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

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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.