Tıp 1 dıyabetes mellitus tanısı olan ergenlerde yatışı olan ve olmayan hastaların benlik saygısı ve aile tutumlarının karşılaştırlması

Abstract

Introduction: Type 1 Diabetes Mellitus (T1 DM) disease as one of the most common chronic diseases known in children and adolescents and therefore represents important health problems in this population. Children and adolescents who was diagnosed with T1DM, the disease should be approached as a whole, and the psychological status, adaptation difficulties and attitudes of the patients and their caregivers, which significantly affect the treatment compliance, should be evaluated as well as the physical dimension. We aimed to assess self-esteem and parenting attitudes in Type 1 DM children and adolescent patients with and without treatment compliance. Subjects and Methods: The ethics committee approval of the study is obtained, then the study was carried out descriptively in pediatric endocrinology clinics of Bezmialem Vakıf University hospital, 40 T1DM diagnosed children and adolescents aged 12-18 years, who has hospitalization for DM compliance problems accepted to participate in the study were chosen as study groups and 38 children and adolescents who were followed up with a diagnosis of T1DM without hospitalization in pediatric endocrinology outpatient clinic and accepted to be included in the study were selected as the control group. After obtaining the informed consent form for both groups, a data collection form including sociodemographic information was filled by the researcher. In the psychiatric evaluation, the diagnoses were made by the researcher in the Schedule for Affective Disorders and Schizophrenia for School Aged Children Kiddie-SADS-lifetime Version (K-SADS-PL) semi-structured interview, and the participants were also asked to fill in the Parental Attitude Scale and the Coopersmith Self-Esteem Inventory. Results: The age and gender of the patients in the case and control groups of our study did not differ significantly (p> 0.05). The mean age at diagnosis was found to be 8.5 ± 4.1 in the case group and 10.6 ± 3.1 in the control group, and as a result, the age of diagnosis in the case group was found to be significantly lower than the control group (p = 0.023). In this study, the mean last HbA1c levels of the case group were 9.4 ± 2.1 and the mean last HbA1c value of the control group was 7.6 ± 1.2, and this value was found to be statistically significantly higher in the case group (p<0.001). K-SADS-PL-DSM-5 semi-structured psychiatric evaluation results were determined as more depression diagnosis, Generalized Anxiety Disorder and Social Phobia diagnosis in the case group (depression p <0.001), (generalized anxiety p<0.001), (social phobia p = 0.011). It was determined that 76.2% of the mothers in the case group showed democratic attitude and 23.8% authoritarian attitude. In this group, the attitude of fathers is 69.0% democrat and 31.0% authoritarian. In the control group, 92% of the mothers were democratic and 7.9% were authoritarian, 84.2% of the fathers were democratic and 15.8% were authoritarian. Comparison of groups showed that authoritarian parental attitude was significantly higher in the case group (Mother Democrat p = 0.006), (Father Democrat p = 0.023). Looking at the mean scores distribution of the sub-dimension of the Coopersmith Self-Esteem Inventory, the self-esteem and general scores of the case group participants were found to be significantly lower than the control group, and similarly, the home-family self-esteem score showed a significant difference (full score p = 0.007), (overall score p = 0.048 ), (family home score p = 0.002). Conclusion: In our study, the relationship between poor metabolic control and inappropriate treatment compliance of T1DM in child and adolescents with their low self-esteem and authoritarian attitude of their parents has been determind. In addition, the high rates of pshychiatric disorders which determined in the study group with poor metabolic control show that T1DM is not only a physical disease, but also negatively affects the psychological, social and emotional functionality of the individuals. Keywords: Type 1 diyabetes mellitus, self steem, authoritarian parentin style, pscychiyatric disorders