Diabetes mellitus is among the most common chronic diseases in children and adolescents, affecting approximately 1 in 400 children. Type 1 diabetes mellitus (T1DM) requires a complex and arduous daily management regimen. The disease can present dramatic changes in daily life, placing a significant psychological burden on the child. Behavioral and psychological factors can significantly influence the course and progression of T1DM. These interactions are bidirectional—metabolic and biological fluctuations produce alterations in emotions and behaviors, and psychological functioning predicts glycemic control and other medical outcomes.
A particularly high-risk group within the T1DM patient population is adolescents. Given the critical biological, cognitive, emotional, and social changes that occur during adolescence, glycemic control typically diminishes. T1DM can also increase the adolescent's risk for psychiatric illness and can contribute to decreased self-esteem, conflict with family, peer difficulties, and poor coping with illness demands.
To address this need, the dissertation sought to design a program that appropriately addresses the psychological care of T1DM adolescents, to format the program for integration into the tertiary medical clinic setting, and to design an evaluation tool that can be used to evaluate the program for clinical utility in future studies. Although prior studies have identified specific components of interventions (e.g., cognitive-behavioral therapy, coping skills training, stress management, motivational interviewing) that have been shown to be generally effective in improving psychological outcomes, never before have each of the tested individual interventions been integrated to create a comprehensive, multi-level program for this population. In addition, no comprehensive program to the investigator's knowledge has been specifically designed for implementation in an integrated care context, where patients are treated by an interdisciplinary team of professionals.
Empirical findings in the literature were systematically evaluated to identify the most efficacious programmatic elements. Then, applying the recommendations discussed in the health services delivery literature, the program content was designed for delivery of services within the medical clinic in the most feasible and effective way. Finally, program evaluation was discussed, and an evaluation measure was developed for use in future pilot studies investigating the efficacy and utility of this program.
|Commitee:||Sazgar, Sepida, deMayo, Robert|
|School Location:||United States -- California|
|Source:||DAI-B 75/07(E), Dissertation Abstracts International|
|Subjects:||Developmental psychology, Clinical psychology, Health care management|
|Keywords:||Adolescents, Integrated psychological care, Type 1 diabetes|
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