The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: Findings from a randomized, controlled trial
The effects of multisystemic therapy on diabetes stress among adolescents with chronically poorly controlled type 1 diabetes: Findings from a randomized, controlled trial
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DOI：
10.1542/peds.2005-0638
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发表时间：
2005-12-01
期刊：
影响因子：
8
通讯作者：
Cakan, N
中科院分区：
文献类型：
--
作者：
Ellis, DA;Frey, MA;Cakan, N
目标。本研究的目的是确定多系统治疗（MST），一种强化的，以家庭为基础的心理治疗，是否可以减少慢性控制不良的青少年1型糖尿病患者的糖尿病相关压力。应激也被评估为MST对依从性和代谢控制的影响的中介。一项随机对照试验对127名患有1型糖尿病和慢性代谢控制不良的青少年（研究入组时和过去1年血红蛋白A1c水平为bb0 = 8%）进行了研究，这些青少年在中西部一个主要城市的儿童医院接受了糖尿病治疗。随机分配到MST组的参与者接受了类似6个月的治疗。在基线和7个月后测试（即治疗终止）收集数据。通过自我报告问卷来评估糖尿病相关压力的变化。我们使用结构方程模型来检验应激水平的变化在多大程度上介导了MST干预改善依从性和代谢控制的能力。在意向治疗分析中，参与MST与糖尿病相关应激的显著降低相关。适度的测试没有发现年龄、性别或种族的显著影响，这表明干预在减少所有参与者的糖尿病压力方面同样有效。然而，结构方程模型并不支持糖尿病应激作为MST改善健康结果的机制。相反，最终模型表明MST通过提高方案依从性来改善代谢控制。强化的、以家庭为基础的心理治疗可以减少慢性控制不良的1型糖尿病青少年的糖尿病相关压力。这种压力的减轻对糖尿病青少年的心理健康很重要，因为他们未来的健康并发症风险很高。
Objective. The goal of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes. Stress was also evaluated as a mediator of the effect of MST on adherence and metabolic control.Methods. A randomized, controlled trial was conducted with 127 adolescents with type 1 diabetes mellitus and chronically poor metabolic control (hemoglobin A1c levels of >= 8% at study enrollment and for the past 1 year) who received their diabetes care in a children's hospital located in a major Midwestern city. Participants assigned randomly to MST received treatment for similar to 6 months. Data were collected at baseline and at a 7-month posttest (ie, treatment termination). Changes in diabetes-related stress, as measured with a self-report questionnaire, were assessed. Structural equation models were used to test the degree to which changes in stress levels mediated the ability of the MST intervention to improve adherence and metabolic control.Results. In intent-to-treat analyses, participation in MST was associated with significant reductions in diabetes-related stress. Tests for moderation found no significant effects of age, gender, or ethnicity, which suggests that the intervention was equally effective in reducing diabetes stress for all participants. However, structural equation modeling did not provide support for diabetes stress as the mechanism through which MST improved health outcomes. Rather, the final model suggested that MST improved metabolic control through increased regimen adherence.Conclusions. Intensive, home-based psychotherapy reduces diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes. Such stress reductions are important for the psychological wellbeing of a subset of youths with diabetes who are at high risk for future health complications.