BioMed Research International
Volume 2019 (2019), Article ID 6821575, 10 pages
https://doi.org/10.1155/2019/6821575

Research Article

Assessment of Psychosocial Functioning of Mothers of Children with Diabetes Mellitus Compared to Mothers of Healthy Children

Marta Makara-Studzińska,¹ Siva Somasundaram,² Ghulam Md. Ashraf,³ Małgorzata Gogacz,⁴ Agata Madej,⁵ Bernadetta Izydorczyk,⁵ Jerzy Leszek,⁶ Svetlana A. Lebedeva,⁷ Vladimir N. Chubarev,⁷ Vadim V. Tarasov,⁷ Eric Kirkland,⁸ and Gjumrakch Aliev7,9,10

¹Health Psychology Unit, Collegium Medicum, Jagiellonian University, Kraków, Poland
²Department of Biological Sciences, Salem University, Salem, WV 26426, USA
³King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
⁴Department of Applied Psychology, Medical University of Lublin, Poland
⁵Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
⁶Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
⁷Sechenov First Moscow State Medical University (Sechenov University), 119991, Moscow, Russia
⁸School of Education & Business, Professor and Vice President, Salem University, WV, 26426, USA
⁹Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, 142432, Russia
¹⁰GALLY International Biomedical Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX, 78229, USA

Correspondence should be addressed to Gjumrakch Aliev; aliev03@gmail.com

Received 20 December 2018; Revised 10 February 2019; Accepted 19 March 2019; Published 9 April 2019

Academic Editor: Takashi Yazawa

Copyright © 2019 Marta Makara-Studzińska et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Diabetes mellitus (DM) is a chronic disease requiring changes in the behaviour of the entire family. The responsibility for implementing doctor’s recommendations falls mainly upon the mother. The aim of this study is to assess the psychosocial functioning of mothers of children with DM compared to mothers of healthy children. The study involved 120 mothers: 60 with children with DM and 60 with healthy children. Data were collected using an original social-demographic questionnaire developed by the authors as well as Antonovsky’s Sense of Coherence Scale (SOC-29), Schwarzer and Schultz’s Berlin Social Support Scales (BSSS), Rosenberg’s Self-Esteem Scale (SES), and Zigmond and Snaith’s Hospital Anxiety and Depression Scale (HADS). The assessment scales were standardised and accredited by the Polish Psychological Association. The results suggest that DM in children has no effect on the psychosocial functioning of mothers regarding their self-esteem and sense of coherence. However, mothers of children with DM are well-prepared for living in a difficult situation. Social support offered to mothers of diabetic children helps them to maintain their psychosocial health.

1. Introduction

It has been reported that about 1400 children in Poland were diagnosed with diabetes mellitus (DM) in 2012[1]. DM is a chronic metabolic disorder characterised by deficiency of insulin or insulin action leading to hyperglycaemia. The causative factors include genetic disorders and influence of the external environment, which can cause an insufficient insulin level or insulin resistance [2]. The World Health Organization (WHO) distinguished two classifications of DM.

(i)Type 1 (T1DM) is insulin-dependent and commonly first diagnosed in childhood or puberty.(ii)Type 2 (T2DM) is insulin-independent and mainly affects individuals over 30 years of age [2].

In the past, DM was classified as one of the greatest global health issues. The United Nations considers it a disease of civilization. It was classified as one of four globally relevant noncommunicable diseases that most afflict mankind worldwide [3, 4]. A child suffering from T1DM requires long-term care that entails considerable on-going effort and sacrifice on the part of the entire family [5–7]. Diabetologists recommend that effective treatment of DM depends on effective education of caregivers to implement the comprehensive treatment that is necessary to maintain the child’s health. This care involves regular attention by medical specialists, nurses, psychologists, and dietitians [8]. Mothers play a centrally important role in managing the health care of diabetic children [9–11].

To be successful, mothers need to adapt to the needs of their children for holistic care. As but one example, many children with DM suffer from sleep disorders due to their strong emotions surrounding the disease and its progression [9–11]. Lustman et al. established that daily health-maintenance activity related to the disease constitute a burden for both the mother and the child [12]. Some recommend the parents, especially mothers, need to adopt a specific form of nurturing mother-child relationship.

According to Wojciechowska et al., parents’ involvement in the treatment should focus on engagement and care within the family unit as a collaboration of partners [13]. The mother must set specific goals for herself and appropriate tasks to be performed by the child (e.g., learning how to do blood testing for glucose levels on their own, developing health-promoting habits, and preventing complications). The mother also must monitor and evaluate her own and her child’s compliance with treatment plans and achievement of specific goals.

DM also affects the perceived quality of life across the spectrum of mental, physical, and social areas of life and development. The concept of quality of life involves the child’s health, physical functioning, well-being, satisfaction with life, and psychosocial adaptation [14].

The specific aim of this study is to assess the psychosocial functioning of mothers of diabetic children, compared to mothers of healthy children. The study involved 120 female participants, 60 of whom were taking care of children with diabetes compared to 60 with healthy children.

2. Materials and Methods

2.1. Study Group and Research Procedure

This project was approved by the Bioethical Committee of the Medical Institute in Lublin (Poland) no. KE-0254/123/2013. The study involved 120 female participants. A study of 60 mothers of diabetic children was conducted by the Professor Niewiedzioł’s Support Group for Children and Adolescents with DM in Lublin between the years 2013 and 2015. The study of 60 mothers of healthy children was conducted in a nursery and a school.

The experimental group comprised mothers of diabetic children; the control group comprised mothers of healthy children. Respondents were informed of the research objective and were promised anonymity. They were assured that the findings would be used solely for scientific purposes. All participants completed informed consent forms.

2.2. Research Tools

Data were collected using an original social-demographic questionnaire developed by the authors as well as Antonovsky’s Sense of Coherence Scale (SOC-29), Schwarzer and Schultz’s Berlin Social Support Scales (BSSS), Rosenberg’s Self-Esteem Scale (SES), and Zigmond and Snaith’s Hospital Anxiety and Depression Scale (HADS). The assessment scales were standardised and accredited by the Polish Psychological Association.

2.2.1. Original Social-Demographic Questionnaire

The questionnaires were completed individually in private. Demographic questions included the participant’s age, place of residence, education, marital status, and source of income, as well as the sex and age of the child with T1DM (Tables 1(f) and 1(g)). Other questions pertained to problems encountered placing the child in day care, nursery, or school; the impact of the disease on learning; disease duration; alarming symptoms noticed before the diagnosis; the necessary care for the child as well as whether the child has and uses an insulin pump or the reasons for not having and using one. Some questions pertained to the mother’s reflections on changes in her circumstances and behaviour after the child was diagnosed with DM. For example, the change of material conditions (insulin is expensive), the amount of time spent with the family, changes in relations with the partner since the child’s diagnosis, and the group of people supporting the mother.

Table 1

(a) The age Factor of Mothers

The age Factor
N
Min
Max
Median
Mean
SD

The mothers of diabetic children
60
29
60
40
40.73
7.24

The mothers with healthy children
60
27
56
41
41.63
6.65

(b) The Place of Residence

Place of residence
Participants

The mothers of diabetic children
The mothers with healthy children

N
%
N
%

Village
8
13.3
14
23.3

City up to 25 thousand inhabitants
6
10.0
8
13.3

City 25-100 thousand inhabitants
12
20.0
29
48.3

City over 100 thousand inhabitants
34
56.7
9
15.0

Total
60
100.0
60
100.0

Chi Sq. P < 0.001

(c) Education of Mothers

Education
Participants

The mothers of diabetic children
The mothers with healthy children

N
%
N
%

Primary education
0
0.0
1
1.7

Vocational education
3
5.0
5
8.3

Secondary education
22
36.7
12
20.0

Higher education
34
56.7
42
70.0

Other
1
1.7
0
0.0

Total
60
100.0
60
100.0

Chi Sq. P < 0.2

(d) The Marital status of Mothers

Marital status
Participants

The mothers of diabetic children
The mothers with healthy children

N
%
N
%

Unmarried
0
0.0
2
3.3

Married
50
83.3
54
90.0

Widow
2
3.3
0
0.0

Divorced
6
10.0
4
6.7

Free relationship
2
3.3
0
0.0

Total
60
100.0
60
100.0

Chi Sq. P < 0.2

(e) The source of income of Mothers

The source of income
Participants

The mothers of diabetic children
The mothers of healthy children

N
%
N
%

Economic activity
11
18.3
5
8.3

Professional work
36
60.0
52
86.7

Pension
5
8.3
0
0.0

Old-age pension
3
5.0
0
0.0

Unemployed
5
8.3
3
5.0

Total
60
100.0
60
100.0

Chi Sq. P < 0.02

(f) The Gender of Children

Gender of Children
Participants

diabetic children
healthy children

N
%
N
%

Female
65
65.0
49
49.0

Male
35
35.0
51
51.0

Total
100
100.0
100
100.0

Chi Sq. P < 0.05

(g) The Status of Educating Schools

Status of Educating Schools
Children

Diabetic
Healthy

%
%

Nursery
0.0
0.0

Preschool
3.3
12.0

Primary school
56.7
43.4

Middle school
40.0
44.6

Total
100.0
100.0

Chi Sq. P < 0.05

(h) Hardship in finding nursery/preschool/school for child

Hardship in finding nursery/preschool/school for child
Participants

The mothers of diabetic children
The mothers with healthy children

N
%
N
%

Yes
6
10.0
7
11.9

No
54
90.0
52
88.1

Total
60
100.0
59
100.0

Chi Sq. P < 1.0

The remaining group of questions pertained to the child’s ability to care for him- or herself (i.e., the ability to test blood sugar levels, the way insulin in administered, and whether dietary rules are observed). The results in the authors’ original sociodemographic questionnaire enabled us to characterise the mothers participating in the study

The instrument is as follows (Tables 1(a)–1(g)). After reading the questionnaire, please kindly mark the selected answers with a cross and enter your own in the designated places.

2.2.2. Antonovsky’s Sense of Coherence Scale (SOC-29)

The SOC-29 measures an individual’s general sense of coherence. The sense of coherence is operationally defined as feelings of being understood, resourceful, and sensible. The instrument has 29 items in the form of questions scored on a Likert-type scale from 1 to 7. The total score is the sum of a given individual’s scores for the 29 items. The maximum possible score is 203, while the lowest is 29. Higher scores correlate positively with a stronger sense of coherence [15].

2.2.3. Schwarzer & Schultz’s Berlin Social Support Scales (BSSS)

BSSS is a set of scales used for measuring cognitive and behavioural dimensions of social support with special reference to individuals supporting the mothers of diabetic and healthy children. The scales were adapted to Polish by Łuszczyńska et al. [16]. The BSSS contains five subscales: (1) perceived available support, (2) need for support, (3) support seeking, (4) actually received support, and (5) protective buffering support. Protective buffering support is operationally defined as an amalgam of hiding worries, denying concerns, and yielding to one’s partner in an effort to avoid disagreements and reduce one’s partner’s upset and burden. The answers were rated on a Likert-type scale from 1 to 4.

2.2.4. Rosenberg’s Self-Esteem Scale (SES)

The scale measures general self-esteem, operationally defined as a composite attitude towards oneself. The SES consists of 10 statements that respondents complete on a Likert-type scale from 1 to 4. The results can range from 10 to 40. The Polish adaptation of this method was developed by M. Łaguna, K. Lachowicz-Tabaczek, and I. Dzwonkowska [17].

2.2.5. Zigmond and Snaith’s Hospital Anxiety and Depression Scale (HADS)

It is used as a screening tool to identify anxiety and depressive symptoms and consists of two independent subscales. Each of them contains 7 statements on the actual condition of the participant. In total, the scale consists of 14 questions. The respondent assesses intensity of a given trait on a scale ranging from 0 to 3. The participants were subjected to the assessment only in the last week prior to the study. From among the above-described research tools, SOC-29, BSSS, SES, and HADS were accredited by the Polish Psychological Association.

2.3. Statistical Methods

The statistical analysis of the obtained results was conducted using IBM SPSS Statistics software. The following methods of statistical tests were used:

(i)Kolmogorov-Smirnov test(ii)Mann-Whitney U test(iii)Kruskal-Wallis test(iv)Spearman’s rank order correlation

3. Results

Table 1 summarizes the original social-demographic questionnaire. It lists the results of diabetic children and healthy children and their mothers side by side.

The youngest mother of a diabetic child was 29 years, whereas the oldest was 60. The youngest mother of a healthy child was 27 and the oldest was 56. Thirty-four (56.7%) mothers of diabetic children resided in a city with a population over 100 thousand, while the group of mothers of healthy children had 29 (48.3%) who resided in towns with a population of 25-100 thousand.

The highest number of mothers of diabetic children (34 or 56.7%) and healthy children (42 or 70.0%) reported having completed higher education. Among the mothers of diabetic children, 50 (83.3%) and 54 (90%) of the mothers of healthy children were married. An analysis of the source of income showed that most of the study participants were professionally active in both the group of mothers of diabetic children (36 or 60%) and healthy children (52 or 86.7%).

The age of diabetic children ranged from 7 to 16 years. Twenty percent of them were 13 years old. Girls constituted 65% of the group, while boys accounted for 35%. Most often, the number of children in families of diabetic children was estimated at two (46.7%). Families with three children were the fewest (15%). During the study, a clear majority of diabetic children (56.7%) attended primary schools. A slightly lower percentage (40%) attended lower secondary schools, while the fewest children (3.3%) attended nurseries. Fifty-four (90%) of the surveyed mothers did not report any problems with finding a place for their children in day care/nursery/school. Based on the analysis, it was found that 73.3% of diabetic children did not notice any changes in learning, while 20% reported that learning deteriorated. About 6.7% of mothers reported their children to be more eager to study. Diabetic children were most often the second child in the family (40%) and somewhat less often the only child (35%) or the first child (20%). Most of the children suffered from the disease starting from 1.5 to 13 years of age. The mean age at the diagnosis was slightly over 5 years. Over half of the study participants (60%) noticed symptoms of the disease before the diagnosis, and 68.3% of the mothers declared that their children required continuous care.

A clear majority of the diabetic children (86.7%) had an insulin pump. The main cause for not having an insulin pump was the child’s reluctance (55.6%), followed by fear (33.3%), and lack of information on the therapeutically insulin pump (11.1%).

Seventy-five percent (75%) of the mothers of diabetic children stated that their children could calculate carbohydrate exchanges. Most of the diabetic children (95%) could measure blood sugar levels by themselves. Half of the participants reported their children measured their blood sugar levels more than 5 times per day; 28.3% reported that it is done before every meal. According to 61.7% of mothers of diabetic children, their children followed the dietary rules and 28.3% of them complied with such recommendations shortly after the diagnosis, while the remaining 10% were not following such rules and never did. According to most of the respondents (60%), their financial conditions did not change from the time of diagnosis. The very same fraction (60%) of mothers spend the same amount of time with their families as before the diagnosis of the disease, and 79.7% of the participants reported that their relations with their partner did not change. However, the remaining 20.3% of the respondents indicated there was a change. Thirty-nine mothers (65%) of diabetic children received support from the immediate family, 28 (46.7%) from partners, 15 (25%) from friends, 10 (16.7%) from parents, and 4 (6.7%) from neighbours.

The group of healthy children consisted of 51 (51%) boys and 49 (49%) girls. Most children in this group were aged between 14 and 16 (13.6% each). Forty-one (44.6%) of them attended a lower secondary school, 40 (43.4%) attended primary school, and 11 (12%) attended a nursery. The majority of mothers (88.1%) of healthy children did not report any problems with finding a place for their children in a day care/nursery/school.

The results of the analyses presented in the tables indicate that both the mothers of diabetic children and the mothers of healthy children are not significantly different to each other regarding the level of self-esteem, sense of coherence, anxiety, and depression.

The mothers of diabetic children received most support from their immediate family (65%), followed by their husbands/partners (46.7%). The mothers of healthy children received similar perceived levels of support both from the immediate family and from husband/partner (70% each) (Table 2).

Table 2: Individuals supporting the mothers of diabetic and healthy children.

Who provides you with reliable support in difficult situations?
Group

mothers of diabetic children
mothers of healthy children

N
%
N
%

husband/partner
28
46.7%
42
70%

immediate family
39
65%
42
70%

neighbours
4
6.7%
10
16.7%

friends
15
25%
19
31.7%

parents of diabetic children
10
16.7%
0
0%

The total % is not equal to 100, as the participants were free to check any number of answers.

Statistically significant positive correlations were found between self-esteem levels and sense of coherence (Table 3). Therefore, the higher the self-esteem levels, the greater the sense of coherence in general and in its individual dimensions. This finding applied to both the mothers of diabetic children and the mothers of healthy children,

Table 3: Correlations between self-esteem and sense of coherence in the surveyed groups of women.

Sense of Coherence Scale  
(SOC-29)
Group

mothers of diabetic children
mothers of healthy children

Self-Esteem Scale
Self-Esteem Scale

rho
p
rho
p

Sense of being understood
0.562
<0. 001
0.458
<0. 001

Resourcefulness
0.389
0.002
0.475
<0. 001

Sensibleness
0.464
<0. 001
0.499
<0. 001

General sense of coherence
0.519
<0. 001
0.529
<0. 001

In both groups, statistically significant negative correlations were found between anxiety, depression, and sense of coherence (Table 4). Higher levels of anxiety and depression were correlated with the lower sense of coherence in general and in its individual dimensions. Statistically significant negative correlations were noted in the groups of mothers of diabetic children and healthy children between anxiety and depression and self-esteem levels. The higher the level of anxiety and depression, the lower the self-esteem levels in the study participants (Tables 4 and 5).

Table 4: Correlations between anxiety, depression, and sense of coherence in the groups of women.

Sense of Coherence Scale  
(SOC-29)
Group

mothers of diabetic children
mothers of healthy children

Anxiety
Depression
Anxiety
Depression

rho
P
rho
p
rho
p
rho
p

Sense of being understood
-0.522
<0.001
-0.408
0.001
-0.564
<0.001
-0.611
<0.001

Resourcefulness
-0.496
<0. 001
-0.479
<0.001
-0.599
<0.001
-0.649
<0. 001

Sensibleness
-0.469
<0. 001
-0.470
<0.001
-0.588
<0.001
-0.654
<0. 001

General sense of coherence
-0.559
<0. 001
-0.489
<0.001
-0.658
<0.001
-0.718
<0. 001

Table 5: Correlations between anxiety, depression, and level of self-esteem in the female participants.

Self-Esteem Scale

Group

mothers of diabetic children
mothers of healthy children

Rho
p
rho
P

Anxiety
-0.481
<0. 001
-0.431
0.001

Depression
-0.476
<0. 001
-0.586
<0. 001

Only depression and support are correlated in a statistically significant manner (Table 6). Anxiety did not correlate significantly with support. In the group of mothers of diabetic children, high levels of protective buffering support were associated with the higher levels of depression. In contrast, in the group of mothers of healthy children, the higher the level of the dimensions of support (perceived general available support, perceived available emotional support, perceived available instrumental support, actually received general support, actually received emotional support, actually received institutional support, actually received informative support, satisfaction with actually received support), the lower the level of depression.

Table 6: Correlations between anxiety, depression, and support.

Berlin Social Support Scales (BSSS)
Group

mothers of diabetic children
mothers of healthy children

Anxiety
Depression
Anxiety
Depression

 Rho
p
rho
P
rho
P
rho
p

Perceived general available support
-0.107
0.415
-0.193
0.139
-0.238
0.068
-0.422
0.001

Perceived available emotional support
-0.119
0.367
-0.177
0.177
-0.219
0.092
-0.339
0.008

Perceived available instrumental support
-0.065
0.622
-0.150
0.252
-0.226
0.083
-0.450
<0.001

Need for support
0.090
0.492
0.051
0.696
0.091
0.488
-0.103
0.433

Seeking support
-0.030
0.819
-0.104
0.429
-0.067
0.611
-0.187
0.152

Actually received general support
-0.223
0.087
-0.152
0.246
-0.180
0.169
-0.473
<0.001

Actually received emotional support
-0.137
0.295
-0.168
0.199
-0.145
0.268
-0.397
<0.002

Actually received institutional support
-0.165
0.208
-0.129
0.326
-0.075
0.566
-0.432
<0.001

Actually received informative support
-0.116
0.379
-0.035
0.790
-0.239
0.066
-0.338
<0.008

Satisfaction with actually received support
-0.119
0.367
-0.131
0.318
-0.081
0.539
-0.307
0.017

Protective buffering support
0.097
0.462
0.320
0.013
-0.078
0.553
-0.013
0.924

Positive correlations were found both in the group of mothers of diabetic children with the severity of DM as a cofounding factor and in the group of mothers of healthy children between self-esteem levels and support (Table 7). Among the mothers of diabetic children, the higher the level of specific dimensions of support (i.e., perceived general available support, perceived available emotional support, perceived available instrumental support, actually received general support, actually received emotional support, and actually received institutional support), the higher self-esteem levels. While among the mothers of healthy children, the higher the level of specific dimensions of support (perceived general available support, perceived available emotional support, perceived available instrumental support, actually received general support, actually received emotional support, actually received institutional support, and actually received informative support), the higher the self-esteem levels.

Table 7: Correlations between self-esteem and support.

Berlin Social Support Scales (BSSS)
Self-Esteem Scale

Group

mothers of diabetic children
mothers of healthy children

rho
P
 Rho
P

Perceived general available support
0.394
0.002
0.582
<0. 001

Perceived available emotional support
0.396
0.002
0.526
<0. 001

Perceived available instrumental support
0.328
0.010
0.571
<0. 001

Need for support
0.005
0.969
0.118
0.369

Seeking support
0.231
0.075
0.180
0.168

Actually received general support
0.300
0.020
0.340
0.008

Actually received emotional support
0.330
0.010
0.349
0.006

Actually received institutional support
0.291
0.024
0.283
0.028

Actually received informative support
0.191
0.144
0.312
0.015

Satisfaction with actually received support
0.233
0.073
0.230
0.077

Protective buffering support
-0.072
0.583
-0.207
0.113

Statistically significant positive correlations were found among the mothers of diabetic children between senses of coherence and support (Table 8). The higher the perceived general available support, perceived available emotional support, and perceived available instrumental support, the higher the sense of coherence in general and in individual dimensions. The higher the actually received general support and actually received emotional support, the greater the sense of coherence in general and in all of its individual dimensions. The higher the actually received institutional support, the greater the sense of coherence in general and in all of its individual dimensions except for sensibleness. The higher the actually received informative support, the greater the sense of coherence in terms of resourcefulness. The greater the satisfaction with the actually received support, the greater the sense of being understood, sensibleness, and the general sense of coherence.

Table 8: Correlations between sense of coherence and support among the mothers of diabetic children.

Mothers of diabetic children
Sense of being understood
Resourcefulness
Sensibleness
General sense of coherence

rho
p
rho
P
rho
P
rho
P

Perceived general available support
0.408
<0.001
0.487
<0.001
0.405
0.001
0.463
<0. 001

Perceived available emotional support
0.450
<0.001
0.467
<0.001
0.348
0.006
0.457
<0. 001

Perceived available instrumental support
0.324
0.012
0.453
<0.001
0.400
0.002
0.418
<0.001

Need for support
0.031
0.813
0.110
0.403
0.079
0.548
0.074
0.574

Seeking support
0.240
0.065
0.181
0.167
0.143
0.275
0.206
0.114

Actually received general support
0.358
0.005
0.455
<0.001
0.285
0.027
0.414
0.001

Actually received emotional support
0.305
0.018
0.425
<0.001
0.307
0.017
0.395
0.002

Actually received institutional support
0.344
0.007
0.376
0.003
0.239
0.066
0.341
0.008

Actually received informative support
0.234
0.071
0.292
0.024
0.141
0.281
0.254
0.050

Satisfaction with actually received support
0.415
0.001
0.384
0.002
0.253
0.051
0.410
0.001

Protective buffering support
-0.044
0.737
-0.153
0.244
-0.089
0.497
-0.079
0.549

Statistically significant positive correlations occurred in the group of mothers of healthy children between the sense of coherence and support (Table 9). The higher the perceived general available support, perceived available emotional support, perceived available instrumental support, and actually received informative support, the greater sense of coherence in general and in all of its individual dimensions. In turn, the greater the actually received general support, actually received emotional support, actually received institutional support and satisfaction with actually received support, the greater sense of coherence in general and in all of its individual dimensions except for the sense of being understood.

Table 9: Correlations between sense of coherence and support in groups of mothers of diabetic children.

Mothers of healthy children
Sense of being understood
Resourcefulness
Sensibleness
General sense of coherence

rho
p
rho
P
rho
P
rho
p

Perceived available general support
0.343
0.007
0.434
<0.001
0.377
0.003
0.418
0.001

Perceived available emotional support
0.334
0.009
0.396
0.002
0.299
0.020
0.377
0.003

Perceived available instrumental support
0.330
0.010
0.454
<0.001
0.424
0.001
0.438
<0. 001

Need for support
-0.116
0.378
-0.063
0.632
-0.092
0.485
-0.114
0.387

Support seeking
-0.100
0.448
0.007
0.959
-0.050
0.707
-0.053
0.689

Actually received general support
0.249
0.055
0.447
<0. 001
0.452
0.001
0.427
0.001

Actually received emotional support
0.195
0.136
0.397
0.002
0.385
0.002
0.364
0.004

Actually received institutional support
0.121
0.357
0.297
0.021
0.357
0.005
0.280
0.030

Actually received informative support
0.282
0.029
0.411
0.001
0.357
0.005
0.382
0.003

Satisfaction with actually received support
0.131
0.319
0.273
0.035
0.318
0.013
0.264
0.042

Protective buffering support
0.138
0.292
-0.016
0.903
-0.210
0.108
-0.018
0.894

4. Discussion

The aim of the study was to assess the psychosocial functioning of mothers of diabetic children compared to a control group of mothers of healthy children. Diabetic children receive care from their mothers at various ages. The mothers of diabetic children were aged from 29 to 60 years and the highest percentage of them resided in cities with a population over 100 thousand, while the lowest percentage lived in towns of up to 25 thousand. The research conducted by Gawłowicz [18] showed that 55% of the participants lived in rural areas, while 45% lived in urban areas. The mean age of mothers was estimated at around 40 years. Irrespective of the patients geographical locations the psychosocial functioning of mothers do not affect the diabetic care of their children.

The general sense of coherence and its constituent parts (sense of being understood, resourcefulness, and sensibleness) were subjected to analysis. The respondents obtained scores similar to the average. Studies conducted by Kurowska et al. [19] on the relation between sense of coherence and general mental health proved that in a group of people with a high level of sense of coherence symptoms of anxiety, insomnia, and depression are less common compared to individuals with a low level of sense of coherence (SOC). In turn, J. Dymecka [20] claims that a serious disease affecting a family member constitutes a source of great stress to a given family; hence, it is important to analyze sense of coherence in the mother-father system. Parents of children who experience a disability such as a chronic disease have a significantly lower sense of coherence than other parents [20]. In the source literature, a difference in a sense of coherence is reported between parents who accepted their child’s disease and parents who cannot come to terms with the diagnosis [21]. Though, sense of coherence is a permanent parameter and the earlier findings suggested that the significant changes were found in patients with a low SOC level and the increase of SOC was observed after a 10-week treatment and was stable even after six months. In addition, the results suggest that the therapy can be more effective in patients with a low SOC level and not in high SOC [22].

The studies reported by Horsch et al. [23] showed that the mothers of diabetic children manifest symptoms typical of the posttraumatic stress disorders after the diagnosis. Seventeen percent (17%) of female participants report severe or moderate depressive symptoms, while 40% reported moderate or severe anxiety (Tables 4 and 5). According to Bowers et al. [24], a long-term sadness is reported by parents after their child was diagnosed with a chronic disease. Studies conducted by Kędziora [25] showed that mothers respond with an initial increase in anxiety that subsides to an extent after a year. A report on anxiety of mothers of children with DM and those with epilepsy manifest a similar average level of anxiety [26].

A mother caring for a child with a chronic disease begins a new period in her life that requires her to learn new skills, to set new achievable goals, and to deal effectively with her fears. After the diagnosis, mothers of diabetic children undertake new actions, overcoming their fears, and establishing new contacts with individuals who offer them support [13]. A positive role can be played by the family by actively engaging issues experienced by the diabetic child and by sharing tasks between all family members.

As a chronic disease, diabetes mellitus causes can be overcome using social support. This finding is similar to reports by the authors regarding adaptation to an incurable disease [27, 28]. Social support fulfills a significant role in the shaping of an individual’s physical and mental condition. It prevents formation of adverse tension in contrast to situations where no support is provided to such a person [29, 30]. Pisula and Czaplińska [31] reported that the level of education of mothers of adolescents suffering from chronic diseases is positively correlated with the manner in which they cope with associated stress. The findings showed that received support has a positive effect on self-esteem levels. In the source literature, no studies were found that would directly pertain to the correlation between support and self-esteem levels in mothers caring for children with diabetes mellitus.

The results presented in this paper indicate that both the patient and the family require ongoing psychological assistance. Furthermore, the best results can be obtained through combining medical care and psychosocial support (Tables 6–9). An important part is played by psychoeducation, participation in support groups, and training sessions dedicated to the subject of coping with diabetes mellitus. The aggregate effects facilitate emotional adaptation to living with the disease for both the child and the family members.

5. Conclusions

Mothers of children diagnosed with diabetes mellitus are immersed suddenly in a difficult situation related to this chronic, progressive disease that has the potentially for serious, life-threatening effects on their children. Mothers of diabetic children who reported high self-esteem and general sense of coherence also reported were positively correlated with receiving professional counselling support that addresses specific issues and offers general information on additional sources of available help.

A high sense of coherence is reported as a health-promoting factor that facilitates choosing optimal behaviours that enable preserving good health, including mental health. Mothers of diabetic children and mothers of healthy children are not significantly different with respect to self-esteem levels, sense of coherence, anxiety, and depression. Positive correlations are enhanced by receiving professional medical and psychological help (e.g., the Support Group for Children and Adolescents with Diabetes), participation in training sessions, and support from loved ones.

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Consent

All the mothers participating in the study completed informed consent forms.

Conflicts of Interest

Gjumrakch Aliev was employed by GALLY International Biomedical Research Consulting LLC, San Antonio, Texas, USA. All other authors declare no competing interests.

Acknowledgments

This work is supported by Russian Academic Excellence project “5-100” for the Sechenov University, Moscow, Russian Federation.

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