Family-based, psychosocial intervention for depressed youth with type 1 diabetes

描述(由申请人提供)： 尽管有多学科的专科护理，但在世界各地的许多儿科糖尿病中心中，血糖控制仍然处于次优状态。患有1型糖尿病的青少年面临着控制不佳的高风险，部分原因是行为和情感上的挑战。行为挑战的形式是对糖尿病治疗方案的不遵守--这是患有1型糖尿病的青少年面临的一个常见问题。情绪挑战包括抑郁，抑郁症在患有1型糖尿病的青少年中的患病率是没有糖尿病的青少年的2-3倍。此外，遵从性差和抑郁都与促进次优控制方面的家庭功能问题(例如，家庭冲突)有关。有效的干预措施是可用的，然而，这些旨在促进遵约和改善家庭功能的以家庭为基础的干预措施通常不会有针对性地部署在具有临床意义的共病抑郁症青少年中。这些有明显抑郁症状的青少年可以通过有效的心理干预进行治疗，通常是认知行为干预，但这些干预措施并不总是考虑1型糖尿病及其相关处理的背景。因此，患有1型糖尿病的抑郁青少年的治疗需求尚未得到满足。为了解决这一未得到满足的需求，本研究采用随机对照设计来测试一种新的、基于家庭的认知行为干预措施，以减少抑郁症状，改善家庭功能，并提高依从性。干预分两个阶段进行(1-减少抑郁症状和家庭冲突，2-促进坚持)，因为如果首先解决个人和家庭功能变量，改善坚持的努力将有更大的成功可能性。52名青少年和他们的主要照顾者将参加这项研究。鉴于这类干预措施的缺乏和问题的重要性，这项研究是及时和重要的，因为它有可能对特定于糖尿病的健康结果产生积极影响。

DESCRIPTION (provided by applicant): Despite multidisciplinary specialty care, glycemic control remains suboptimal in many pediatric diabetes centers world-wide. Adolescents with type 1 diabetes are at high risk for suboptimal control due in part to behavioral and emotional challenges. Behavioral challenges come in the form of poor adherence to the diabetes management regimen - a common problem facing adolescents with type 1 diabetes. Emotional challenges include depression, which is 2-3 times more prevalent in adolescents with type 1 diabetes than their adolescent counterparts without diabetes. Further, both poor adherence and depression are linked with problematic family functioning (e.g., family conflict) in promoting suboptimal control. Effective interventions are available, however, these family-based interventions aimed at adherence promotion and improved family functioning do not typically have targeted deployment in adolescents with clinically significant, comorbid depression. These adolescents with significant depressive symptoms may be treated with effective psychological interventions, typically cognitive-behavioral in nature, but these interventions do not always consider the context of type 1 diabetes and its associated management. Thus, there is an unmet treatment need for depressed adolescents with type 1 diabetes. To address this unmet need, this study employs a randomized, controlled design to test a new, family-based, cognitive-behavioral intervention to reduce depressive symptoms, improve family functioning, and improve adherence. The intervention is delivered in two phases (1 - reduction of depressive symptoms and family conflict, 2 - adherence promotion) as efforts to improve adherence will have a greater likelihood of success if individual and family functioning variables are addressed first. Fifty-two adolescents and their primary caregivers will be enrolled in the study. Given the absence of this type of intervention and the significance of the problem, this study is timely and important, as it has the potential to positively impact diabetes-specific health outcomes.