A Biopsychosocial Approach to the Onset of Childhood Diabetes

Abstract: This thesis is a part of a prospective multi-centre study concerning psychosocial aspects of importance for the onset and course of insulin-dependent diabetes mellitus (IDDM). The investigated population was all children with onset of IDDM in the participating clinics during 1988 and 1989. Of 79 diseased children, 67 participated in the study. To each child a healthy control child was chosen, 61 accepted to participate. Data was collected by interviews and self-report questionnaires at the first hospital admission, two months after onset, and at the end of the first year. Many of the instruments were designed and/or tested for reliability and validity, as the network map and the crisis questionnaires. The children with diabetes had experienced a higher life stress than the control children, especially during their first two years of life. Some more case children had shown behaviour symptoms before onset than the control children. These facts support the hypothesis that stress might interact with autoimmune mechanisms during the development of the disease. There were insignificant differences between the cases and controls regarding social support and family function. The children did not differ from a normal population by psychological assessment. Most parents reacted with strong to moderate distress at the onset. The children showed lesser reactions than the parents. During the first year, most families adapted well to the disease. A pattern with injection anxiety but low general distress at onset for children and mothers was associated with a better metabolic control during the first two years.