Self-Disclosure, Secrecy, and Parental Knowledge in Caucasian and Latino Youth Managing Type 1 Diabetes

A qualitative and quantitative examination of self-disclosure and secrecy was conducted to gain insight into their connections with parental knowledge and adolescent type 1 diabetes management. This is the first study to examine adolescent diabetes-related disclosure and secrecy in a diverse sample while considering the broader context of the parent-adolescent relationship. Participants were Caucasian and Latina mothers and their adolescents with type 1 diabetes (N = 118 dyads, 48% Latino, 54% female adolescents, 10 to 15 years old, illness duration > 1 year, 25% on insulin pump). Qualitative data consisted of coding adolescent responses to interview questions about two self-identified diabetes-related stressful events: “Does your mother (father) know about this stressful event?” and “As far as you know, how did your mother (father) find out?” Quantitative data included adolescent responses to questionnaires measuring diabetes self-disclosure to and secrecy from mothers and fathers, maternal and paternal knowledge, maternal and paternal acceptance (i.e. relationship quality), adherence, and depressive symptoms. Mothers also completed a maternal knowledge questionnaire and HbA1c was extracted from medical records. Sociodemographic data were collected by adolescent and maternal reports. Qualitative analysis revealed 10 ways in which parents came to know of their adolescents’ diabetes-related stressful events. For both stressful events, adolescent disclosed to parent was the most common code for mothers’ and fathers’ knowledge, mother present-observes was the second most frequent code for mothers, and mother discloses to father was the second most frequent code for fathers. Self-disclosure and secrecy predicted adolescent reports of maternal and paternal knowledge, whereas only self-disclosure and not secrecy predicted maternal reports of her own knowledge. Self-disclosure but not secrecy was associated with HbA1c, and secrecy but not self-disclosure was related to adherence, independent of both parental knowledge and acceptance. Although higher self-disclosure to mothers and lower secrecy to fathers were correlated with lower depressive symptoms, these associations were not statistically reliable after covarying parental acceptance and/or knowledge. These results provide a more thorough understanding of the relationship between adolescent self-disclosure and secrecy with health outcomes, raise questions about the focus on parental monitoring in interventions to improve diabetes management during adolescence, and point to important directions for future research.