Spiritual Coping and Quality of Life in Adolescents with Chronic Illness

描述（由申请人提供）：背景：宗教/精神应对，即个人如何利用宗教/精神来应对压力源，如慢性疾病，已经与成年人的身体和心理结果的改善有关，但对患有慢性疾病（如哮喘）的青少年的宗教/精神应对知之甚少。目标：作为一名对精神和应对青少年慢性疾病感兴趣的临床健康心理学家，本奖项的具体目标是：A)提高我在测量开发和研究方法方面的技能，以有效评估宗教/精神因素与青少年健康结果之间的关系；b)验证在青少年中广泛使用的2种成人灵性测量方法，以及c)开发和试点测试一种基于灵性的干预措施，以评估在患有慢性疾病的青少年中使用的可行性。培训：为了我的职业发展，我计划在具体的定性和定量方法、数据分析和论文/拨款准备方面进行进一步的培训。培训活动还将包括课程作业、辅助数据分析指导和临床工作。我的导师团队由精神、健康相关生活质量、青少年医学、慢性病和研究方法领域的顶尖专家组成：Joel Tsevat，医学博士，公共卫生硕士（主要共同发起人），Susan Rosenthal，博士（共同发起人），Maria Britto，医学博士，公共卫生硕士，Kenneth Pargament，博士和Paul Succop，博士。研究设计/方法：研究计划包括3个项目，共涉及165例青少年哮喘门诊患者。项目1是一项对25名青少年进行的质性研究，使用半结构化访谈来确定：a)青少年是否可以理解2种广泛使用的成人灵性测量，b)使用的宗教/精神应对策略的范围和深度，以及c)青少年使用宗教/精神应对策略的原因。项目二是对115名青少年进行定量前瞻性研究，使用问卷调查：A)利用探索性因子分析和其他统计技术评估2种成人灵性测量的心理测量特性；b)检验宗教信仰/灵性、宗教/精神应对与健康结果（即健康相关的生活质量、抑郁/焦虑）之间的横断面和纵向关系，并使用结构方程模型评估调节变量（如发育阶段/年龄）和潜在的中介途径(如：社会支持)。项目3是一项有25名青少年参与的试点可行性研究，旨在检验从项目1和项目2的研究结果中发展出来的基于精神的干预措施是否适用于患有哮喘的青少年。研究结果将为纵向随机对照试验的R01应用提供信息，该试验比较了基于精神的干预与标准的社会心理干预，以改善患有慢性疾病的青少年的健康结果。

DESCRIPTION (provided by applicant): Background: Religious/spiritual coping, that is, how individuals use religion/spirituality to deal with a stressor like a chronic illness, has been associated with improved physical and psychological outcomes in adults, but little is known about religious/spiritual coping in adolescents with a chronic illness, such as asthma. Objectives: As a clinical health psychologist interested in spirituality and coping in adolescents with chronic illness, the specific objectives for this award are to: a) enhance my skills in measurement development and research methodology to assess effectively the relationships between religious/spiritual factors and health outcomes for adolescents, b) validate 2 widely-used adult spirituality measures for use in adolescents, and c) develop and pilot test a spiritually-based intervention to assess feasibility of use in adolescents with a chronic illness. Training: For my career development, I plan to take further training in specific qualitative and quantitative methods, data analysis, and manuscript/grant preparation. Training activities will also include coursework, mentored secondary data analyses, and clinical work. My mentorship team is comprised of leading experts in the fields of spirituality, health-related quality of life, adolescent medicine, chronic illness, and research methodology: Joel Tsevat, MD, MPH (primary co-sponsor), Susan Rosenthal, PhD (co-sponsor), Maria Britto, MD, MPH, Kenneth Pargament, PhD, and Paul Succop, PhD. Research Design/Methods: The research plan consists of 3 projects involving a total of 165 adolescent outpatients with asthma. Project 1 is a qualitative study with 25 adolescents using semi-structured interviews to determine: a) whether 2 widely-used adult spirituality measures are understandable by adolescents, b) the range and depth of religious/spiritual coping strategies used, and c) why adolescents use religious/spiritual coping strategies. Project 2 is a quantitative prospective study with 115 adolescents using questionnaires to: a) assess the psychometric properties of 2 adult spirituality measures utilizing exploratory factor analysis and other statistical techniques, and b) examine the cross-sectional and longitudinal relationships among religiosity/spirituality, religious/spiritual coping, and health outcomes (i.e., health-related quality of life, depression/anxiety), and use structural equation modeling to assess moderating variables (e.g., developmental stage/age) and potential mediating pathways (e.g., social support). Project 3 is a pilot feasibility study with 25 adolescents to examine whether a spiritually-based intervention developed from findings from Projects 1 and 2 is feasible for use in adolescents with asthma. Findings will inform an R01 application of a longitudinal randomized controlled trial comparing a spiritually-based intervention versus a standard psychosocial intervention to improve health outcomes in adolescents with chronic illness.