The purpose of this application is complete a longitudinal study of the psychosocial and medical course of 95 children with insulin-dependent diabetes mellitus (IDDM) who have been under observation since IDDM-onset when they were 8-to-13-years old. Over the next few years, the cases will have reached adolescence; most will have been observed for at least the first 6 years of their IDDM and will be entering the period for diabetic complications; close to 40% are projected to have their first episode of major psychiatric illness by Year 6 of the IDDM; and a high proportion will have become noncompliant with their diabetic regimen. The central goals are to complete the analyses of the longitudinal data already collected, together with the psychiatric, psychosocial and medical data to be obtained at the exit interviews. Issues to be investigated are stated in the forms of hypotheses, predictive propositions or questions, and as a set of descriptive analysis. The issues to be examined include the relationship of psychiatric illness and psychologic adjustment to the onset of diabetic complications and metabolic control; the effect of the IDDM on the subjects' intelligence, academic achievement and self-esteem; the role of stressful life events in psychosocial and medical problems; the role of social support, competence, and self-esteem on compliance and medical aspects of IDDM. A special goal will be to identify base-line variables (assessed early during the course of IDDM) in order to predict longer term psychosocial and medical outcomes. Parental, familial, and sociodemographic variables will also be examined in regard to their effects on the outcomes of interest. The project entails a repeated measures design with a broad-based psychosocial assessment battery, including a semistructured psychiatric interview. Ss are evaluated once every 8-10 months. Medical variables are assessed independent of the psychosocial data and include measures of metabolic control and diabetic complications. This study will provide findings of import to pediatric teams by identifying salient psychosocial elements of IDDM and their relationship to aspects of the medical course.
