Short-term impact of a stress management and health promotion program on perceived stress, parental stress, health locus of control, and cortisol levels in parents of children and adolescents with diabetes type 1: a pilot randomized controlled trial

Explore (NY). Mar-Apr 2014;10(2):88-98. doi: 10.1016/j.explore.2013.12.004. Epub 2013 Dec 17.


Background: Parents of children and adolescents with diabetes type 1 (DT1) usually experience high stress levels, as they have to cope with multiple demands in their everyday life. Different complex interventions have been implemented, which sometimes have led to opposite results.

Objective: The purpose of this study was to assess stress levels in parents of children and adolescents with DT1 and to evaluate the effectiveness of a stress management program (progressive muscle relaxation combined with diaphragmatic breathing) in reducing perceived and parenting stress, increasing internal locus of control, promoting healthy lifestyle, and normalizing cortisol levels.

Study design: Randomized controlled trial.

Methods: A total of 44 parents were randomly assigned to the intervention group (performing relaxation for eight weeks, n = 19) and control group (n = 25). Pre-post measurements included cortisol levels, lifestyle characteristics, perceived stress, perception of health, and parenting stress.

Results: A statistically significant decrease in perceived stress (from 27.21 to 19.00, P = .001), as well as in parenting stress (from 85.79 to 73.68, P = .003), was observed in the intervention group. A statistically significant difference was found in perceived stress between the two groups after the intervention (Dmean = 6.64, P = .010). No significant difference was revealed between or within the groups in cortisol levels. Significant improvement was reported by the subjects of the intervention group in various lifestyle parameters.

Conclusions: Relaxation techniques seem to have a positive impact on stress and on various lifestyle factors in parents of children and adolescents with DT1. Future research on long-term benefits of an intervention program comprising of various relaxation schemes is warranted.

Keywords: Diabetes type 1; cortisol; parenting stress; perceived stress; stress management.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adaptation, Psychological
  • Adolescent
  • Adult
  • Aged
  • Breathing Exercises
  • Child
  • Diabetes Mellitus, Type 1*
  • Female
  • Health Promotion*
  • Humans
  • Hydrocortisone / metabolism*
  • Internal-External Control*
  • Life Style
  • Male
  • Middle Aged
  • Muscle Relaxation
  • Parenting / psychology*
  • Parents / psychology
  • Perception
  • Pilot Projects
  • Program Evaluation
  • Relaxation / psychology*
  • Self Efficacy
  • Stress, Psychological / therapy*


  • Hydrocortisone