Depression and Health Care Interactions in Adolescents and Young Adults with T1D

患有 T1D 的青少年和年轻人的抑郁症与医疗保健的相互作用

• 批准号: 9164343
• 负责人: Maureen Monaghan
• 金额: $ 8.75万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9164343
• 关键词: Achievement; Acute; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Age; American; Attention; Behavior Therapy; Blood Glucose; Caring; Chronic; Clinic; Clinic Visits; Clinical; Code; Communication; Complement; Data; Data Analyses; Depression screen; Deterioration; Development; Diabetes Mellitus; Disclosure; Discourse analysis; Evidence based intervention; Goals; Growth; Health; Health Communication; Health Personnel; Healthcare; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Light; Link; Medical; Mental Depression; Mental Health; Modeling; Moods; Outcome; Parents; Participant; Patient Care; Patient Participation; Patient Self-Report; Patients; Perception; Personal Satisfaction; Population; Provider; Recommendation; Reporting; Research; Resources; Risk; Roter; Sampling; Sampling Studies; Self Care; Systems Analysis; Time; Visit; Youth; cohort; depressive symptoms; evidence base; glucose monitor; glycemic control; health care quality; high risk; meetings; satisfaction; skills; therapy development; time use

PROJECT SUMMARY/ABSTRACT This project aims to explore patient-provider communication about depressive symptoms in a targeted sample of adolescents and young adults (AYAs; ages 16-22) with type 1 diabetes (T1D) and evaluate associations among depressive symptoms, indicators of satisfaction with diabetes care, and related health outcomes. AYAs with T1D are at high risk for negative health outcomes and also endorse relatively high rates of depressive symptoms during this developmental period. Research with adolescents and adults has demonstrated the significant negative impact of depressive symptoms on T1D self-care, including adherence and glycemic control. However, broader examination of the impact of depressive symptoms on health care interactions, including communication with health care providers, disclosure of depressive symptoms, and satisfaction with medical care, is needed. The proposed study complements study aims for an ongoing K23 study and utilizes secondary data analysis of clinic visit recordings from AYAs with and without elevated depressive symptoms (estimated n = 92 recordings) to evaluate communication content and exchanges related to mental health care, allowing for direct observation of how sensitive issues like mental health are raised in medical care. Results will be paired with existing data on communication quality to examine potential changes in the quality of patient- provider communication that are related to depressive symptoms. Further, depressive symptoms will be examined over time and used to predict key health outcomes associated with engagement in medical care, including satisfaction with care, attendance, and glycemic control. To elicit patient and health care provider perspectives on best practices for addressing mental health in routine medical care, new qualitative interviews will be conducted with select AYAs with T1D (n=15), parents (n=15), and health care providers (n=5) to gain in- depth understanding of the impact of mood on clinic interactions and existing interventions for depression that may be applicable to T1D. The long-term goal of this study is to enhance understanding of the impact of depressive symptoms in AYAs with T1D and inform behavioral intervention development to promote high- quality communication with health care providers, with additional evidence based supports identified for youth with depression. Results from this study build on current research and have the potential to promote well-being and reduce negative health outcomes in AYAs with T1D, with the additional goal of enhancing engagement in medical care during the transition to independence.

项目总结/摘要 本项目旨在探讨患者与提供者在目标样本中关于抑郁症状的沟通 1型糖尿病（T1 D）青少年和年轻人（AYAs;年龄16-22岁）的研究，并评估 抑郁症状、糖尿病护理满意度指标和相关健康结果。Ayas 患有T1 D的人处于负面健康结果的高风险中，并且也支持相对较高的抑郁率。 在这一发展时期的症状。对青少年和成人的研究表明， 抑郁症状对T1 D自我护理的显著负面影响，包括依从性和血糖 控制然而，更广泛地研究抑郁症状对医疗保健相互作用的影响， 包括与卫生保健提供者的沟通，抑郁症状的披露，以及对 医疗护理是必要的。拟议研究补充了正在进行的K23研究的研究目标，并利用 有和无抑郁症状加重的AYA的门诊访视记录的次要数据分析 （估计n = 92个录音）以评估与心理健康护理相关的沟通内容和交流， 允许直接观察医疗保健中如何提出心理健康等敏感问题。结果将 与现有的沟通质量数据配对，以检查患者质量的潜在变化- 与抑郁症状有关的供应商沟通。此外，抑郁症状将 随着时间的推移进行检查，并用于预测与医疗保健相关的关键健康结果， 包括对护理、出勤和血糖控制的满意度。为了让患者和医疗保健提供者 关于在常规医疗护理中解决心理健康问题的最佳做法的观点，新的定性访谈 将与选定的T1 D AYA（n=15）、父母（n=15）和医疗保健提供者（n=5）一起进行，以获得- 深入了解情绪对临床互动和现有抑郁症干预措施的影响， 可能适用于T1 D。这项研究的长期目标是加强对 患有T1 D的AYAs的抑郁症状，并告知行为干预的发展，以促进高 与卫生保健提供者进行高质量的沟通，并为青年提供更多的循证支持 抑郁症这项研究的结果建立在目前的研究基础上，有可能促进幸福感 并减少T1 D患者的AYAs的负面健康结果，另外一个目标是加强参与 在向独立过渡期间提供医疗服务。