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)的青少年必须在复杂的日常治疗方案之间取得平衡，同时还必须面对这一发育时期的情感、社会和学业要求。不足为奇的是，青少年出现焦虑和抑郁症状的风险增加，应对和解决问题的技能差，养生法坚持不力，以及糖尿病特有的负面健康后果，如血糖控制不佳和反复发生的糖尿病酮症酸中毒。尽管一些针对青少年行为和情绪功能不良的心理干预措施显示出对疾病管理和结果的有益影响，但没有任何预防计划可以让青少年掌握行为技能和认知策略，从而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，这项拟议的研究将测试宾夕法尼亚大学弹性计划(PRP)针对糖尿病的适应是否为T1D青少年预防计划的可行候选者。我们的研究团队处于进行这项研究的独特地位，因为我们已经对该计划(PRP T1D)进行了调整和试点测试。我们将采用随机对照设计，比较PRP T1D和教育干预(EI)在弹性特征、抑郁症状、依从性行为和血糖结果方面的差异。我们将在两个地点招募280名患有T1D的青少年，衡量基线、干预后和五次监测访问时的中介因素(即变化机制)和结果，时间跨度为另外24个月。我们的主要结果是预防抑郁和次优的血糖控制。此外，我们将评估弹性和行为依从性是否作为改变我们主要结果的机制。这项研究的潜在影响不仅在于预防患有T1D的高危青年人群的抑郁，这本身就是危险和昂贵的，而且还在于防止T1D的一个常见、昂贵和危险的问题-次优血糖控制。通过预防抑郁，我们改变了危险的轨迹，走向不遵守和糟糕的健康结果。此外，干预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被测试，而且对于这一患有T1D的高危青年群体来说，还不存在任何预防干预模式。这项研究的结果将在科学理解T1D的预防机制方面开辟新的天地，并将减少临床护理的惊人成本，并在未来预防并发症。此外，我们的结果将推广到其他儿科慢性疾病，这些疾病显示抑郁和负面健康结果之间存在类似的强有力的关联。我们的研究团队处于开展这项研究的独特地位，因为我们在进行随机对照试验方面拥有丰富的专业知识，我们融入了具有强大基础设施的多学科团队，以促进我们的工作取得成功，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.