title: Relationships among stressful life events and physiological markers, treatment adherence, and psychosocial functioning among youth with type 2 diabetes.
abstract: OBJECTIVE
  To examine the relationships between stressful life events and physiological measures, adherence to prescribed oral medication regimens, depressive symptoms, and impaired quality of life (QoL) in adolescents with recent-onset type 2 diabetes (T2D).
  
  
  METHODS
  Data were collected from 497 ethnically diverse participants (66% female) in the final year of the Treatment Options for Type 2 Diabetes in Adolescents and Youth multicenter clinical trial. Exposure to 32 possible events over the previous year and rating of subsequent distress were collected by self-report and summarized as a major stressors score. This score was analyzed for relationship to glycemic control (hemoglobin A1c and treatment failure), body mass index, diagnosis of hypertension or triglyceride dyslipidemia, adherence to a prescribed oral medication regimen, presence of depressive symptoms, and impaired QoL.
  
  
  RESULTS
  The total number of major stressful life events in the adolescents with T2D was calculated, with 33% reporting none, 67% reporting ≥ 1, 47% reporting ≥ 2, 33% reporting ≥ 3, and 20% reporting ≥ 4. There were no associations between the major stressors score and physiological measures or diagnosis of comorbidities. The odds of medication nonadherence increased significantly from those reporting ≥ 1 major stressor (OR, 1.58; P = .0265) to those reporting ≥ 4 major stressors (OR, 2.70; P = .0009). Significant odds of elevated depressive symptoms and impaired QoL were also found with increased reporting of major stressors.
  
  
  CONCLUSIONS
  Exposure to major stressful life events is associated with lower adherence to prescribed oral medication regimens and impaired psychosocial functioning in adolescents with T2D.
authors.affiliation: Department of Pediatrics, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO.
authors.forename: Natalie
authors.initials: N
authors.lastname: Walders-Abramson
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Venditti
authors.affiliation: Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Ievers-Landis
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Barbara
authors.initials: B
authors.lastname: Anderson
authors.affiliation: George Washington University Biostatistics Center, Rockville, MD. Electronic address: elghorml@bsc.gwu.edu.
authors.forename: Laure
authors.initials: L
authors.lastname: El Ghormli
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Geffner
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Joan
authors.initials: J
authors.lastname: Kaplan
authors.affiliation: Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Michaela B
authors.initials: MB
authors.lastname: Koontz
authors.affiliation: State University of New York Upstate Medical University, Syracuse, NY.
authors.forename: Ron
authors.initials: R
authors.lastname: Saletsky
authors.affiliation: George Washington University Biostatistics Center, Rockville, MD.
authors.forename: Marisa
authors.initials: M
authors.lastname: Payan
authors.affiliation: Department of Pediatrics, Division of Endocrinology & Metabolism, Children's Hospital Los Angeles, Los Angeles CA.
authors.forename: Patrice
authors.initials: P
authors.lastname: Yasuda
mesh_terms: D000293:Adolescent; D002648:Child; D003863:Depression / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011788:Quality of Life; D055815:Young Adult; D016903:Drug Monitoring