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

描述（由申请人提供）：本次指导患者导向研究职业发展奖（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（即代谢控制不良）和社会心理结果（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压力和应对模型，该模型将慢性疾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适应过程介导的，并受到人口和疾病变量的调节。本研究采用多方法、前瞻性的方法来检验三大类风险和保护因素作为预测青少年在12个月内对疾病的生理和社会心理适应的影响：a)应对策略（主要控制、次要控制和脱离参与应对）；b)家庭功能（母亲参与、亲子冲突）；c)产妇适应（抑郁和焦虑症状）。K23奖将在耶鲁大学进行，由一个多学科的导师团队组成，其中包括一位主要导师，Margaret Grey博士，博士，注册护士，以及两位次要导师，William Tamborlane医学博士和Alan Delamater博士。每位导师都是各自领域的专家，能够为申请人提供以下方面的额外指导和经验：(1)青少年T1D的病理生理学；(2)将申请人之前对儿童青少年风险和保护因素的研究转化为对青少年T1D的纵向研究；(3)先进的稿件和论文写作技巧。获得这些技能将为申请人建立一个专注于发展基于家庭的认知行为预防干预措施的研究生涯做好准备，这些干预措施针对有负面心理社会和身体后果风险的儿童和青少年，特别是患有慢性儿科疾病的青少年，如T1D。相关性（见说明）：这项研究有可能极大地改善患有慢性疾病的青少年及其家庭的生活质量。期望接下来的研究能够成为一项基于家庭的认知行为预防干预青少年孤独症及其母亲的试点和可行性研究，重点是提高青少年对适应性应对的使用，缓解父母的痛苦，促进最佳育儿行为。

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.