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

描述（由申请人提供）：患有 1 型糖尿病 (T1D) 的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、社交和学业需求。毫不奇怪，青少年出现焦虑和抑郁症状、应对和解决问题的能力差、治疗方案依从性差以及糖尿病特有的负面健康结果（例如血糖控制不佳和复发性糖尿病酮症酸中毒）的风险增加。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，但目前还没有为青少年提供行为技能和认知策略的预防计划，这些项目已证明可以随着时间的推移降低心理功能不良的风险和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复原力计划 (PRP) 的糖尿病特异性适应性调整是否是针对 1 型糖尿病青少年的预防计划的可行候选方案。PRP 是一项完善的计划，可证明健康青少年的复原力提升和抑郁症预防。我们的研究团队在开展这项研究方面处于独特的地位，因为我们已经调整并试点了该计划（PRP T1D）。我们将采用随机对照设计，并将 PRP T1D 与教育干预 (EI) 在复原力特征、抑郁症状、依从行为和血糖结果方面进行比较。我们将在两个地点招募 280 名 T1D 青少年，测量基线、干预后以及为期 24 个月的五次监测访问的中介因素（即变化机制）和结果。我们的主要结果是预防抑郁症和次优血糖控制。此外，我们将评估弹性和行为依从性是否可以作为我们主要结果的改变机制。这项研究的潜在影响不仅在于预防 1 型糖尿病青少年高危人群的抑郁症（抑郁症本身就危险且成本高昂），而且还在于预防血糖控制不佳，这是 1 型糖尿病中常见的、昂贵且危险的问题。通过预防抑郁症，我们可以改变不依从和不良健康结果的危险轨迹。此外，干预措施还可以培养复原力技能，作为改善健康结果的保护机制。经过测试的预防性干预模型非常少，而且针对这一患有 T1D 的高危青少年群体，目前还没有任何模型存在。这项研究的结果将为对 T1D 预防机制的科学理解开辟新天地，并应减少临床护理的惊人成本并预防未来的并发症。此外，我们的结果将推广到其他儿科慢性疾病，这些疾病显示抑郁症和负面健康结果之间也存在类似的紧密关联。我们的研究团队在开展这项研究方面拥有独特的优势，因为我们在进行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，并且我们在这一人群中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.