from the present study. The results were based on self reported paper and pencil
measures with the exception of HbA1c level. One difficulty with self-reported measures is that the information collected is given by the participant only and the participant might give information that is perceived as socially desirable. Future research might want to collect information relevant to diabetes management and separation-
individuation from different sources including the young person, parents, and health professionals working with the young person.
A cross sectional design was utilised in the present study and so it was not possible to measure the changes in separation-individuation and diabetes management across time. Future research could include longitudinal designs that would allow investigation of the effects of separation-individuation on diabetes management across time during the developmental stages of adolescence and young adulthood into
separation-individuation process and diabetes management across time and in different developmental stages.
HbA1c level was collected the same day as the questionnaires were completed and as such this measure of HbA1c level is only able to provide a limited view of how factors examined in the present study are related to the young women’s metabolic control (Palmer et al., 2009). All the young women with Type 1 Diabetes participating in the present study knew their HbA1c level at the time of completing the questionnaires and this may have influenced their responses to the diabetes management measure in that respondents who perceived their HbA1c level as “good” might have answered that they engage in recommended self care behaviours more often than was the case. It is also possible that in the period immediately prior to their clinic appointment all participants attempt to improve their diabetes management.
Generalizability of the statistical findings should be made with care due to factors such as no information about SES background, the recruitment process, and a small sample of participants with Type 1 Diabetes. Previous overseas research has found a link between SES of the young person’s family and metabolic control with lower SES being related to poorer metabolic control in children , adolescents (Pereira et al., 2008), and adults (Jiang, Andrews, Stryer, & Friedman, 2005). As this information was not collected in the present study it is difficult to make assumptions of how the results may generalize to different populations of young women with Type 1 Diabetes. However, it is also important to recognise the impact of low SES may not be so evident in
Australian samples because of availability of free health care.
As recruitment of young women with a diagnosis of Type 1 Diabetes took place during routine check ups at diabetes clinics only young women with diabetes who attended appointments at regular intervals were included in the present study. Thus,
generalization of the results to young women who do not regularly attend medical appointments in relation to their diabetes cannot be assumed. The recruitment process also affected the number of young women with Type 1 Diabetes who participated in the present study. It was not possible to send out letters to all the young women with Type 1 Diabetes who were registered with a specific diabetes clinic due to limited resources. Mail outs inviting all patients registered with a hospital or clinic have been used as a recruitment procedure in previous studies and have resulted in recruitment of larger samples (Ciechanowski et al., 2005).
Separation-individuation and diabetes management is of course relevant and important in males as well as females. Another limitation of the present study is that only young women were recruited. Sex differences in young adult roles and in autonomous behaviour have been reported in the literature (P. Cohen et al., 2003). Literature on the separation-individuation process further suggests that there are differences between male and females in terms of how they view the importance of relationships with parents and suggests that relationship factors may play a more important role for women (Lapsley et al., 1989). In a study of American university students males were reported to have greater difficulties in the separation-individuation process compared to females (Lapsley et al., 2001). Future research might want to explore gender differences in the separation-individuation process in an Australian sample of adolescents and young adults.
Furthermore, this study only investigated the young person’s perception of maternal attachment, care, and overprotection. Including parental factors related to fathers and asking about paternal attachment may provide important information in relation to the process of separation-individuation and factors important for diabetes management in the young person.
5.6 Contributions of the Study
The present study has contributed to the research literature on separation- individuation and diabetes management in young Australian adult women. Very few studies have explored the general factors influencing the important developmental process of separation-individuation in adolescence and young adulthood and there have been no Australian studies that have examined separation-individuation specifically in young adult women. The results of the present study suggested that depressive
symptoms together with the parental factor perceived maternal care and attachment to peers were important predictors of the level of separation-individuation in young women. Such findings may have implications for psychological work undertaken with this population.
While a number of studies have alluded to changes in parenting when a child has been diagnosed with a chronic illness there have been no studies that have considered whether being diagnosed with Type 1 Diabetes would influence separation-
individuation in young adults. Even though the results of the present study could not satisfactorily answer this question due to the small number of participants diagnosed with Type 1 Diabetes in early childhood, correlations between depressive symptoms, acceptance of having diabetes, and separation-individuation suggested that there is a relationship between more depressive symptoms, a less resolved separation-
individuation process, and poorer acceptance of having diabetes.
Correlational analysis revealed that more depressive symptoms and less
acceptance of having diabetes were associated with poorer diabetes management in this sample of young women with Type 1 Diabetes which is consistent with findings from previous studies. However, these factors did not reliably predict the variance of diabetes management when tested via a hierarchical regression. Nevertheless, screening for
depressive symptoms in young people as part of the professional care they receive seems important as this may help to identify people who will have difficulties managing their diabetes and who can then be offered treatment (McGrady et al., 2009).
Research in the area of diabetes management in young people is of great importance as poor diabetes management can result in serious health risks. Generally research attention has been focused on adolescents or adults of varying ages. The inclusion of young adults as part of samples covering the complete adult spectrum may mask the issues that arise for young people in the transitional period between
adolescence and adulthood. The current study aimed to redress this neglect by focusing specifically on this important developmental period.