Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. e826-e832 (doi:10.1542/peds.2005-0638)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ellis, D. A.
Right arrow Articles by Cakan, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ellis, D. A.
Right arrow Articles by Cakan, N.
Related Collections
Right arrow Endocrinology

ELECTRONIC ARTICLE

The Effects of Multisystemic Therapy on Diabetes Stress Among Adolescents With Chronically Poorly Controlled Type 1 Diabetes: Findings From a Randomized, Controlled Trial

Deborah A. Ellis, PhD*, Maureen A. Frey, PhD{ddagger}, Sylvie Naar-King, PhD{ddagger}, Thomas Templin, PhD§, Phillippe B. Cunningham, PhD|| and Nedim Cakan, MD{ddagger}

* Department of Psychiatry and Behavioral Neurosciences
{ddagger} Carman and Ann Adams Department of Pediatrics
§ School of Nursing, Wayne State University, Detroit, Michigan
|| Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina

Objective. The goal of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes. Stress was also evaluated as a mediator of the effect of MST on adherence and metabolic control.

Methods. A randomized, controlled trial was conducted with 127 adolescents with type 1 diabetes mellitus and chronically poor metabolic control (hemoglobin A1c levels of ≥8% at study enrollment and for the past 1 year) who received their diabetes care in a children's hospital located in a major Midwestern city. Participants assigned randomly to MST received treatment for ~6 months. Data were collected at baseline and at a 7-month posttest (ie, treatment termination). Changes in diabetes-related stress, as measured with a self-report questionnaire, were assessed. Structural equation models were used to test the degree to which changes in stress levels mediated the ability of the MST intervention to improve adherence and metabolic control.

Results. In intent-to-treat analyses, participation in MST was associated with significant reductions in diabetes-related stress. Tests for moderation found no significant effects of age, gender, or ethnicity, which suggests that the intervention was equally effective in reducing diabetes stress for all participants. However, structural equation modeling did not provide support for diabetes stress as the mechanism through which MST improved health outcomes. Rather, the final model suggested that MST improved metabolic control through increased regimen adherence.

Conclusions. Intensive, home-based psychotherapy reduces diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes. Such stress reductions are important for the psychological wellbeing of a subset of youths with diabetes who are at high risk for future health complications.

Key Words: multisystemic therapy • diabetes mellitus type 1

Abbreviations: MST, multisystemic therapy • CPMC, chronically poor metabolic control • HbA1c, hemoglobin A1c

Accepted Jun 7, 2005.




This article has been cited by other articles:


Home page
 The Diabetes EducatorHome page
E. B. Fisher, C. T. Thorpe, B. M. DeVellis, and R. F. DeVellis
Healthy Coping, Negative Emotions, and Diabetes Management: A Systematic Review and Appraisal
The Diabetes Educator, November 1, 2007; 33(6): 1080 - 1103.
[Abstract] [Full Text] [PDF]