Communication and Coping for Mothers of Adolescents With Type 1 Diabetes

Mothers of adolescents with type 1 diabetes experience high levels of depressive symptoms,
which impair their ability to monitor and manage diabetes treatment effectively. The regimen
recommended for type 1 diabetes is complex and demanding, and caregivers - especially mothers
- experience stress related to the burden of treatment management. This stress is associated
with increased risk for psychosocial problems in caregivers, with rates of clinically
significant depressive symptoms evident in up to 61% of parents. Further, maternal depressive
symptoms are one of the strongest predictors of negative outcomes in adolescents, including
deteriorating glycemic control, problems with adherence, poorer quality of life, and greater
risk for depression. Given that adolescents are a high-risk population for suboptimal
glycemic control - with only 17% meeting treatment goals - there is a critical need for novel
interventions to improve outcomes in adolescents with T1D. Yet, previous behavioral
interventions for youth with diabetes have had only modest effects on glycemic control, and
none have directly targeted maternal depressive symptoms. Responding to the American Diabetes
Association's call to address the psychosocial needs of people with diabetes and their family
members, the proposed project has the potential to improve outcomes in both adolescents with
type 1 diabetes and their mothers.

Building on effective interventions to treat depression in adults, and our own pilot work in
this population, the proposed study will use a rigorous approach to evaluate the efficacy of
a cognitive-behavioral intervention for mothers of adolescents with type 1 diabetes to
promote the use of adaptive coping strategies and positive parenting practices. The aims of
this study are to: 1) evaluate the effects of the Communication & Coping intervention on
diabetes-related outcomes; 2) evaluate the effects of the Communication & Coping intervention
on psychosocial outcomes; and 3) explore the differential impact of the intervention across
demographic factors. Mothers who are randomized to the Communication & Coping Intervention
will receive individual cognitive-behavioral therapy sessions by phone, as well as access to
a Facebook group to augment the material covered in calls and provide social support. Mothers
randomized to the Attention Control condition will receive educational materials and phone
check-ins, as well as a Facebook group with educational posts. Adolescents and their mothers
will be assessed at baseline and again post-intervention, at 3 months, 6 months, and 12
months. We hypothesize that the adolescents of mothers who receive the intervention will
demonstrate improvements in diabetes outcomes (i.e., glycemic control, adherence), as well as
psychosocial outcomes (i.e., improved quality of life, fewer depressive symptoms) compared to
those in the attention control condition. This approach is innovative by targeting maternal
depressive symptoms and the quality of parental involvement in mothers of adolescents with
type 1 diabetes.

Inclusion Criteria:

- Female caregiver of an adolescent with type 1 diabetes

- Adolescent age 11-17

- Adolescent diagnosed with type 1 diabetes for at least 12 months

- Caregiver reports mild to moderate depressive symptoms (PHQ-9 score of 5-19)

- English speaking

Exclusion Criteria:

- Caregiver reports minimal depressive symptoms (PHQ-9 score less than 5)

- Caregiver reports severe depressive symptoms (PHQ-9 score 20 or higher)

- Caregiver reports history of severe psychopathology (bipolar disorder or
schizophrenia)

- Caregiver reports that adolescent has history of severe psychopathology (bipolar
disorder or schizophrenia)