Peer Relationships in Youth with Type 1 Diabetes: Development and Directionality of Effects

Adolescence and emerging adulthood are life phases that present challenging normative tasks, such as becoming independent from parents and developing supportive relationships with peers. Type 1 diabetes (T1D) is a chronic disease that significantly impacts the daily lives of youth, adding an extra layer of complexity to an already challenging journey to adulthood. From childhood onwards, peers become an increasingly important and influential part of people's lives. Peers may support youth to overcome normative and diabetes-related challenges, but they may also interfere with healthy adjustment to diabetes. Having to deal with T1D could, in turn, complicate the normative challenge of engaging in supportive peer relationships. Research examining peer relationships in youth with T1D is scarce, inconclusive, and characterized by several research gaps. This limits our understanding of how peer relationships develop and how they may play a role for the functioning of youth with T1D. The present dissertation is guided by two major research questions: 1. "How do peer relationships affect youth with type 1 diabetes?"; and 2. "How does type 1 diabetes affect peer relationships?". Cross-sectional and longitudinal studies in large samples of youth with T1D are combined with state-of-the-art statistical techniques to address these questions. Part I of the dissertation focuses on bidirectional relationships between the parental and peer context and the functioning of youth with T1D. In Chapter 1, we mainly found effects going from the social context to functioning with diabetes. More specific, we found that emotional support from friends negatively predicted diabetes-specific distress on top of parental responsiveness. In emerging adults, we found extreme peer orientation to predict worse glycemic levels. In Chapter 2, we found that the extent to which youth integrate diabetes into their identity predicted adaptive peer functioning. Specifically, youth who accept, as opposed to reject, diabetes were found to perceive relatively more support from friends and have lower extreme peer orientation over time. Part II of the dissertation focuses on effects from the peer context to general and diabetes functioning. In Chapter 3, we found that diabetes-specific support from friends was unrelated to general and diabetes functioning. However, for youth who disliked this type of support, receiving more diabetes-specific support was associated with more diabetes-specific distress. Finally, in Part III we compared youth with T1D to community youth to investigate whether having T1D could affect social relationships. In Chapter 4, we found that youth with T1D perceive fewer support from friends than community youth, but also that they had lower levels of extreme peer orientation. In Chapter 5, we found that youth with T1D perceived somewhat lower levels of companionship and support from friends. Whether differences were found with community youth depended on age and gender. In sum, the findings of this dissertation demonstrate that friends are important contributors to the psychological well-being of youth with T1D as sources of emotional support. In addition, youth with T1D are somewhat more likely to struggle with peer relationships, and those who do are at risk for general and diabetes-related maladjustment. The dissertation concludes with a discussion of the theoretical and clinical implications of these findings.

Publication year:2023

Accessibility:Embargoed