koppels namen deel aan het onderzoek en vulden maximaal vier keer de Nederlandstalige versie van de Resilience Scale (RS-nl) in, gespreid over een tijdsspanne van twee jaar. Variatie in veerkracht binnen koppels kwam frequent voor. Bovendien bleek de invloed van geslacht beperkt op behaalde scores. Verdere analyses toonden geen grote tijdseffecten aan, veerkracht bleek eerder stabiel te blijven over de meetmomenten. Er dient echter rekening gehouden te worden met een grote drop-out over de tijd die mogelijks een vertekend beeld veroorzaakt. Een opvallende bevinding van ons onderzoek is dat 20% van de respondenten op het tijdstip van de diagnose een klinische afwijkende score behaalde. De resultaten van dit onderzoek zullen verder toegelicht en gekaderd worden binnen recente inzichten over veerkracht bij ouders van een ernstig ziek kind.status: publishe

Illness perceptions in youth with type 1 diabetes and their parents: A triadic approach

Objectives. Type 1 diabetes constitutes a challenging illness both for the patient and its immediate context. Especially parents play a crucial role in illness adaptation and management of adolescent and emerging adult patients. The present study addressed the combined role of patient and parental illness perceptions to understand how type 1 diabetes impacts both patient and parental functioning. Previous research focused mainly on the role of illness perceptions and patient self-regulation, but a triadic approach investigating how patient and parental illness perceptions interact in predicting functioning remains forthcoming. Methods. Selected from the Belgian Diabetes Registry, a total of 330 patients-mothers-fathers triads participated. Mean age of patients (52% female) was 18.25 (SD = 2.98). Patients and both their parents completed questionnaires on their own illness perceptions (Brief IPQ) and functioning (depressive symptoms, life satisfaction). Additionally, patients reported on their treatment adherence. HbA1 values were obtained from patients’ medical records. Results. A series of regression analyses indicated that, although a person’s own illness perceptions predicted his or her functioning, illness perceptions of other close relatives were also predictive. Further, significant two- and three-way interaction terms indicated that illness perceptions of different members of the triad interacted in predicting patient and parental functioning. For instance, with respect to the illness perception of personal control, treatment adherence was highest when both patients and mothers scored high on perceived personal control. Likewise, fathers’ life satisfaction was highest when both fathers and patients scored high on perceived personal control. Conclusions. The present study encourages researchers to take the family as a system into account when examining individual functioning, both of patients with type 1 diabetes and their parents.status: publishe

Parental Illness Intrusiveness and Youth Glycemic Control in Type 1 Diabetes: Intergenerational Associations

Introduction. Type 1 Diabetes (T1D) is a chronic condition accompanied by strict treatment guidelines, impacting both the patient and the surrounding family. Although previous literature has examined specific associations linking parental and youth functioning, studies examining encompassing intergenerational models are scarce. The present multi-informant study investigated an intergenerational path-model, linking illness intrusiveness in parents to patient glycemic control. More specifically, parental functioning (illness intrusiveness and depressive symptoms) was expected to predict patient functioning (depressive symptoms, treatment adherence, and glycemic control) through parenting practices (overprotection and psychological control). Methods. 316 patient-mother dyads and 277 patient-father dyads participated at the first wave of an ongoing longitudinal study (patients with T1D, aged 14-25, living at home). Parents reported on their experience of illness-intrusiveness, their depressive symptoms, and patient’s treatment adherence. Patients indicated their depressive symptoms and treatment adherence. Medical records provided HbA1c-values. Parenting practices, as operationalized by the dimensions of overprotection and psychological control, were assessed in both parents and patients. Results. Structural equation modelling favored our hypothesized path model to an alternative, child-driven model. An adequate fit was found for both patient-mother and patient-father dyads. Parental functioning predicted patient functioning with parenting practices as intervening mechanisms. Parental illness intrusiveness was associated with parental depressive symptoms, both predicting overprotection and psychological control. Psychological control in particular predicted patient depressive symptoms, treatment adherence, and glycemic control. Discussion. These findings underscore the importance of the context when considering the functioning of youth with T1D. Longitudinal analyses are warranted to further investigate bidirectional or transactional pathways.status: publishe

Personality functioning in adolescents and emerging adults with type 1 diabetes: A longitudinal approach

Purpose. Although prior research has stressed the role of personality in adjusting to type 1 diabetes, longitudinal research is lacking. The objectives of the present study were twofold: (1) to chart the development of patients’ personality over a 2-year period; and (2) to examine prospective associations among personality, treatment adherence, glycemic control, and diabetes-specific distress. Methods. Adolescents and emerging adults with type 1 diabetes, aged 14 to 25 (Mage=18.86 years, 54% female), participated in a 3-wave longitudinal study spanning 2 years (n=560 at Time 1). Patients filled out questionnaires on Big Five personality traits, treatment adherence, and diabetes-specific distress. HbA1c-values were obtained from treating physicians. We used latent growth curve modeling to examine the development of patients’ personality. Cross-lagged path analysis was performed to examine prospective associations among the study variables. Results. First, we observed mean-level increases in extraversion, agreeableness, and conscientiousness over the course of the study. Second, we uncovered bidirectional associations between personality and several important indicators of adjustment. Lower conscientiousness and higher extraversion predicted a relative decrease in treatment adherence one year later. Poorer treatment adherence, in turn, predicted relative decreases in conscientiousness and agreeableness over time. Furthermore, lower emotional stability predicted a relative increase in distress one year later. Higher distress, in turn, predicted a relative decrease in agreeableness over time. Finally, lower conscientiousness predicted poorer glycemic control one year later. Conclusions. This study found young patients to move toward a more mature personality and stressed the importance of personality in adjusting to type 1 diabetes.status: publishe

The Role of Peers for Diabetes Management in Adolescents and Emerging Adults with Type 1 Diabetes: A Longitudinal Study

Objective. The increasing importance of peers in adolescence and emerging adulthood has been widely acknowledged. However, longitudinal research linking the peer context to diabetes management and outcomes is scarce. The present longitudinal study in a large sample of youth with type 1 diabetes related both positive and negative peer variables to diabetes outcomes over a time interval of one year. Research Design and Methods. Our sample consisted of 467 adolescents (14-17 years) and emerging adults (18-25 years) with type 1 diabetes who participated in a two-wave longitudinal study. Questionnaires tapped into peer support, extreme peer orientation, parental responsiveness, diabetes-related distress, and treatment adherence. HbA1c-values were obtained from patients’ treating physicians. Cross-lagged analysis from a structural equation modelling approach was performed to assess directionality of effects. Results. Peer support negatively predicted diabetes-related distress over time. Extreme peer orientation positively predicted treatment distress over time. Parental responsiveness negatively predicted food distress over time. Treatment adherence negatively predicted extreme peer orientation, treatment distress, and HbA1c-values over time. For emerging adults specifically, there was a reciprocal relationship between HbA1c-values and extreme peer orientation, as they positively predicted each other. Conclusions. This study highlights the importance of peers in predicting the functioning of youth with type 1 diabetes. Additionally, treatment adherence at baseline was found to negatively predict extreme peer orientation, treatment distress, and worse glycemic control over time. In sum, the present study underscores the importance of the peer context for adolescents and emerging adults with type 1 diabetes.status: publishe