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

描述（由申请人提供）：1型糖尿病（T1D）青少年必须平衡复杂的日常治疗方案，同时还要面对这个发育时期的情感，社会和学术需求。毫不奇怪，青少年焦虑和抑郁症状的风险增加，应对和解决问题的能力差，方案依从性差，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。虽然针对青少年不良行为和情绪功能的少数心理干预措施对疾病管理和结果产生了有益的影响，但没有预防计划为青少年提供行为技能和认知策略，以降低不良心理功能的风险和随着时间的推移产生负面健康结果的风险。因此，拟议的研究将测试宾夕法尼亚州韧性计划（PRP）的糖尿病特定适应，这是一个成熟的计划，证明了健康青年的韧性促进和抑郁预防，是否是T1D青少年预防计划的可行候选人。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测试了该计划（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果方面进行比较。我们将在两个研究中心招募280名T1D青少年，测量介质（即，变化机制）和基线、干预后和5次监测访视时的结果，时间跨度为24个月。我们的主要成果是预防抑郁症和血糖控制不佳。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的变化机制。这项研究的潜在影响不仅在于预防T1D青少年高危人群的抑郁症，这本身就是危险和昂贵的，而且还在于预防血糖控制不佳，这是T1D中常见的，昂贵的和危险的问题。通过预防抑郁症，我们改变了不遵守和不良健康结果的危险轨迹。此外，干预措施还培养了复原力技能，作为改善健康结果的保护机制。很少有预防性干预模式已经过测试，而且对于T1D青少年这一高危群体来说，根本不存在。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天地，并应减少临床护理的惊人成本，并预防未来的并发症。此外，我们的研究结果将推广到其他儿科慢性疾病，这些疾病在抑郁症和负面健康结果之间显示出类似的强关联。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RCT方面拥有互补的专业知识，我们被整合到具有强大基础设施的多学科团队中，以促进我们工作的成功，并且我们在这一人群中拥有丰富的临床经验和专业知识。 公共卫生相关性：1型糖尿病青少年患抑郁症状和糖尿病特异性负面健康结果的风险增加。虽然针对青少年不良行为和情绪功能的少数心理干预措施对疾病管理和结果产生了有益的影响，但没有预防计划为青少年提供减少这些风险所需的行为技能和认知策略。因此，拟议的研究将测试针对1型糖尿病青少年的适应性预防计划是否会随着时间的推移降低抑郁症状的风险和负面健康结果的风险。

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.