The relationship between parent-child metacognitions, attitudes towards diabetes, psychological resilience, and depression-anxiety in adolescents with diabetes

Chronic diseases are health problems that cannot be completely cured, often requiring long-term follow-up and treatment, and cause a deterioration in an individual's daily functionality and quality of life. Advances in the treatment options for childhood diseases have increased survival rates, leading to an extension of the duration individuals will live with the disease. Today, the increasing prevalence of diabetes and its negative impact on quality of life have made it more important worldwide. The psychological effects of chronic diseases on children are often not given due attention. In diabetes, the primary focus tends to be on monitoring blood sugar levels and complications. However, studies have shown that the psychological state of adolescents affects their adaptation to diabetes and their active participation in the treatment process. In our study, we aimed to investigate the relationships between higher-order cognitive beliefs, attitudes, psychological resilience, and levels of depression-anxiety in adolescents diagnosed with diabetes, in order to create early intervention opportunities for psychological impacts. METHOD The sample of the study consists of adolescents diagnosed with diabetes who applied to the Pediatric Endocrinology Clinic of Pamukkale University Faculty of Medicine, as well as adolescents who have not been previously diagnosed with any chronic disease. The study included 62 adolescents diagnosed with diabetes and 60 healthy volunteer adolescents, aged between 12 and 18 years. The volunteers included in the study filled out the following scales with the researcher's assistance: The Child's Attitude Towards Their Illness Scale (CATIS), MetaCognitions Questionnaire for Children (MCQ-C), Revised Child Anxiety and Depression Scale-Child Form (RCAD-C) and Child and Youth Psychological Resilience Scale-12 (CYPRS-12). The control group, included in the study, filled out the scales, except for the CATIS, with the researcher's assistance. The parents of the included volunteers filled out the Meta-Cognitions Questionnaire-30 (MCQ-30) with the researcher's assistance. In addition, a detailed sociodemographic data form was filled out by the researcher through face-to-face interviews with the parents. FINDINGS As a result of our study, no significant difference was found between young people diagnosed with diabetes and young people in the control group in terms of the levels of positive beliefs about worry (p=0.624), negative beliefs about worry (p=0.302), superstitious, punishment and responsibility beliefs (p=0.442), cognitive monitoring (p=0.920) and total score (p=0.923), psychological resilience (p=0.492), depression (p=0.0456) and anxiety (p=0.289). The scores of the parents of young people diagnosed with diabetes on the Positive Beliefs About Worry (p=0.013) and Beliefs about the need to control thoughts (p=0.036) subscales of the MCQ-30 were found to be higher than those of the control group parents. In young individuals diagnosed with diabetes, attitudes towards diabetes were found to be positively correlated with psychological resilience (p=0.000). Attitudes towards diabetes were found to be negatively correlated with depression (p=0.000) and anxiety (p=0.000) levels, as well as with MCQ-30 including positive beliefs about worry (p=0.003), cognitive confidence (p=0.022), beliefs about the need to control thoughts (p=0.022), and the total score (p=0.006). Additionally, negative beliefs about worry on the MCQ-C (p=0.002), superstitious, punishment and responsibility beliefs (p=0.001), cognitive monitoring (p=0.026), and the total score (p=0.000) were also negatively correlated. The level of psychological resilience was found to be negatively correlated with depression (p=0.000) and anxiety (p=0.000) symptoms, as well as with positive beliefs about worry (p=0.029), negative beliefs about worry (p=0.009), superstitious, punishment and responsibility beliefs (p=0.037), and the total score (p=0.019) on the MCQ-C. A positive correlation was observed between depression levels and the positive beliefs about worry (p=0.002), cognitive confidence (p=0.007), beliefs about the need to control thoughts (p=0.004) and the total score (p=0.005) on the MCQ-30, as well as with positive beliefs about worry (p=0.007), negative beliefs about worry (p=0.000), superstitious, punishment and responsibility beliefs (p=0.000), cognitive monitoring (p=0.000) and the total score (p=0.000) on the MCQ-C. A positive correlation was observed between anxiety levels and the positive beliefs about worry (p=0.008), cognitive confidence (p=0.001), beliefs about the need to control thoughts (p=0.001) and the total score (p=0.002) on the MCQ-30, as well as with positive beliefs about worry (p=0.008), negative beliefs about worry (p=0.000), superstitious, punishment and responsibility beliefs (p=0.000), cognitive monitoring (p=0.001) and the total score (p=0.000) on the MCQ-C. Additionally, a positive correlation was observed between the beliefs about the need to control thoughts score on the MCQ-30 and the superstitious, punishment and responsibility beliefs (p=0.003), and the total score (p=0.006) on the MCQ-C. Furthermore, a positive correlation was found between the total score on the MCQ-30 and the total score on the MCQ-C (p=0.020). Although the HBA1C levels in young individuals diagnosed with diabetes were lower in those with a more positive attitude, this difference was not statistically significant (p=0.299). CONCLUSION In conclusion, our study is important in terms of examining the relationship between metacognition, attitudes towards diabetes, psychological resilience, and depression-anxiety levels in adolescents with diabetes. Our study may contribute to the literature by highlighting the relationship between psychological state and metacognition, attitude, and psychological resilience in adolescents diagnosed with diabetes, and by providing guidance for early intervention studies in this field. Keywords: Attitude towards chronic ıllness, metacognition, depression, anxiety, psychological resilience