Supporting Teen Problem-Solving (STEPS) 3 year outcomes: Preventing diabetes-specific emotional distress and depressive symptoms in adolescents with type 1 diabetes

Abstract

Objective: This article reports the 3-year outcomes for the Supporting Teen Problem-Solving (STePS) multisite Randomized Control Trial (RCT); reporting the overall impact of the STePS trial, and the differential impact of each arm of the trial (a resilience promoting intervention [PRP T1D] vs. a diabetes education intervention [EI]) on diabetes-specific emotional distress and depressive symptoms.

Method: Participants included 264 adolescents with Type 1 diabetes (T1D), ages 14-18, in Chicago and San Francisco. Both intervention arms lasted 4.5 months and assessments were conducted at baseline, postintervention (4.5 months), and 5 follow-up visits (8, 12, 16, 28, and 40 months from baseline). Intervention efficacy was investigated using latent growth curve modeling (LGCM) to analyze the rate and shape of change of outcomes from preintervention across postintervention and follow-up time points.

Results: Mean age of participants was 15.7 years, mean T1D duration was 6.9 years, mean HbA1c at baseline was 9.1%. The sample was diverse with nearly 35% identifying as racial or ethnic minorities, and 60% were female. PRP T1D participants reported significantly lower diabetes distress compared with EI participants, and the effect size increased over time. For the pooled sample, while 40% of youth reported elevated distress at baseline, only 23% reported elevated distress 3 years postintervention. Moreover, PRP T1D participants experienced a significant decline in depressive symptoms from 16 to 40 months postbaseline, while participants in the education arm did not.

Conclusions: Results from the 3-year outcomes assessment demonstrate the robust effects of PRP T1D in adolescents with declines in distress and depressive symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Figure 1.

CONSORT Diagram

Figure 2. Linear Latent Growth Curve Model of Change in the Outcome Variable Across Seven Time-Points

Note. LGCMs or curve-of-factor models were evaluated separately for each outcome variable (i.e., diabetes-specific distress, depressive symptoms, glycemic control, blood glucose monitoring frequency, diabetes management behaviors, time in range). The intercept was set at the final time-point (40 months post-baseline) by specifying the zero point of the slope factor at T7. The loadings of the linear slope factor across the seven respective time-points were set to the amount of time between assessment time-points (−10, −8.875, −8, −7, −6, −3, 0 months), with a one-unit change in time equal to four months.

Figure 3. Piecewise Model Depicting Change in Diabetes Distress from Pre-Intervention to 40 Months Post-Baseline (About Three Years Post-Intervention) Separately for Each Intervention Group (PRP T1D: N = 133; EI: N = 131)

Note. The clinical cut-off score for diabetes distress is > 44 (Shapiro et al., 2018).

Figure 4. Piecewise Model Depicting Change in Depressive Symptoms from Pre-Intervention to 40 Months Post-Baseline (Roughly Three Years Post-Intervention) Separately for Each Intervention Group (PRP T1D: N = 133; EI: N = 131)

Note. Clinical cut-off scores for depressive symptoms are ≥ 15 for mild depressive symptoms and ≥ 20 for moderate depressive symptoms (Kovacs, 2003).