Resilience Promotion in Teens with Type 1 Diabetes: Preventing Negative Outcomes

描述（由申请人提供）：青少年1型糖尿病（T1D）必须平衡复杂的日常治疗方案，同时也要面对这一发展时期的情感、社会和学业需求。毫不奇怪，青少年出现焦虑和抑郁症状的风险增加，应对和解决问题的能力差，对治疗方案的依从性差，以及糖尿病特有的负面健康结果，如血糖控制不佳和复发性糖尿病酮症酸中毒。尽管一些针对青少年不良行为和情绪功能的心理干预措施显示出对疾病管理和结果的有益影响，但目前还没有一项预防计划能够让青少年掌握行为技能和认知策略，从而显示出随着时间的推移，减少不良心理功能的风险和负面健康结果的风险。因此，本研究将测试Penn Resilience Program （PRP）的糖尿病特异性适应是否可以作为T1D青少年预防方案的可行候选方案。Penn Resilience Program （PRP）是一个完善的方案，证明了健康青少年的恢复力促进和抑郁预防。我们的研究团队在进行这项研究方面处于独特的地位，因为我们已经适应并试点了该计划（PRP T1D）。我们将采用随机对照设计，并将PRP T1D与教育干预（EI）在恢复力特征、抑郁症状、依从性行为和血糖结局方面进行比较。我们将在两个地点招募280名患有T1D的青少年，在基线、干预后和另外24个月的5次监测访问中测量中介因素（即变化机制）和结果。我们的主要结果是预防抑郁和亚理想血糖控制。此外，我们将评估弹性和行为依从性是否作为我们主要结果变化的机制。本研究的潜在影响不仅在于预防青少年T1D患者的抑郁，这本身是危险和昂贵的，而且还在于预防T1D患者常见、昂贵和危险的血糖控制不佳问题。通过预防抑郁，我们改变了不遵守规定和健康状况不佳的危险轨迹。此外，该干预措施还培养适应能力，作为改善健康结果的保护机制。很少有预防干预模型被测试过，而且没有针对这一高危青少年T1D群体的模型。这项研究的结果将在对T1D预防机制的科学理解方面开辟新的领域，并应在未来减少临床护理的惊人成本和预防并发症。此外，我们的结果将推广到其他儿科慢性疾病，这些疾病显示出抑郁症与负面健康结果之间类似的强大关联。我们的研究团队在开展这项研究方面具有独特的优势，因为我们在开展随机对照试验方面拥有互补的专业知识，我们融入了具有强大基础设施的多学科团队，以促进我们工作的成功，我们在这一人群方面拥有丰富的临床经验和专业知识。

DESCRIPTION (provided by applicant): Adolescents with type 1 diabetes (T1D) must balance a complex daily treatment regimen while also facing the emotional, social and academic demands of this developmental period. Not surprisingly, adolescents are at increased risk for anxiety and depressive symptoms, poor coping and problem-solving skills, poor regimen adherence, and negative diabetes-specific health outcomes such as suboptimal glycemic control and recurrent diabetic ketoacidosis. Although a handful of psychological interventions targeting adolescents' poor behavioral and emotional functioning demonstrate beneficial effects on disease management and outcomes, no prevention programs exist that equip adolescents with behavioral skills and cognitive strategies shown to reduce both the risk of poor psychological functioning and the risk of negative health outcomes over time. Therefore, the proposed study will test whether a diabetes-specific adaptation of the Penn Resilience Program (PRP), a well-established program that demonstrates resilience promotion and depression prevention in healthy youth, is a viable candidate for a prevention program for adolescents with T1D. Our research team is in a unique position to conduct this research because we have adapted and pilot tested this program (PRP T1D). We will employ a randomized, controlled design and compare PRP T1D to an educational intervention (EI) on resilience characteristics, depressive symptoms, adherence behaviors, and glycemic outcomes. We will recruit 280 adolescents with T1D across two sites, measuring mediators (i.e., mechanisms of change) and outcomes at baseline, post-intervention, and at five surveillance visits spanning an additional 24 months. Our primary outcomes are prevention of depression and suboptimal glycemic control. Further, we will evaluate whether resilience and behavioral adherence function as mechanisms of change for our primary outcomes. The potential impact of this study is not only in preventing depression in this high risk population of youth with T1D, which is dangerous and costly by itself, but also in preventing suboptimal glycemic control, a common, expensive, and dangerous problem in T1D. By preventing depression, we alter dangerous trajectories toward nonadherence and poor health outcomes. Further, the intervention builds resilience skills which serve as protective mechanisms for improving health outcomes. Very few preventive intervention models have been tested, and none exist for this high risk group of youth with T1D. Results from this study will break new ground in the scientific understanding of the mechanisms of prevention in T1D and should reduce the staggering costs of clinical care and prevent complications in the future. In addition, our results will be generalizable to other pediatric chronic conditions which show similarly robust associations between depression and negative health outcomes. Our research team is uniquely positioned to carry out this research as we have complimentary expertise in conducting RCTs, we are integrated in to multidisciplinary teams with strong infrastructures to promote success in our work, and we have substantial clinical experience and expertise with this population. PUBLIC HEALTH RELEVANCE: Adolescents with type 1 diabetes are at increased risk for depressive symptoms and negative diabetes-specific health outcomes. Although a handful of psychological interventions targeting adolescents' poor behavioral and emotional functioning demonstrate beneficial effects on disease management and outcomes, no prevention programs exist that equip adolescents with behavioral skills and cognitive strategies necessary to reduce these risks. Therefore, the proposed research will test whether a diabetes-specific adaptation of a resilience promoting prevention program for adolescents with type 1 diabetes will reduce both the risk of depressive symptoms and the risk of negative health outcomes over time.