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Disability-Stress-Coping Model _Wallander _ Varni_ 1995_

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									   Quality of Life Impact of Chronic Conditions                           Psychosocial outcomes of diabetes
                                                                              Disease specific
                          Material Physical Social Emotional Productive           Impact of diabetes
                                                                                  Worries about diabetes
   Abdominal Disorders        ?    ***      **      ***         ?
   Asthma                     ?    ***      ***     ***         *                 Satisfaction with diabetes
   Cancer                     ?    ***      ***     ***         *             General
   Cardiovascular Disease     ?    *        *       *           *
   Cystic Fibrosis            ?    ***      ?       ***         ?                 General well-being
   Headaches                  ?    ***      **      **          +
   Diabetes Mellitus          ?    *        +       *           *
   Intellectual Disability    **   *        ***     ***         ***

   (Koot & Wallander, 2001)




Disability-Stress-Coping Model (Wallander & Varni, 1995)                  Adapted Disability-Stress-Coping Model
       Condition                                                          (Wallander & Varni, 1995)
      parameters

               Functional
             Independence

                  Psychological                               Child
                     Stress                                 Adjustment                                             Psychosoc
                                                                                                                    Outcome
                                      Stress
                                    Processing
                         Intrapersonal            Social
                            Factors               Factors




       Adapted Disability-Stress-Coping Model                             Adapted Disability-Stress-Coping Model
       (Wallander & Varni, 1995)                                          (Wallander & Varni, 1995)


               Condition                                                         Condition
              parameters                                                        parameters




                                                            Psychosoc           Psychological                      Psychosoc
                                                             Outcome               Stress                           Outcome




                                                                                                                               1
    Adapted Disability-Stress-Coping Model                    Adapted Disability-Stress-Coping Model
    (Wallander & Varni, 1995)                                 (Wallander & Varni, 1995)



           Condition                                                 Condition
          parameters                                                parameters




          Psychological         Mental       Psychosoc              Psychological            Mental     Psychosoc
             Stress             Health        Outcome                  Stress                Health      Outcome


                                                                                 Personal and
                                                                                 Social Factors




Example: Diabetes in Adolescents                          Sample Characteristics
                                                           Male                            207 (45.4%)
                                                           Female                          249 (54.6%)
                                                           Age                             14.8 yrs (12-19)
                                                           SES                             4.9
                                                           Age at D/                       8.6
                                                           Duration of Diabetes            6.1
                                                           HbA1c                           8.9 (5.4-15.9)
                                                           HbA1c > 9.5                     30.4%




Study Variables                                           Study Variables
    Condition                                                  Mental Health
        HbA1c                                                     Internalizing problems
        Hospitalization for dysregulation, ketoacidosis           Externalizing problems


    Psychosocial Stress                                        Personal and Social Factors
        Worries about hypos                                       Global self-worth
        Complaints due to hypos and hypers                        Diabetes-related support - parents
        Needle anxiety                                            Diabetes-related support - friends
        Daily stress                                              General support
                                                                  Parent-teen conflicts




                                                                                                                    2
Bivariate Correlations between Predictors and QL       Bivariate Correlations between Predictors and QL
Measures: Condition and Stress                         Measures: Mental Health and Personal-Social

                                     Satis- Well-                                               Satis- Well-
                        Impact Worry faction being                                 Impact Worry faction being

     HbA1c              .15     .11    (-.09) (-.07)        Internalizing          .59       .59      -.42   -.67
     Hospitalization    .21     .22    -.20   -.10          Externalizing          .37       .28      -.30   -.24

     Worries            .59     .58    -.35   -.52          Global self-worth      -.43     -.40       .43    .52
     Complaints         .62     .49    -.37   -.56          D-support, parents      .20      .16       .10   (-.07)
                                                            D-support, friends      .18      .24       (.00) (-.06)
     Needle anxiety     .38     .34    -.27   -.31
                                                            General support        -.24     -.17       .36    .26
     Stress             .34     .32    -.23   -.33
                                                            Conflicts               .37      .27      -.30   -.26




Multivariate Models for Predicting QL                        Model for Impact of Diabetes



  Impact of Diabetes (R2 = .56)        ß

    Worries about hypos                 .20
    Complaints due to hypos/hypers      .30
                                                                    Worries
    Needle anxiety                      .10                        Complaints                            Diabetes
                                                                    Anxiety                               Impact
    Global self-worth                  -.11
    Diabetes support, parents           .11
                                                                            Self-worth (-)
    Parent-teen conflicts               .11                               D-support-Parent
                                                                              Conflicts




Multivariate Models for Predicting QL                        Model for Worries about Diabetes


                                                                Hospitalization
  Worries about Diabetes (R2 =.46) ß

    Hospitalization                    .12
                                                                                      Internalizing
    Worries about hypos                .26
    Internalizing problems             .31                                                               Diabetes
                                                                     Worries
                                                                                                         Worries
    Diabetes support, friends          .11

                                                                               D-Support-
                                                                                Friends




                                                                                                                      3
Multivariate Models for Predicting QL                      Model for Satisfaction with Diabetes



 Satisfaction with Diabetes                    (R2
 =.32)                             ß

    Complaints due to hypos/hypers      -.17
    Global self-worth                    .19                                                          Diabetes
                                                                Complaints (-)
                                                                                                     Satisfaction
    Diabetes support, parents            .11
    General support                      .17
                                                                           Self-worth
                                                                        D-support-Parents
                                                                            Support




Multivariate Models for Predicting QL                      Model for General Well-Being



 General well-being (R2 = .57)           ß
                                                                                 Internalizing (-)
                                                                                  Externalizing
    Worries about hypos                 -.10
    Complaints due to hypos/hypers      -.24
    Internalizing problems              -.41                    Worries (-)                           General
                                                               Complaints (-)                        Well-Being
    Externalizing problems               .10
    Global self-worth                    .22
    Diabetes support, friends            .15                               Self-Worth
                                                                        D-Support-Friends




Conclusions                                           Conclusions
 Impact of diabetes is mainly related to condition-    General well-being is mainly related to condition-
 related stress and support                            related stress, mental health and condition-
 Worries about diabetes are mainly related to the      specific support
 severity of the condition and related stress, and     Global self-worth is important in all models
 internalizing problems                                It is helpful to use both condition-specific and
 Satisfaction with diabetes is mainly related to       generic measures
 condition-related stress and both condition-          It is helpful to use a theoretical framework to
 specific and general support                          explain differences in QL




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