Coping, Parenting & Maternal-Child Adjustment in Adolescents with Type 1 Diabetes

描述(由申请者提供)：这个以患者为导向的研究职业发展奖(K23)的目标是了解预测青少年适应1型糖尿病(T1D)的风险和保护因素。患有T1D的青少年面临适应不良的风险，包括生理结果(即代谢控制不良)和心理社会结果(例如抑郁症状、生活质量差)。指导这项研究的总体框架是交易性压力和应对模型，该模型将慢性病视为儿童和家庭试图适应的潜在压力源。儿童适应被认为是由儿童和家庭的适应过程调节的，并受到人口统计和疾病变量的调节。这项拟议的研究使用多方法、前瞻性的方法来检验三大类风险和保护因素作为青少年在12个月内对疾病的生理和心理社会适应的预测因素的效果：a)应对策略(初级控制、次级控制和脱离应对)；b)家庭功能(母亲参与、亲子冲突)；以及c)母亲适应(抑郁和焦虑症状)。K23奖将在耶鲁大学进行，由多学科导师组成的团队，其中包括一名主要导师玛格丽特·格雷博士，RN博士，以及两名二级导师威廉·坦博兰医学博士和艾伦·德拉马特博士。这些导师中的每一个都是各自领域的专家，将能够为申请人提供额外的指导和经验：(1)青少年T1D的病理生理学；(2)将申请人之前关于儿童和青少年风险和保护因素的研究转化为对患有T1D的青少年的纵向研究；以及(3)高级手稿和资助写作技能。获得这些技能将为申请人建立一个研究生涯做好准备，重点是为面临负面心理社会和身体后果风险的儿童和青少年，特别是患有T1D等慢性儿科疾病的青少年开发基于家庭的认知-行为预防干预措施。相关性(见说明)：这项研究有可能极大地提高患有慢性病的青少年及其家庭的生活质量。预计接下来的研究将是针对患有TD的青少年及其母亲进行基于家庭的认知-行为预防干预的试点和可行性研究，重点是改善青少年对适应性应对的使用，缓解父母的痛苦，促进最佳父母行为。 公共卫生相关性：这项研究有可能极大地提高患有慢性病的青少年及其家庭的生活质量。预计接下来的研究将是以家庭为基础的认知行为预防干预的先导性和可行性研究，旨在改善青少年对适应性应对的使用，缓解父母的痛苦，促进最佳父母行为。

DESCRIPTION (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to understand the risk and protective factors predicting adolescents' adjustment to type 1 diabetes (T1D). Adolescents with T1D are at risk for poor adjustment, including both physiological (i.e., poor metabolic control) and psychosocial outcomes (e.g., depressive symptoms, poor quality of life). The overarching framework guiding this research is the Transactional Stress and Coping Model, which views chronic illness as a potential stressor to which children and families attempt to adapt. Child adjustment is thought to be mediated by child and family adaptational processes and moderated by demographic and illness variables. The proposed study uses a multi-method, prospective approach to examine the effects of three broad categories of risk and protective factors as predictors of adolescents' physiological and psychosocial adjustment to the illness over 12 months: a) Coping Strategies (primary control, secondary control, and disengagement coping); b) Family Functioning (maternal involvement, parent-child conflict); and c) Maternal Adjustment (symptoms of depression and anxiety). The K23 Award will be conducted at Yale University with a multidisciplinary team of mentors, consisting of a primary mentor, Margaret Grey, Dr.PH, RN, and two secondary mentors, William Tamborlane, MD, and Alan Delamater, PhD. Each of these mentors are experts in their respective fields and will be able to provide the applicant with additional instruction and experience in: (1) the pathophysiology of T1D in adolescents; (2) translating the applicant's previous research on risk and protective factors in children and adolescents to longitudinal research in adolescents with T1D; and (3) advanced manuscript and grant writing skills. The acquisition of these skills will prepare the applicant to build a research career focused on developing family-based cognitive-behavioral preventive interventions for children and adolescents at risk for negative psychosocial and physical outcomes, particularly adolescents with chronic pediatric conditions, such as T1D. RELEVANCE (See instructions): This study has the potential to greatly improve the quality of life in adolescents with chronic illness and their families. It is expected that the study to follow will be a pilot and feasibility study of a family-based cognitive-behavioral preventive intervention for adolescents with Tl D and their mothers, focusing on improving adolescents' use of adaptive coping, relieving parents' distress, and promoting the best parenting behaviors. PUBLIC HEALTH RELEVANCE: This study has the potential to greatly improve the quality of life in adolescents with chronic illness and their families. It is expected that the study to follow will be a pilot and feasibility study of a family-based cognitive behavioral preventive intervention for adolescents with Tl D and their mothers, focusing on improving adolescents' use of adaptive coping, relieving parents' distress, and promoting the best parenting behaviors.