가족환경 및 부모의 양육행동이 제1형 당뇨병 환아의 혈당 관리 및 우울 증상에 미치는 영향
Effects of Family Environment and Parenting Behavior on Glycemic Control and Depressive Symptoms in Children with Type 1 Diabetes
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목 적:제1형 당뇨병을 앓고 있는 자녀를 둔 가족의 사회경제학적 특징, 가족환경, 부모의 양육행동, 가족 기능이 환아의 혈당 조절과 우울 증상에 어떤 영향을 미치는지 알아보고자 하였다. 방 법:동아대학교 의료원, 메리놀병원, 왈레스기념 침례병원, 고신대학교 복음병원의 소아청소년과에서 제1형 당뇨병으로 진료중인 10세에서 17세의 소아 및 청소년 58명을 대상으로 하였다. 이들과 부모를 대상으로 가족기능지수, 부모양육행동척도 및 가정환경척도에 대한 설문조사를 통해 가족 내 환경이 혈당 관리 및 우울 증상에 어떤 영향을 미치는지 조사하였다. 결 과:당화혈색소와 우울 증상은 양의 상관관계(r=0.43, P=0.001)가 있었으며 당뇨병 유병기간을 통제 하더라도 통계적으로 유의한 양의 상관관계(r=0.40, P=0.002)가 있었다. 혈당 조절 정도와 가족기능지수는 직접적인 연관관계가 없었다. 가정환경척도를 분석한 결과, 가족 구성원들 사이의 ‘결합력’(β=-0.422, P=0.005) 및 ‘성취 지향성’(β=-0.323, P=0.013)이 높을수록 당화혈색소는 낮았다. 그러나 가족생활에 이용되는 규칙과 방법들이 설정되는 정도인 ‘조절성’(β=0.356, P=0.009)이 높을수록 당화혈색소는 높게 나타났다. 가족기능지수가 높은 가정일수록 환아의 우울 증상 점수가 의미있게 낮았다(P=0.001). 제1형 당뇨병으로 치료 받고 있는 환아에서 가족기능지수가 높은 가정의 부모들이 ‘합리적 설명’(부:P=0.025, 모:P=0.001)의 양육 태도를 보였다. ‘애정’(부:P= 0.001, 모:P=0.001) 항목이 높은 양육 태도를 보였다. 부모의 양육행동을 분석한 결과, 아버지의 ‘감독’(β=-0.325, P=0.045) 항목이 높을수록 환아의 우울 증상은 적었다. 어머니의 ‘합리적 설명’(β=-0.507, P=0.011) 항목이 높을수록 환아의 우울 증상이 적었다. 결 론:소아 및 청소년들의 제1형 당뇨병 관리에 있어서 중요한 역할을 하는 가족 내 환경을 개선하고자 하는 노력이 필요하리라 생각된다. 또한, 부모의 양육 행동이 제1형 당뇨병을 가진 환아들의 우울 증상에 영향을 미치는 점을 고려하여 자녀의 양육에 세심한 배려가 필요하리라 생각된다.
Abstract
Purpose:We aimed to evaluate the influence of family environment, parenting behavior, and psychological characteristics on metabolic control in children with type 1 diabetes mellitus (DM). Methods:We performed a statistical survey among Korean children (adolescents; age, 11–17 years) undergoing treatment for type 1 DM for more than a year and the parents of these children. We obtained the glycosylated hemoglobin (HbA1c) levels; children’s depression inventory (CDI) scores; family affection, partnership, growth, adaptation, resolve (APGAR) scores; parenting behavior inventory (PBI) scores; and scores of the Korean version of family environment scale (FES-K) for these families. The results of the survey were collected and analyzed using statistical methods. Results:We found a statistically significant evidence of a positive relationship between HbA1c levels and depressive symptoms (r=0.43, P=0.001). However, there was no relationship between HbA1c levels and family APGAR scores. FES-cohesion scale (β=-0.422, P=0.005), achievement orientation scale (β=-0.323, P=0.013), and control scale (β=0.356, P=0.009)-were significant predictors of HbA1c levels. In the family APGAR index, low CDI score (P=0.001) were indicative of a highly functional family. Furthermore, the family APGAR scale showed a statistically significant association with the reasoning and affection subscales of the PBI scale and inverse association with the inconsistency subscale of the PBI scale. Multiple-regression analysis of the data revealed that the monitoring (β=-0.325, P=0.045) and reasoning (β=-0.507, P=0.011) variables of the paternal and maternal PBI scale, respectively, were significant predictors of a child’s depressive symptoms. Conclusion:Improvements in family environment and parenting behavior may help improve metabolic control and reduce depressive symptoms in children with type 1 DM.
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