July 12, 2023

Improving mothers’ anxiety and depression may help teens’ health, too.

Raising a child who has a chronic illness can be stressful.

Parents managing the child’s care often struggle with stress, anxiety and/or depression. This is especially true of mothers, who tend to be the primary caregiver dealing with the details of that care. The mental and physical work of keeping track of things like prescription medications, diet and appointments can be exhausting, which may lead to caregiver burnout.

 “Moms report higher stress than dads do, when we look at parents of kids with diabetes,” said Sarah Jaser, Ph.D., of the Pediatric Diabetes Program at Monroe Carell Jr. Children’s Hospital at Vanderbilt. 

Adolescents struggle with managing their diabetes in particular. For their mothers, wondering if the chronically ill teen is sticking to their treatment regimen, or worrying what might happen to them when they are at school, at a friend’s house or any other situation when a parent is not there to ensure their safety, can also be tiring and scary. 

“During adolescence, there’s a handoff of responsibility from parents to children for managing the illness. The transition often leads to problems with diabetes management and to an increase in family conflict,” Jaser said. 

Jaser is the coauthor of an article outlining a trial of a new program called Communication & Coping. The program is studying whether teaching mothers to nurture their own mental health and improve how they interact with their chronically ill children would help the teens do a better job of managing their own diabetes.

The program recruited mothers who reported having mild or moderate depression, as measured by a questionnaire widely used in psychiatry. The mothers in the program had a private Facebook group just for them. Jaser and colleagues posted advice each day to that Facebook page. The mothers could discuss their own experiences with the other members of the group. Each mother also had seven individual phone sessions with trained members of the research team. 

Communication & Coping borrowed techniques from positive parenting programs and from cognitive behavioral therapy used to treat depression in adults. Cognitive behavioral therapy focuses on changing someone’s patterns of thinking. The program used those strategies to help the mothers ease their own stress and teach parenting skills. If you have a child with type 1 diabetes, or another chronic medical condition, the researchers offer these tips used in the program for protecting your own mental health:

Set aside time to take care of yourself

To avoid caregiver burnout, you can carve out time for yourself, in whatever form will be most helpful for you. Maybe you need a quiet 15 minutes of reading time each day. Or a 30-minute daily walk. Manicures, massages —  any kind of physical pampering that makes you feel better physically — can help you mentally. The point is making sure you have regular time, even in short bursts, that’s only for doing what makes you happy. 

Dealing with “hot thoughts”

Anxious mothers can let negative thoughts get out of control. Jaser’s program helped them identify the fears and emotions behind negative thoughts, to lower stress levels.

For example: Imagine you are late to pick up your child from school. You might start thinking, “I’m late. My kid will be upset. Others will think I’m a bad mom.” That idea, of being a bad parent, may be the part that makes you feel the most anxious, upset or guilty. Or a different “hot thought” in the same situation might be, “My kid’s all alone, so they’re not safe.”

When you have a general thought (“I am stressed out”), Jaser said, identify the specific stress or fear that’s causing the upset (“other people will think I’m a bad parent”). The idea is to challenge or examine that specific stress point. In this case, the parent might take a moment to think, “Does literally everyone think I’m a bad mother because I’m five minutes late?” Questioning whether your thought is realistic may help you realize that it’s exaggerated.

“A lot (of these anxious, depressed moms) really worry that their child could have a serious health consequence or even die. It’s not totally unrealistic, but also not as likely as they think it is,” Jaser said. In those cases, it’s not about whether the thought is true, but whether it’s helpful: “Is my worrying about that helping me be a better parent or helping my child?”

Set aside times when diabetes talk is taboo

Another valuable strategy for these mothers: spending positive time with their teen that is not focused on diabetes or anything that’s not going well.

“For some families, it might be a whole day,” Jaser said. “They go hiking, or for a picnic. But for some moms pulled in a million different directions, it could mean 10 minutes to walk the dog with the kid, just to be together and not focus on the diabetes part.”

When your child has a chronic illness, it’s easy to ask them – first and frequently – “how are you feeling? Is your blood sugar ok?” etc. But, Jaser said, “Kids say that [the illness] ‘is all my mom ever asks me about and it’s all we ever talk about.’ ” The study challenged the mothers to talk about something else, and set aside time when they intentionally avoid talking about the teen’s medical condition. 

“For any family, when you have those positive times together it puts money in the bank for when you have a stressful interaction,” Jaser said. “You are coming at it from a better place.”

Let your teen help solve problems

On the other hand, when it’s time to discuss your child’s diabetes and how well they are managing it (or not), framing the conversation as a brief problem-solving session can help. The parent and teen pick the biggest problem they’re facing and brainstorm some solutions together.

Allow someone else to share the load 

Jaser recalls study participants who felt burned out doing all the work of managing the child’s chronic illness, but they had a hard time letting anyone else share the load.

“Some would get up every single night to check on the teen,” Jaser said. “… Moms would do this even if they didn’t need to. … They would say, ‘I don’t feel like I can trust anyone else to do it the way I do.’ ”

This contributes to burnout. Jaser urges these mothers to start delegating some of the work to another adult. Besides a co-parent, maybe there’s a grandparent who could also provide some respite?

Find support from other parents

The mothers used the Facebook group to gain practical and emotional support from others in same situation.

Look for online or in-person support groups of parents of children with the same condition as your child. Online groups or those who meet with regularly scheduled virtual calls are a time-saving way to make these connections, Jaser said. If you can’t find a similar Facebook group, consider starting one.

The greatest benefit of these groups, whether online or in person, is the connection with other parents who are dealing with the same challenges. 

When you may need therapy for yourself

If worries about your child are interfering with your relationships with your children and other family members, or with your work or school, consider getting therapy to help manage that anxiety.

If you are already in therapy but it’s not helping, consider searching for a different therapist, one who specializes in helping parents of children with chronic medical conditions.

Jaser noted that there are programs and studies for families of children with diabetes. One, Behavioral Families System Therapy used family therapy sessions to improve family dynamics, though it did not focus specifically on parents’ mental health.

Jaser’s program ran for 12 months. In spring 2023, she was collecting follow-up data, aiming to have full results later in 2023. Mothers who completed the program reported that it was helpful, Jaser said. They left feedback such as: “It introduced me to things I wouldn’t have thought about in regards to communicating with my child,” Jaser said, and “Great connecting with others on Facebook who also have a child with diabetes.”

Woman smiling with woman doctor

Personalized Primary Care

It’s important to take care of yourself so you can take great care of your young children and teenagers. A primary care provider will work with you over the years to be a partner in your well-being. This provider can also refer you to specialized care, including a therapist, if you need that. If you do not have a primary care physician, consider making an appointment with a member of the Vanderbilt Primary Care team.

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