Relationship of self-efficacy and binging to adherence to diabetes regimen among adolescents.

OBJECTIVE: To test the hypothesis that poorer adherence to diabetes care is related to four variables associated with self-concept in adolescents with diabetes: self-esteem, self-efficacy, depression, and binging behavior. In addition, we expected adolescent females to be less adherent to diabetes care. RESEARCH DESIGN AND METHODS: We recruited 193 consecutive patients (aged 13-18 yr) with insulin-dependent diabetes mellitus during their regular quarterly visit to a diabetes clinic in a large urban hospital. Participants completed the Rosenberg Self-Esteem Scale, the Children's Depression Inventory, an assessment of the frequency of binging in the past 3 mo, and parallel forms of an adherence scale and a self-efficacy scale that were developed for use in this study. RESULTS: Adolescents who reported lower adherence tended to report lower self-esteem (r = 0.45, P less than 0.001) and self-efficacy (r = 0.57, P less than 0.001), more depressive symptoms (r = -0.50, P less than 0.001), more binging (r = -0.36, P less than 0.001), and had higher HbA1c (r = -0.24, P less than 0.001) than those with higher adherence scores. Together, the psychological variables accounted for 50% of the variance in adherence. There was no sex difference in reported binging, but, as expected, adolescent females reported less adherence overall (F[7,184] = 2.5, P = 0.018). CONCLUSIONS: Treatment adherence in adolescents with insulin-dependent diabetes mellitus is associated with behavioral and psychological variables. These findings suggest that specific behavioral and cognitive interventions could be used to improve adherence in those individuals who lack confidence in their ability to perform diabetes-related tasks.

Influence of functional impairment and social support on depressive symptoms in persons with diabetes.

Tested the buffering model of social support among 158 adults with diabetes. We predicted that, among patients with higher levels of illness-related impairment, adequate social support would act as a buffer against depression. Measures included the Beck Depression Inventory; the Sickness Impact Profile; and an assessment of the adequacy of social support to enable the patient to deal with illness-related tasks, domestic chores, financial responsibilities, and emotional needs. Depressive symptoms correlated positively with functional impairment (r = .58, p less than .001) and negatively with the adequacy of social support (r = -.31, p less than .001). In addition, social support moderated depression in the face of greater impairment such that, among patients who reported the most illness-related functional disabilities, adequate support provided a relative protection from depression. The findings suggest that individuals with inadequate support are most at risk to become depressed when disability related to illness increases.

When a child dies: the sociobiology of bereavement.

According to modern evolutionary theory, the fitness of individuals consists of both their personal reproductive success and the reproductive success of those with whom they share genes in common. It follows that one of the most biologically costly events possible is the death of a child. This study investigated the grief intensity of bereaved parents and their immediate families using ratings made by 263 bereaved parents. Predictions were derived from sociobiological tenets relating to parental investment, paternal uncertainty, and the propagation potential of both parents and children. Consequently, it was found that mothers grieved more than fathers, healthy children were grieved for more than unhealthy children; male children were grieved for more than female children; health of child and sex of child interacted such that the pattern of grief intensity obtained was healthy male greater than healthy female = unhealthy female = unhealthy male; similar children were grieved for more than dissimilar children; maternal grandmothers grieved more than either maternal grandfathers or paternal grandmothers, who in turn grieved more than paternal grandfathers; and mothers' siblings grieved more than fathers' siblings.

Stress, social support, and symptoms of depression in spouses of the medically ill.

This study investigated the level and frequency of depressive symptoms in spouses of dialysis patients, as a function of a) severity of patient disease, b) level of stress experienced by the spouse, and c) perception of support from the ill partner. The subjects were forty patients who had begun dialysis in the last year and their spouses. Measures of depression, impact on family, perceived social support, and disease severity were applied. Significant depressive symptoms were reported by 20 percent of spouses. Symptom severity was not correlated with age, sex, or occupation of the spouses, nor with level of depression or functional impairment of the dialysis patients. The amount of social support received from the ill partner accounted for 37 percent of the variance in spouse depression, while social and financial stressors reported by the spouse explained 13 percent of the variance in spouse symptoms. These findings suggest that depressive symptoms in spouses of dialysis patients are associated with the social and economic consequences of the illness for the family but even more so with the amount of perceived support from the patient. The determinants of this perceived support need further exploration.

Gene-culture coevolution of complex social behavior: human altruism and mate choice.

The hypothesis is examined that genes bias the development of complex social behavior in one direction over alternatives. Studies of altruism and political attitudes in twins estimate that approximately 50% of the variance is associated with direct genetic inheritance, virtually 0% with the twin's common family environment, and the remainder with each twin's specific environment. Studies of human marriages show that spouses choose each other on the basis of similarity, assorting on the most genetically influenced of a set of homogeneous attributes. These data imply a genetic canalization of social influences such that, within the constraints allowed by the total spectrum of cultural alternatives, people create environments maximally compatible with their genotypes.