Akdogan, RidvanDuken, Mehmet Emin2026-03-012026-03-0120260882-596310.1016/j.pedn.2026.01.0402-s2.0-105029305942https://doi.org/10.1016/j.pedn.2026.01.040https://hdl.handle.net/20.500.14720/29835Background: Childhood type 1 diabetes poses substantial challenges for disease management and psychosocial well-being. Caregivers play a central role in diabetes care, and their psychological distress and caregiving burden may negatively influence children's mental health and illness-related outcomes. This study aimed to examine the associations between caregivers' psychological well-being and caregiving burden and the mental health and illness attitudes of children with type 1 diabetes. Methods: This cross-sectional study included 129 child-caregiver dyads (caregivers were all mothers) of children aged 10-18 years with type 1 diabetes who were followed at a pediatric endocrinology outpatient clinic in Turkey. Data were collected using validated questionnaires and analyzed using structural equation modeling. Results: Caregivers' depression, anxiety, stress, and caregiving burden were significantly associated with children's emotional, behavioral, and social difficulties (r = 0.51-0.77, p < 0.001). Structural equation modeling supported a sequential pathway in which caregiving burden predicted parental psychological distress, which in turn influenced children's illness attitudes and psychosocial outcomes (beta = 0.52-0.66, p < 0.001). Conclusion: Caregiver mental health plays a critical role in children's illness perception and psychosocial adjustment. Supporting caregivers may indirectly improve coping and psychosocial well-being in children with type 1 diabetes. Practice implications: Pediatric and family nurses should incorporate caregiver psychological assessment and support into diabetes management. Family-centered interventions addressing caregiver distress and burden may enhance children's coping capacity, illness attitudes, and psychosocial well-being. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.eninfo:eu-repo/semantics/closedAccessCaregiver BurdenChild Mental HealthDiabetes Mellitus Type 1Family NursingPsychological StressArticle