Vasco Costa

Type 1 diabetes (T1D) in early childhood presents unique challenges, especially for parents who are mainly responsible for T1D treatment. Fear of Hypoglycemia (FH) is a major concern, asyoung children often cannot identify or communicate symptoms, increasing the risk of severe consequences. Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP) is the only validated psychological intervention specifically developed to target parental FH in early childhood. This protocol outlines plans to translate, adapt and implement REDCHiP in Portugal. A Feasibility Randomized Controlled Trial (FRCT) will be conducted using a two-arm, open-label design and a mixed-method approach among parents of children up to 8 years old. Participants will be randomly allocated (1:1) to the intervention or treatment as usual (TAU) and assessed at baseline, postintervention, and three-month follow-up. Primary outcomes will focus on parental psychological adjustment, including FH and diabetes distress. Secondary outcomes will evaluate children’s Glycated Hemoglobin (HbA1c), via Glucose Management Indicator (GMI) and Blood Glucose Sample Test, and Time Below Range (TBR), Time In Range (TIR), and Time Above Range (TAR). Semi-structured interviews will explore participants’ experiences with this intervention. This study represents the first international adaptation and implementation of REDCHiP and the first evaluation of its feasibility and acceptability in a European context. Findings may inform the integration of culturally adapted psychological support and digital interventions into pediatric diabetes care.

Parents of children and adolescents with type 1 diabetes (T1D) are responsible for intensive daily disease management and often experience high levels of emotional distress. This study examined whether fear of hypoglycemia mediates the association between parents’ emotion regulation strategies and diabetes-related distress. Participants were recruited through Facebook and WhatsApp groups for parents of children and adolescents with T1D, and data was collected via self-report online questionnaires. A total of 102 parents, 92.2% mothers (aged 32–58 years) of children with T1D aged 8–17 years, completed measures of fear of hypoglycemia (Hypoglycemia Fear Survey—Parent Version), diabetes distress (Problem Areas in Diabetes-Parent Revised) and emotion regulation strategies (Emotion Regulation Questionnaire), along with a sociodemographic questionnaire. Four mediation models were tested using PROCESS, including cognitive reappraisal and expressive suppression as predictors and the worry and behavior subscales of fear of hypoglycemia as mediators. Results revealed a significant indirect effect of worry on the relationship between cognitive reappraisal and diabetes distress (indirect effect = −0.15, 95% CI [−0.35, −0.02]), highlighting worry as a potential mediator between these variables, while the direct effect was negative but non-significant. No significant indirect effects were found for expressive suppression on the behavior subscale (indirect effect = 0.12; 95% IC [−0.07; 0.36]) or on the worry subscale (indirect effect = 0.07; 95% IC [−0.08; 0.24]). These findings suggest that cognitive reappraisal may be associated with lower diabetes-related distress through lower levels of excessive worry about hypoglycemia. Clinically, the results highlight fear-related cognition can be a relevant intervention target, alongside emotion regulation skills, in psychosocial support programs for parents of youth with T1D.

This study examined the role of work–family conflict as a linking mechanism between difficulties in emotion regulation (ER) and perceived parental self-efficacy (PPSE). Participants were 228 working parents (74.6% women; mean age = 45.24, SD = 7.16), who completed self-report measures of ER difficulties, work–family conflict, and PPSE. Lack of emotional awareness and non-acceptance of emotions were positively related to PPSE, but these associations were not significant when work–family conflict dimensions were considered. Difficulties in goal-directed behavior and limited access to ER strategies were associated with lower PSSE, with strain-based conflict emerging as a relevant pathway for difficulties in goal-directed behavior (95% CI [0.04, 2.67]). Difficulties controlling impulsive behaviors and lack of emotional clarity were linked to lower perceived PPSE through behavior-based conflict (95% CI [−2.04, −0.15]; [−2.01, −0.09], respectively). Overall, the findings suggest that specific ER difficulties may reduce parents’ confidence by increasing strain and behavioral interference between work and family roles. Promoting ER skills may help parents manage these demands more effectively and maintain a stronger sense of parental efficacy.

Background/Objectives: Hypoglycemia occurs when blood glucose levels drop significantly below the normal range leading to unpleasant symptoms and a greater risk of acute complications. Fear of hypoglycemia (FH) is a conditioned psychological response to hypoglycemia frequently experienced by people with type 1 diabetes (T1D) and their loved ones. The present study aimed to examine the psychometric properties of a Portuguese translation of the Hypoglycemia Fear Survey—Parents (HFS-P) for the parents of youths with T1D. Methods: The sample consisted of 102 parents (M = 44.58 years old; SD = 5.01; mothers = 92.2%) of youths with T1D (8 to 17 years of age; M = 12.67; SD = 2.58). Confirmatory Factor Analysis (CFA) and convergent validity were performed to examine the factor structure and the construct validity of the HFS-P. Results: CFA supports a refined two-factor 18-item version of the HFS-P. The results indicate good psychometric properties (χ² [129] = 220.47.; p ≤ 0.001; χ²/DF = 1.71; RMSEA = 0.08; SRMR = 0.07; CFI = 0.93; TLI = 0.91; GFI = 0.93) along with good to excellent internal consistency coefficients (behavior subscale: α = 0.81, total: α = 0.93, and worry: α = 0.94). Conclusions: Our Portuguese version of the HFS-P appears reliable for assessing FH in parents of youths with T1D, and is ready for use in clinical research and to evaluate psychological interventions targeting parental FH in the Portuguese context.

Purpose of Review: This review aimed to summarize the evidence regarding the relationship between parental psychosocial (e.g., fear of hypoglycemia, stress and family conflict) and glycemic outcomes in children between the age of 1–10 years old. Recent Findings: Type 1 Diabetes (T1D) in young children can be very complex to manage for their parents since they are the main individuals responsible for T1D tasks. Also, parental psychological adjustment impacts children’s glycemic outcomes. Summary: This systematic review was performed following the PRISMA guidelines. The search process was conducted in four databases from 2019 to 2024. From a total of 215 studies, 5 were included. We identified five studies that found direct associations between parental psychosocial variables and children's glycemic outcomes. These findings suggest a unidirectional perspective, evidencing the need to examine the longitudinal interplay between these variables. In sum, promoting parental psychological interventions may be fundamental for enhancing children’s glycemic outcomes.

The effects of the pandemic on mental health can be studied through different variables, such as the number of COVID-19 stressors, the stressor types, and the stress responses. Understanding the sources of mental strain is crucial for developing effective interventions. The present study analyzed the relationship between these COVID-19-related variables and positive and negative mental health. A cross-sectional study was conducted with 666 individuals from the Portuguese general population, mostly females (65.5%) between 16–93 years old. They completed self-report measures regarding the number of COVID-19 stressors, the stressor types, the stress responses (IES-R), and positive (MHC-SF) and negative mental health (BSI-18). The results demonstrated that a higher number of COVID-19-experienced stressors and more stress responses were related to worse mental health. Regarding stressor types, experiences not related to the COVID-19 infection (e.g., tension at home) presented the largest effects on mental health. The strongest predictor was the stress responses for negative (β = 0.50) and positive mental health (β = −0.17). The predictors explained more about negative mental health than positive. These findings support the idea that individual appraisals play a crucial role in mental health.