Relationship Between Diabetes Distress and Depressive Symptoms Among Parent–Child Dyads With Type 1 Diabetes in the Chinese Family Context: The Actor and Partner Effects Analysis

Diabetes distress significantly contributes to depressive symptoms in children with type 1 diabetes (T1D). Few studies have examined the bidirectional contributions of both parents' and children's diabetes distress to their own (actor effect) and each other's (partner effect) depressive symptoms within the family context. This study aimed to evaluate these actor and partner effects using the actor-partner interdependence model (APIM) and to identify factors associated with depressive symptoms among children with T1D and their parents in China. This cross-sectional study recruited 333 children (aged 8-12 years) with T1D and their parents via social media platforms using an online questionnaire. Data were collected on sociodemographic and clinical characteristics, diabetes distress, and depressive symptoms. APIM and hierarchical linear regression analyzes were conducted. Actor effects indicated that increased diabetes distress was associated with depressive symptoms in both children with T1D and their parents. Partner effects revealed that only children's diabetes distress was positively associated with parental depressive symptoms. The risk factor for children's depressive symptoms was elevated A1C levels. Greater parental depressive symptoms were associated with being a father (vs. mother), lower family income, children not receiving insulin pump therapy, elevated A1C levels (≥ 7.5%), and DKA episodes. These findings demonstrate the interdependence of diabetes distress and depressive symptoms within family dynamics. Understanding both individual and familial factors associated with depressive symptoms in parent-child dyads with T1D can inform family-centered interventions.