Communication and Coping: Addressing Mothers' Needs to Improve Outcomes in Adolescents with T1D

摘要 患有1型糖尿病的青少年的母亲会经历高度的抑郁症状，这会损害他们的 有效监测和管理糖尿病治疗的能力。鉴于青少年是高危人群 对于次优血糖控制--只有17%达到治疗目标--迫切需要新的 改善青少年T1D预后的干预措施。然而，之前针对青少年的行为干预 糖尿病患者并没有直接针对母亲的抑郁症状。以有效的干预措施为基础 在成人中治疗抑郁症，以及我们自己在这一人群中的试点工作，拟议的研究将使用严格的 评估认知-行为干预对1型青少年母亲的效果的方法 促进使用适应性应对策略和积极的育儿做法。结果来自我们的 初步研究表明，对青少年的生活质量和抑郁症状有显著的干预效果。在……里面 此外，母亲接受干预的青少年在 血糖控制，我们发现支持干预对中介变量的影响， 对母亲抑郁症状和家庭冲突的影响。本研究修订的目的是：1)评估 沟通与应对干预对糖尿病相关结局的影响2)效果评估 沟通与应对干预对心理社会结局的影响；3)探讨不同的影响 跨人口因素的干预。随机化的母亲沟通与应对 干预将通过电话接受个人认知行为治疗，以及访问 Facebook小组，以增加电话中涵盖的材料，并提供社会支持。母亲们被随机分配到 注意力控制条件将收到教育材料和电话签到，以及Facebook 拥有教育岗位的小组。青少年及其母亲将在基线时进行评估，之后再进行评估 干预时间分别为3个月、6个月、12个月。我们假设，母亲的青少年 接受干预将显示糖尿病结果的改善(即，血糖控制， 坚持)，以及心理社会结果(即，改善生活质量，减少抑郁症状) 与注意控制条件下的受试者相比。这种方法是创新的，它以产妇为目标 青少年1型糖尿病母亲的抑郁症状和父母参与的质量。 响应美国糖尿病协会的号召，解决糖尿病患者的心理社会需求 对于糖尿病及其家庭成员，拟议的项目有可能改善这两个方面的结果 患有1型糖尿病的青少年及其母亲。

ABSTRACT Mothers of adolescents with type 1 diabetes experience high levels of depressive symptoms, which impair their ability to monitor and manage diabetes treatment effectively. Given that adolescents are a high-risk population for suboptimal glycemic control – with only 17% meeting treatment goals - there is a critical need for novel interventions to improve outcomes in adolescents with T1D. Yet, previous behavioral interventions for youth with diabetes have not directly targeted maternal depressive symptoms. Building on effective interventions to treat depression in adults, and our own pilot work in this population, the proposed study will use a rigorous approach to evaluate the efficacy of a cognitive-behavioral intervention for mothers of adolescents with type 1 diabetes to promote the use of adaptive coping strategies and positive parenting practices. Results from our pilot study indicated significant intervention effects on adolescents’ quality of life and depressive symptoms. In addition, adolescents whose mothers received the intervention demonstrated promising improvements in glycemic control, and we found support for the effect of the intervention on mediating variables, with large effects on maternal depressive symptoms and family conflict. The revised aims of this study are to: 1) evaluate the effects of the Communication & Coping intervention on diabetes-related outcomes; 2) evaluate the effects of the Communication & Coping intervention on psychosocial outcomes; and 3) explore the differential impact of the intervention across demographic factors. Mothers who are randomized to the Communication & Coping Intervention will receive individual cognitive-behavioral therapy sessions by phone, as well as access to a Facebook group to augment the material covered in calls and provide social support. Mothers randomized to the Attention Control condition will receive educational materials and phone check-ins, as well as a Facebook group with educational posts. Adolescents and their mothers will be assessed at baseline and again post- intervention, at 3 months, 6 months, and 12 months. We hypothesize that the adolescents of mothers who receive the intervention will demonstrate improvements in diabetes outcomes (i.e., glycemic control, adherence), as well as psychosocial outcomes (i.e., improved quality of life, fewer depressive symptoms) compared to those in the attention control condition. This approach is innovative by targeting maternal depressive symptoms and the quality of parental involvement in mothers of adolescents with type 1 diabetes. Responding to the American Diabetes Association’s call to address the psychosocial needs of people with diabetes and their family members, the proposed project has the potential to improve outcomes in both adolescents with type 1 diabetes and their mothers.