Adolescents And Their Coping Strategies In Diabetes Psychology Essay

Adolescence can be a difficult time when persons have to be confronted with several developmental tasks such as increase autonomy from parents and mounting peer interaction. (Luyckx et al. 2010, 1424 -1429). Adolescence is characterized by speedy biological, physical, cognitive, emotional, and societal transformations. (Grey 2011, 70). Being diagnosed with type 1 diabetes compels numerous supplementary burdens on the young person, occupying all facets of his or her life. (Luyckx et al. 2010, 1424 -1429). Teenagers take on experimen­tation and thrill-seeking attitudes that could negatively have an effect on self-care and medical outcomes. Preceding studies have come up with the deduction that the phase of teenage years is frequently related with disregard of self-monitoring, nourishment treatment recommendations, and pharmacological treatments. (Grey 2011, 70).

Adolescents with type 1 diabetes are confronted with a multifaceted set of growth changes the same altering hassles of the disease. Modification predicament may mutually influence emotional welfare and the track of the disease by contributing to reduced self-management and improper metabolic control. While coping skills are fundamental for emotional and community maturity in the midst of youthful people as an entity, youngsters with diabetes 1

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are confronted with supplementary demands. (Graue et al. 2004 1313).

According to Weinberger et al 2005 during adolescence the prefrontal cortex, the area in the brain in charge of verdict, way of thinking, resolution making, and problem solving, is still growing, which may elucidate the reason behind young people inappropriate reaction to multifarious diabetes self-management situations.

Life transitions are critical times of transformation, which augments stress and have an effect on analytical and coping skills. Changeovers connected stressors consist of moving out of home, commencing study, starting new relationships and the labor force and parenthood

Changes in life patterns influence diabetes supervision and frequently necessitate intricate decisions and are worsened by the expectations and reactions of others, not leaving out health professionals. (Rasmussen et al. 2010 1981-1982). Diabetes supervision needs a whole lot of self-discipline and is considered as being extremely demanding. As a result

Several studies imply that adolescents with diabetes are at a bigger menace than their fit peers for rising psychosomatic symptoms. (Graue et al. 2004, 1313; Luyckx et al. 2010, 1424). Consequently, this section shall briefly examine the coping strategies of adolescents and what can be done to further motivate them in taking through this courageous part thereby enhancing better glycemic control, better metabolic control and as a result efficient self-management.


Coping styles refer to characteristic, routine preferences for habits of handling troubles and may be considered as strategies that people usually employ to manage across an extensive choice of stressors. (Graue et al. 2004, 1313). Coping is a difficult procedure that can be defined as “continually altering cognitive and behavioral efforts to deal with precise outer and/or inner burdens that are seen as overbearing beyond the limits of the person.” The primary phase in coping is cognitive appraisal. After weighing the state of affairs, persons know how to imple­ment coping strategies to diminish suffering or handle the crisis. (Grey 2011, 71).Problem-focused coping refers to efforts made towards handling the issue at hand, rationally and it is meant at altering the circumstances causing anguish. While Emotion focused coping implies efforts to diminish emotional suffering caused by the demanding happening and to deal with or adjust emotions that may go with or act as a consequence from the stressor. In young people with diabetes, avoidance coping and venting emotions have been established to forecast reduced illness-specific self-care activities nevertheless were not linked to metabolic control. Contrarily, habits of coping with stress have also been acknowledged as an essential feature as far as metabolic control is concerned. (Graue et al. 2004, 1313).

Using coping skills training for youths with type 1 diabetes is based on the supposition that ameliorating coping skills could perk up young peoples’ aptitude to deal with the troubles they encounter on a every day in handling diabetes. Adolescents who are given coping skills training have lower A1C levels, better diabetes self-efficacy, and less agony about coping with their diabetes than young people getting intensive management only. More so, adolescents who receive coping skills training can effortlessly handle their diabetes and thus expe­rience less of a harmful impact from diabetes on their quality of life than those who do not get the training. In male participants, coping skills training did not influence unfavorable consequences such as hypoglycemia, diabetic ketoacidosis, or weight gain, but in female participants, coping skills training decreased the incidence of weight gain and hypoglycemic episodes. (Grey 2011, 72).

Another way of helping young people cope is through the use of Social problem solving. This is a process whereby individuals learn to think through the steps of having a problem and arriving a decision about how to deal with that problem. The process equally helps each and everyone to look at all possible outcomes of situations and the subsequent consequences of their decisions. This is very useful for adolescents when they are confronted with peer or fam­ily pressures or any situation in which they are faced with an uncompromising situation like being diabetic. (Foreman 1993).

Six main problem-solving steps have been identified:

1) First and foremost identifying the problem.

2) Determining what goals one wants to achieve.

3) Gener­ating and seeking alternative solutions.

4) Examining the consequences of what the act could lead to.

5) Choosing the solution to the problem.

6) Lastly evaluating the outcome of the decisions. (Foreman et al.1990,69).

A study done from April 2000 till January 2000 which was approved by the regional ethics committee and performed according to the Declaration of Helsinki; covered a cross sectional survey where coping styles were assessed by the following subscales. (Graue et al. 2004, 1314).

Active coping : they take direct action to get around the problem;

Planning: they make a plan of action which they try to follow.

Seeking social support for instrumental reasons: this involves being advised by someone who is versed with the subject about what to do.

Seeking social support for emotional reasons: sharing and discussing one’s feelings with someone thereby getting reassurance and feeling much better after.

Behavioral disengagement: admitting to one’s self that the situation is impossible to deal with, and quit trying. This is a very escapist tendency; unfortunately it happens to be a way of coping for some adolescents.

Mental disengagement: switching activities to take the mind off things; thereby getting the utmost distraction from the subject at hand. (Carver et al.1989,270).

Three subscales from other coping style scales; according to Vitaliano et al. (15) suggest the following coping strategies:

Accepting responsibility: realization that the problem has been brought upon by them.

Aggressive coping: getting irritated and unbearable.

Self-blame: Thinking it is entirely one’s fault.

Previous research initially involving a total of 116 adolescents and further cut off to 113 all between the ages of 13 and 18 ,inclusion criteria being onset of diabetes before age 15, and being diabetic for at least 1 year. It demonstrated that children and adolescents with diabetes differ considerably depending on their ages and in their methods of coping with the diseases. Younger ones mostly coped by expressing feelings through yelling and arguing, whereas the older ones mostly coped by using the avoidance behavior. (Graue et al.2004, 1314).

According to Hanson et al. though poor adherence to treatment often has been linked with developmental problems in adolescence, poor adherence to treatment is mostly caused by the incapability to adapt to coping styles rather than age. It has been demonstrated that strategies that increase the adolescents’ ability to cope with. Both psychosomatic and metabolic adaptation could be prejudiced by those methods that boost the young peoples’s coping capabilities with the illness. (Thuen and Bru, 20).

Following research findings, the next phase of Coping is going to illustrate on the fact that Young people and adolescents would cope and manage T1DM better if they have enough support from these three main sources. Namely support from school, peer support and parental or family support. (Yueh-Ling et al.2010, 258).


Research has given enough evidence to show that schools play a fundamental part in young peoples’ diabetes management. Research have equally gone a long way to prove that enhanced school-based diabetes heed for adolescents is equal to improved diabetes supervision and quality of life (Wagner, Heapy, James and Abbot 2006,766). For numerous youngsters, school is a dominant power in their lives as most of their time revolves around it. Recently, a literature review came up with the result that school connectedness accounted not only to adolescents’ academic performance but also to their health and welfare.(Waters, Cross, and Runions 2009,519).

It is rather unfortunate that, previous studies have demonstrated that many schools do not make available sufficient support for students with T1DM. In many situations, school staff did not have enough mastery of the disease and were not sufficiently taught.(Amillategui et al.2007,1074 ).In some cases the healthy foodstuff provided by the school was limited, some school rules were not flexible thereby intruding with the personal supervision of the young people. Furthermore, teenagers felt stigmatized or discriminated upon by the school staff. (Hayes -Bohn et al.2004, ).

Many uncomfortable situations may arise at school. Increased sensitivity to peer responses can affect the adolescents’ perceptions of diabetes, their emotions are ampered with, and their diabetes self-management behaviors. They may feel embarrassed, or angry when people pay attention to them or ask too many sensitive questions, and they don’t like to be made fun of. When they are faced with these embarrassing situations their very first move is the use of avoidance strategy. For example, the adolescents may want to keep diabetes a secret or try to minimize drawing attention to diabetes self-management-related behaviors. These avoidance behaviors makes them feel comfortable emotionally, while physically, it is detrimental to their health and affect their diabetes self management as well. The boy described how he skipped testing his blood glucose because of social pressure. As the lone health professional at schools, school nurses should ardently construct their professional competencies in diabetes care and show competence in both caring for diabetic students, and educating school colleagues and the student body about T1DM and its management. (Yueh-Ling et al.2010, 260).


Peer relationship development is a complex issue for adolescents who have type 1 diabetes. (Grey 2011, 70).

Despite the fact that, adolescents are developing autonomy and independence, they test their limits through experimental behavior for the formation of their self identities. This is mostly achieved by being part of a peer group, or being allowed into one. Hence peer relationships becomes of ultimate importance and value to them thereby making them very conscious of peer perspectives and peer acceptance (Simpson, 2001). The interplay between these multiple developmental transformations makes adolescence a time of dynamic change. Adolescents are faced with the battle of finding a balance between their

needs as they mature, and diabetes self-management requirements (Sayer et al., 1995). Early adolescents want to be looked upon, the same as their peers rather than be treated in a different manner. The fear of rejection by their peer group and exclusion from peer activities is so domineering that they may make adolescents unwilling to divulge their diagnosis. This fear constantly causes adolescents to deliberately miss blood glucose monitoring and insulin injections or boluses, in addition to that, they consume inadequate foods without taking the appropriate insulin, all of the above mentioned are linked with a decline in metabolic control. (Grey 2011, 70).

It is a dilemma for adolescent diabetes sufferers to reveal their illness. Perhaps, deciding to do so, may enhance their peers to be even more conscious and sensitive to their wants, and lend their support if need be. That is putting on the line the fact that, ignorant and childish peer reaction may hurt their emotions and harm their ego. For this purpose, researchers propose that, adolescents and parents should cautiously contemplate who to tell, what to tell, when to tell, and how and how much to reveal concerning the disease to protect the adolescent’s mental and physical safety. (Davidson et al.2004,74).

Although it has has been demonstrated by research that friends furnish important emotional backup to adolescents with diabetes, many adolescents show scepticism as regards friends’ reactions to their diabetes-related self-management tasks and procedures. (Grey 2011, 70).

Diabetes education should therefore be introduced in schools to change the magnitude of peer understanding of adolescent diabetes sufferer conditions and needs.

(Amillategui et al. 2007, 1079).


Family is the primary focus when it comes to provide support to the diabetic adolescents. Family members are the ones who are most likely to assist with day-to-day demands. Family members are most likely to advise or influence a child with diabetes around issues of disease management and general healthcare. In addition, they represent a model for health behavior, including diet, exercise, and interactions with the healthcare team.

Family dynamics have been shown to have an impact on diabetes management and metabolic control in children and adolescents. Analise Psicologica (1998,101-113) mentioned that family members, particularly parents, are likely to serve as primary sources of support for adolescents with diabetes. Indeed, studies have found that adolescents with supportive, cohesive families have better disease management and glycemic control. Parents of adolescents with type 1 diabetes are involved in a challenging transition: the transfer of primary responsibility for diabetes management from themselves to their children. The ways in which parents are involved (performing tasks, making decisions, providing support, and communicating) would be beneficial for health care professionals too. Providing support to adolescents is one way that parents can be involved while still promoting their adolescents’ development of diabetes management competence and responsibility. Also it has been mentioned that, adolescents report that parents provide more support for diabetes management tasks than do friends. (Kathleen, M. 2003, 184-187).

Involvement from the family in diabetes care can be very helpful in sustaining a healthy lifestyle; however, it is clear that not all kinds of family involvement in diabetes care are helpful. Nowhere is this more evident than with youths with diabetes and their families. For adolescents with diabetes, the involvement of family in diabetes management is even more precarious. By the nature of adolescent development, youths desire greater independence from their parents. (Harris, M 2006).


Being diagnosed with diabetes and living with diabetes can feel overwhelming and stressful from both physical and psychological point of view. Psychological distress directly affects health and indirectly influences a person’s motivation to keep their diabetes in control. When motivation is dampened, the commitments required for effective self-care are difficult to maintain. (AADE, 2012). Every individual reacts differently after being diagnosed by diabetes. Some need more help in coping with psychological stress while some might need more help in coping with lifestyle management. Proper diet and nutrition, regular blood glucose-monitoring, exercise and weight management as the basic rules to follow when it comes to diabetes. In addition, psychological therapies can support an individual in coping strategies. (Delamater, M. 2001, 1286-1292)

However, maintaining the routine and changing lifestyle is always challenging for adolescents. As, living with a disease declines the level of confidence among the adults, educating them how to cope with diabetes is the responsibility of health care providers.(AADE, 2012). There are various factors, which can be applied in coping strategies. The factors mentioned above are found to be common and helpful in coping with diabetes.

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