title: Pathways of emotional autonomy, self-care behaviors, and depressive symptoms on health adaptation in adolescents with type 1 diabetes.
abstract: Adolescents with type 1 diabetes mellitus (T1DM) need to adapt physically and psychologically to the impact of diabetes.
  
  
  
  The purpose of this study was to examine the pathways of emotional autonomy, depressive symptoms, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels and quality of life (QoL) in adolescents with T1DM.
  
  
  
  Cross-sectional design was used in this study. Self-reported questionnaires and medical records were used to collect data from 265 adolescents with T1DM by convenience sampling in Taiwan.
  
  
  
  Structural equation modeling indicated that self-care behaviors directly positively influenced life satisfaction QoL but negatively influenced HbA1c levels. Depressive symptoms directly negatively influenced self-care behaviors and life satisfaction QoL. Emotional autonomy directly negatively influenced self-care behaviors and life-satisfaction QoL but directly positively influenced depressive symptoms.
  
  
  
  Emotional autonomy seems to be a risk factor contributing to poor health adaptation. Health care providers need to help adolescents with T1DM to balance the pursuit of emotional autonomy and health adaptation.
authors.affiliation: Administration Center of Research and Education, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Division of Endocrinology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Fu-Sung
authors.initials: FS
authors.lastname: Lo
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Bai-Hsiun
authors.initials: BH
authors.lastname: Chen
authors.affiliation: Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Lu
authors.affiliation: Department of Nursing, Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Hsin
authors.affiliation: College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan. Electronic address: wrhsia@kmu.edu.tw.
authors.forename: Ruey-Hsia
authors.initials: RH
authors.lastname: Wang
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D026684:Personal Autonomy; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires; D013624:Taiwan
keywords: Adolescents; Depressive symptoms; Emotional autonomy; Glycemic control; Quality of life; Self-care behaviors; Type 1 diabetes