Introduction

Diabetes is one of the most common chronic diseases in childhood and adolescence, threatening the lives and health of patients [2] and increasing the risk of substance abuse [3]. Substance abuse is a multidimensional biological, psychological, social, and spiritual phenomenon in which several internal and external factors are involved [7]. Psychological factors associated with substance abuse include depression and stress [8]. Research has shown an association between substance abuse and depression and stress [15-18]. Conflict resolution and problem solving methods play an effective role in solving problems [22]. Different studies have indicated the relationship of stress and depression with conflict resolution and problem solving skills [27-30] and the relationship of conflict resolution and problem solving skills with substance abuse [32, 33]. This study aimed to examine the effect of stress and depression on substance abuse of adolescents with diabetes through mediation by conflict resolution and problem solving skills.

Materials and Methods

This is a descriptive/correlational study. The study population consists of all adolescents with diabetes who were are members of the Diabetes Association in Urmia city and those referred to Imam Khomeini Hospital in this city in 2019. Of these, 206 patients were determined using Structural Equation Modeling (SEM) and then selected using a purposive sampling method after obtaining informed consent from them. Inclusion criteria for them were: having diabetes, reading and writing literacy, physical health, and not experiencing stressful events such as death and divorce in the past three months. On the other hand, exclusion criteria were: having psychiatric disorders and not using the related medications, unwillingness to complete questionnaire or returning them incomplete. Data collection tools were: Substance Abuse Subtle Screening Inventory adolescent version, Beck’s Depression Inventory, The Perceived Stress Scale, Problem Solving Inventory, and Conflict Resolution Style Inventory. Collected data were analyzed in SPSS V. 21 and LISREL applications by using descriptive (frequency, mean, standard deviation) and inferential (Pearson correlation test, and SEM) statistics at the significance level of P<0.05.

Results

Of 206 participants, 110 were boys (53.40%) and 96 girls (46.60%). The age range of 44 subjects was 11-13 years (21.36%); for 69, 16-16 years (33.49%), and for 93, 17-19 years (45.15%). The relationship of substance abuse with depression and stress was positive and significant, and its relationship with conflict resolution and problem solving skills was negative and significant (P<0.01). All the fit indices indicated the good fit of the substance abuse reduction model in diabetic adolescents. Depression and stress variables were able to predict 13% of changes in problem-solving skills and 9% of changes in conflict resolution skills. The four variables were able to predict 46% of changes in substance abuse.

The results of SEM analysis showed that the direct effect of depression (β=0.02) and stress (β=0.04) on substance abuse was not significant (P>0.05); however, the direct effect of depression (β=-0.23) and stress (β=-0.24) on problem solving skills, and the direct effect of depression (β=-0.16) and stress (β=-0.23) on conflict resolution skills, and the direct effect of problem solving (β=-0.52) and conflict resolution (β=-0.19) on substance abuse were significant. Moreover, the indirect effect of depression through problem solving (β=0.13) and through conflict resolution (β=0.04) on substance abuse, and the indirect effect of stress through problem solving (β=0.13) and through conflict resolution (β=0.06) on substance abuse were significant (P<0.05) (Tables 1 & 2).

Discussion

The findings showed that the direct effect of depression and stress on problem-solving and conflict resolution skills in diabetic adolescents was negative and significant. This is consistent with the results of Heydari, Bayani et al., Sorati, and Ozkan [27-30]. People with depression and stress are prone to problems and lack of appropriate solutions for them due to emotional, behavioral, cognitive, and emotional problems. 

The direct effect of depression and stress on substance abuse in diabetic adolescents was not significant. This was against the results of Mohammad Nia and Mashhadi, Akbari and Amoupour, Olafsdottir et al., and Esmaeelzadeh et al. [15-18]. This discrepancy may be due to the difference in study population. All of these studies were performed on school students, college students, and people without the disease, while the present study was performed on diabetic adolescents. These groups appear to have less tendency towards substance use than patients who have a problem called diabetes.

The direct effect of conflict resolution and problem-solving skills on substance abuse of study samples was negative and significant. This is consistent with the findings of Jaffee and D’Zurilla [32], and Nasrazadani et al. [33]. People who have good conflict resolution and problem-solving skills are less likely to have stress than those no such skills. These skills refer to a cognitive-behavioral process that provides a variety of new and appropriate answers to deal with problematic situations and provides the basis for increasing the possibility of choosing the best and most effective response. Overall, it was concluded that depression and stress increase substance abuse in diabetic adolescents by reducing their conflict resolution and problem-solving skills.

Ethical Considerations

Compliance with ethical guidelines

All ethical principles were considered in this study including obtaining informed consent from participants, confidentiality of their information, and explaining study process to them. Also this study ethically approved in Faculty of Paramedicine,Urmia Branch, Islamic Azad University (Code: IR.IAU.URMIA.REC.1397.022)

Funding

The present paper was extracted from the MSc thesis of the first author, Department of Psychology, Urmia Branch, Islamic Azad University.

Authors' contributions

All authors met the writing standards based on the recommendations of the International Committee of Medical Journal Editors (ICMJE).

Conflicts of interest

The authors declare no conflict of interest.

Acknowledgements

The authors would like to thank the Deputy for Research of Islamic Azad University of Urmia branch, Urmia Diabetes Association, Imam Khomeini Hospital, diabetes specialists

 

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