Introduction
Previous research indicates that mothers of adolescents with type 1 diabetes (T1D) consistently report high levels of stress related to managing their child’s care. Additionally, diabetes-related stress in mothers is associated with increased risk of depression and anxiety. However, the relationship between strategies used by mothers to cope with T1D-related stressors and psychological outcomes has not been thoroughly investigated. We aimed to assess whether the use of coping strategies was linked to symptoms of depression and anxiety in mothers caring for adolescents with T1D.

Methods
Female caregivers of adolescents with T1D (N=151, mean child age = 14.0+2.0, 56% female, 83% non-Hispanic White, HbA1c = 9.0+2.1%) completed the Patient Health Questionnaire (PHQ-9) to assess depressive symptoms, and the Generalized Anxiety Disorder Scale (GADS) to assess symptoms of anxiety. A score of ≥ 10 on either screener indicated clinically significant symptoms. To determine the use of primary control engagement coping (e.g., problem solving), secondary control engagement coping (e.g., positive thinking, acceptance), and disengagement coping strategies (e.g., avoidance), caregivers completed the Responses to Stress Questionnaire – T1D version.

Results
Maternal caregivers with clinically significant depressive symptoms reported lower use of primary control coping strategies (M=.20±.03) than those with minimal or mild depressive symptoms (M=.21±.04, t=-2.1, p=.040). In a multivariable regression analysis adjusting for demographics (child age, parent age, race, marital status, total income), we found that primary control coping (β=-.25) and secondary control coping (β=-.21, both p<.01) were significant predictors of PHQ-9 scores. Additionally, maternal caregivers with clinically significant symptoms of anxiety reported using less secondary control coping strategies (M=.23±.04) than other caregivers (M=.26±.05, t=-4.2, p<.001). The multivariable regression model adjusted for demographics indicated the use of secondary control coping was a significant predictor of GADS scores (β=-.44, p<.001). Disengagement coping strategies were not significantly related to maternal symptoms of depression or anxiety in our sample.

Conclusions
Our findings suggest that the use of primary and secondary control coping strategies may help mitigate diabetes-related stress in caregivers, emphasizing the need for targeted interventions.