الفهرس 
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Abstract
Type 1 diabetes is one of the most common chronic childhood diseases. It can be diagnosed at any age; peaks in onset occur between 5 and 7 years of age and near puberty. Type 1 diabetes mellitus (T1DM) accounts for ∼10% of all diabetes cases, and the incidence rate of childhood T1DM has risen worldwide by ∼2.8%–4.0% each year in the past decades.
Caring for a child with T1DM has been described as an overwhelming experience, requiring constant vigilance. Parents must come to terms with having a child with a life-threatening illness and carrying out a labor-intensive and complicated daily regimen.
Parents live with constant worry about hypoglycemia or hyperglycemia, heightened feelings of responsibility for their child’s health, and the desire to promote optimal growth and development
There is considerable research on the prevalence of parental psychological stress and the impact of such stress on child and family outcomes.
Although the majority of parents of children with T1DM adjust well, approximately 20% to 30% of parents report clinically significant distress, which has been defined as stress (life stress or parenting stress) and symptoms of anxiety, depression, and/or posttraumatic stress
In parents of children with T1DM, psychological stress has been shown to affect family communication, increase family conflict, decrease the ability to parent effectively, negatively affect child psychological adjustment, and contribute to poor parental mental and physical health.
Understanding the experience of parenting a child with T1DM can provide insight into the challenges and needs of parents, thus informing the development of parental and/or family interventions.
Therefore, this study was designed to assess psychological distress in parents of children with T1DM in comparison to parents of non-diabetic children and to assess impact of parent’s stress on control of diabetes in their children.
This comparative cross-sectional study was conducted on 105 parents aged from 25 to 45 years for children aged from 2 to 5 years diagnosed with T1DM enrolled from Diabetes Clinic as cases group, compared to 105 parents of non-diabetic children as control group matching in age and gender recruited from general pediatric clinic, Ain Shams University Hospitals, Cairo, Egypt.
Inclusion criteria of group A (cases group):
• Parents of diabetic children diagnosed by professional endocrinologist as fasting plasma glucose greater than or equal to 126 mg/dl or 2 h postprandial sugar greater than or equal to 200 mg/dl or HbA1c greater than or equal to 6.5% according to American Diabetes Association (2018).
• Age of parents from 25 to 45 years.
• Age of child from 2 to 5 years.
• Children of both genders.
Inclusion criteria of group B (control group):
• Age of parents from 25 to 45 years.
• Age of child from 2 to 5 years.
• Children of both genders.
Exclusion criteria of both groups:
• Presence of co-morbid medical, psychiatric or developmental condition among the parents.
• Parents diagnosed with a mental illness.
• Parents not primarily responsible for the care of the child during his illness.
• Parents who refuse to participate in the study.
The tools used in the study:
1. History taking including parent’s and child’s demographic data: age, gender, family socioeconomic level, parents’ jobs and parent marital status.
2. Laboratory assessment in children of group A, to assess the degree of diabetic control. Also onset and duration of T1DM in the enrolled children, type of insulin regimen (e.g., number of injections prescribed or insulin pump therapy), as well as frequency of daily blood glucose checks were reported.
3. Assessment of parental stress, by using Arabic version of Cohen Perceived Stress Scale 10 [PSS].
4. Assessment of parental anxiety, by using Arabic version of Hamilton Anxiety Rating Scale HAM-A.
5. Assessment of parental depression, by using Arabic version of Beck Depression Inventory-II (BDI-II).
Summary of Our Results
• In comparison to the control group, there was a notable increase in the proportion of parents experiencing moderate stress within the cases group.”
• While there was no statistically significant difference between the two groups in terms of anxiety assessed by the Hamilton Anxiety Rating Scale, there was an increase in the percentage of parents exhibiting severe depression, assessed by the Beck Depression Inventory II, within the cases group (25.7%) compared to the control group (1%).”
• Parents of younger children diagnosed with Type 1 diabetes experienced a rise in their stress levels compared to those with older children.
• The study found no statistically significant relation between the duration of diabetes in months and either the degree of stress, measured by the Cohen Perceived Stress Scale, or depression, assessed by the Beck Depression Inventory II. While children whose parents had very severe anxiety showed a significant relation with the duration of diabetes compared to children with parents experiencing milder forms of anxiety.
• Parents experiencing severe stress suffered from very severe anxiety and severe depression compared to those with mild or moderate stress levels. This indicates a strong association between parental stress, anxiety, and depression.
• Parents with moderate to severe or very severe anxiety tended to have younger children with diabetes compared to parents with mild or mild to moderate anxiety. This indicates that anxiety levels may be higher among parents of younger diabetic children. Furthermore, no significant relationship was observed between the degree of anxiety and the gender of the children.
• Children of parents experiencing moderate and severe depression were found to have a statistically significant lower mean age compared to those with parents not experiencing such degree of depression.
• The study uncovered a statistically significant positive correlation between the perceived stress scale and both the Hamilton Anxiety Rating Scale and the Beck Depression Inventory Scale. Additionally, there was a statistically significant positive correlation between the Hamilton Anxiety Rating Scale and the Beck Depression Inventory Scale.
• The severity of stress, anxiety, and depression each showed a significant association with a higher percentage of uncontrolled diabetes among children