Health psychology: the psychological impact of managing and treating type-1 diabetes for children

Type-1 Diabetes Mellitus (T1DM) is a complex chronic illness which requires intensive insulin replacement treatment via Multiple Daily needle Injections (MDI) or Continuous Subcutaneous Insulin Injections (CSII). Both treatment options cause significant disruptions to the lives of diagnosed children and their families, and are difficult to integrate with everyday life. To improve one’s quality of life and minimise treatment disruptions as well as medical outcomes, consideration of the psychosocial functioning of children with T1DM becomes an important issue. This thesis is presented in the form of two stand-alone pieces of work. The first is a systematic review of quantitative research investigating the psychosocial impact of transitioning to CSII for children. Studies that met the inclusion criteria investigated a range of constructs, indicative of a diverse area of research. Such constructs included child cognitive and emotional functioning, quality of life, impact of treatment, eating patterns, as well as parental and family functioning. Overall published research indicated a trend toward a neutral or positive psychosocial impact of transitioning to CSII for children. In summary, the use of CSII in children appears to be supported by improvements in psychosocial factors in addition to small yet significant medical benefits. The second study used a qualitative approach to understanding the impact of T1DM and its treatment from the child’s own perspective. This approach sought to expand the range of issues addressed and build on current quantitative findings that typically investigate specific variables of interest selected by the researcher. Qualitative interviews, with 17 children (aged 7 to 15) at two different time points in their treatment, sought to holistically understanding the child’s experience of T1DM and the experience of the transition from MDI to CSII. Interviews were analysed using Grounded Theory coding (Glaser, 1979; Strauss & Corbin, 1990), leading to the developmental of the Transitional Stages Model of Treatment and Coping. This model describes key stages of transition and adaptation for children starting with the onset of undiagnosed, vague symptoms. Of particular interest within this model were shifts in the embodiment and interpretation of one’s own bodily cues at each of these stages. Further, children did not seem to strive toward ‘normality’ or autonomy as treatment goals. Instead it was important for children with T1DM to feel supported in a network termed the distributed system of management, involving parents, teachers, peers and technology. Implications for clinical practice and opportunities for psychological intervention are also discussed.