My research interests fall within the domains of health and pediatric psychology. Broadly speaking, I am interested in understanding how people cope adaptively with acute and chronic health threats. My research draws on Leventhal’s self regulatory framework, which posits that health threats activate a common-sense understanding of health problems, which then guides ongoing efforts to manage the threat. Within this framework, health threats are activated at both an abstract rational level (e.g., I have high cholesterol which may increase my risk of heart disease) and a concrete emotional level (e.g., feeling fear and distress upon remembering my father’s heart attack). A general goal of my research is to understand not only how people cope to manage the health threat per se (e.g., change diet and exercise habits to lower cholesterol), but also how negative emotions are generated by health threats, how emotions influence health threat representations and coping behaviors, and how emotions are regulated to promote illness management and well-being.
This general focus is reflected in three related lines of research: a) How tendencies to experience negative emotion (e.g., negative affectivity, neuroticism) influence health behaviors and adjustment to illness; b) How family and developmental factors interface with this self-regulation process; and c) How these illness self-management processes play out differently when embedded in different social contexts (e.g., health care system, race/ethnicity, neighborhood SES). To date, much of my work has focused on studying these issues in adolescents with diabetes. Understanding factors that contribute to successful diabetes management during adolescence is important because this is a time of development when adherence and metabolic control commonly deteriorate, and skills for a lifetime of independent self-care are established. Identifying factors that promote successful diabetes management during adolescence can thus guide more effective interventions. Although insights gained from my research are most directly applicable to adolescents with diabetes, the concepts are general and can be readily extended to other illnesses and developmental contexts.
Emotions and the Self-Regulation of Health Threats
In one of my first studies of adolescents with diabetes, I examined basic aspects of symptom perception and illness self-management (Wiebe et al., 1994). Using experience sampling techniques, I found that trait anxious adolescents with diabetes made a particular type of symptom perception error by over-interpreting the meaning of benign symptom (i.e., they inaccurately believed neutral sensations reflected blood glucose fluctuations). Trait anxious adolescents also had poorer metabolic control, but only when they reported using symptoms to guide their treatment decisions (i.e., when to take insulin or eat a snack). These findings were important because there was a general belief at the time that constructs such as trait anxiety reflected a tendency to report symptoms and complain about symptoms, but were not related to objectively different health experiences. This study demonstrated clear health implications for these symptom complaints when carefully examined from the perspective of self-regulation theory.
Since this time, my students and I have conducted a series of studies examining the central role of negative emotion in the context of illness management. We demonstrated that the emergence of depressive symptoms across adolescence partially explained declines in adherence (Korbel, Wiebe, & Berg, 2007), and that daily negative emotions may impair blood glucose control by undermining one’s competence in dealing with daily diabetes management problems (Fortenberry, Butler, Butner, Berg, Upchurch & Wiebe, 2009). We have also begun to identify individual moderators of associations between affect and illness management. For example, Tran, Wiebe, et al. (2011) found that benefit finding may allow adolescents to maintain diabetes management despite experiencing and acknowledging heightened negative emotion.
Family and Developmental Factors in Adolescent Diabetes Management
Over the past several years, I have been building a transactional developmental model to understand how children with type 1 diabetes and their parents cope with the illness across adolescence. Parents play a crul role in adolescent diabetes management, as children display better outcomes when parents remain involved in diabetes care. Our model views parental involvement in diabetes care during the transition into adolescence as an ongoing transaction between the child and parent as they simultaneously attempt to manage the illness and associated distress, meet the child’s developmental needs for autonomy and individuation, and cultivate the child’s ability to manage diabetes independently.
My cross-sectional research suggests that initial changes in parental involvement are likely to be cued by child age and pubertal maturation, but also reflect a complex set of parent-child developmental expectations, illness representations, and personal goals (Fortenberry, et al....Wiebe, 2014; Palmer, Berg, Wiebe et al., 2004; Palmer et al., 2009). My research also indicates it is not simply the presence of an involved parent, but the manner in which this involvement is experienced by the developing child, that determines medical and psychosocial outcomes. In a sample of 10-15 year olds, appraisals of parents as collaborators were associated with better outcomes regardless of age, while appraisals of parents as controlling were associated with poorer outcomes among older children (Wiebe et al., 2005).
I have eceived several grants from the National Institutes of Diabetes, Digestive, and Kidney Diseases (NIDDK) to examine longitudinal aspects parental involvement in diabetes management across the transition into and through adolescence. This is important given the obvious possibilities that parental involvement could be a response to rather than a cause of the quality of diabetes management. Through a study called ADAPT (Adolescents with Diabetes and Parents Together), we collected longitudinal survey data on 252 adolescents with diabetes and their mothers and fathers, as well as a two week daily diary. Analyses of the daily diary indicated that mother’s and father’s are more intrusive on days the adolescent experiences problems with diabetes management, supporting the possibility that adolescent mismanagement elicits parental control (Berg et al., 2013). In line with the importance of negative emotion in illness management, parental worry was found to mediate the daily association between adolescent problems and parental intrusive involvement, and this involvement appeared to be important for normalizing blood glucose levels over the next 24 hours. In a separate longitudinal data set, we found that maternal depressive symptoms were associated with heightened maternal involvement and slower transfer of responsibility for diabetes care to the adolescent across time (Wiebe et al., 2011). In this case, however, the heightened involvement of mothers with depressive symptoms was not helpful to the adolescent’s diabetes management, demonstrating the importance of examining the role of different dimensions of negative emotion in illness self-regulation.
Broader Social Contextual Influences
Although it has been well-documented that management of type 1 diabetes deteriorates across adolescence, most of these studies have been conducted on middle-class Caucasian samples (potentially because type 1 diabetes is more prevalent among Caucasians, than among ethnic minority populations). Even within these fairly homogeneous samples, however, health disparities exist. In my own research, for example, we found that lower SES could exhaust parental resources and undermine parents’ ability to be effective caregivers to their adolescent with diabetes (Drew et al., 2011). To understand more about when and how health disparities emerge across development, my students and I identified age and sex matched samples of Caucasian, African American, and Latino youth with diabetes, and extracted from medical records their metabolic control from childhood through late adolescence (Wang, Wiebe, & White, 2011). We also obtained neighborhood SES data from census-tract databases. Our findings revealed that adolescence appears to be a time of risk regardless of race/ethnicity, given that all groups displayed deterioration across ages 10 to 17. However, median family income in their neighborhood moderated the rate of deterioration. Caucasians showed the expected pattern where those living in higher income neighborhoods displayed slower deterioration than those living in lower income neighborhoods. For both minority samples, however, the pattern was reversed (i.e., those living in higher income neighborhoods displayed more rapid deterioration across adolescence). This is consistent with several theories about interactions between SES and race/ethnicity (e.g., Hispanic paradox; ethnic density hypothesis), and demonstrates the importance of examining the broader social contexts in which the self-regulation processes are embedded. Through a grant from a research foundation, I recently completed collecting data in a qualitative study of Latino and Caucasian families to explore potential explanations of this intriguing finding.
Another social context that I have examined is the role of the health care provider and health care systems. Health care providers have a unique role to play in families with pediatric conditions because they have a long-standing, personal relationship with both the adolescent and the parent, and are positioned to be a resource to correct adolescent and family mismanagement. In an initial study of mothers, adolescents, and physicians, I found that physicians delivered messages to both adolescent and parent about maintaining parental involvement in diabetes management, and these messages were associated with increases in parental collaboration over the subsequent week (Wiebe et al., 2008). In the large longitudinal data set described above, adolescent, parent, and physician reports after the adolescents’ clinic visit demonstrated that it is not only the specific message that is delivered, but the form of that message that appears to be important for diabetes management. Specifically, we found that families’ reports of physicians’ patient-centered communication predicted improvements in subsequent adherence that were mediated by perceptions that their illness was manageable (Croom et al., 2011).
Future Directions
In my newest grant from the National Institutes of Health, I am extending this work to understand how late adolescents transition out of the parental home, out of pediatric care, and into emerging adulthood. In the READY study mentioned above, we are examining these self-regulation processes in the broader context of the neurocognitive developments that occur across adolescence and young adulthood, changing parent-child relationships, and changing health care systems.