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Exploring CBT-DM’s Absolute and Relative Efficacy for Depressed T1DM Latino youth


This study entails the revision of the 14-sessions Group Cognitive Behavioral Therapy (CBT-DM) manual for depressed Type 1 Diabetes Mellitus (T1DM) Latino youth, and explores its efficacy and added impact over the original culturally-adapted CBT for depression.  After initial manual revision by our expert team, in-depth interviews with diabetes treatment providers, and a small pre-pilot study with the first 10 depressed youth and their parents was conducted to inform the revision of and further refine CBT-DM treatment manual.  Focus groups with youth and parents in the small pre-pilot study served to complete the refinement process.  Overall, 51 depressed youth with T1DM were randomized to CBT-DM or CBT for depression. Youth continued to visit their nutritionist and endocrinologist as needed. We proposed to assess treatment efficacy will by comparing changes on depression, self-esteem and functionality scores, diabetes self-efficacy and quality of life, glycemic control and T1DM self-care behaviors.  We expected that both CBT-DM and CBT will be efficacious in reducing depression, and improving self esteem and functionality.  We also hypothesized that CBT-DM will be superior to CBT in domains related to T1DM (glycemic control and self-care behaviors).  Intake data was obtained with structured diagnostic interviews, self-report scales and laboratory tests of glycosylated hemoglobin (HbA1c).   We assessed youth T1DM health and treatment adherence information, mental health (including depression) diagnostic status, youth cognitive and affective variables, parent and family functioning, and family knowledge about T1DM.  We also evaluated the feasibility and acceptability of treatment, the adequacy of randomization, attrition rates, therapist competence and treatment integrity.  Assessments were conducted at baseline, at weeks 6 and 10 (during treatment), at post-treatment, and at the three- and six-month follow-ups.  Preliminary data suggest that both forms of CBT are associated to changes in depressive symptoms and many other behavioral, cognitive and emotional variables, but only the CBT-DM group showed improvements in self-reported self-care behaviors and in glycemic control at post-treatment.  This investigation is the third step in a research program aimed to bring the benefits of evidence-based treatment (EBT) development to Latino youth with comorbid T1DM and depression, and set the stage for a larger-scale and definite study of treatment efficacy (R01).


INVESTIGADOR: 

Eduardo Cumba-Avilés, Ph.D. - ecumba@ipsi.uprrp.edu




Validation of the Spanish version of the Children’s Depression Inventory-2nd Edition with Adolescents from Puerto Rico


Since 1977, the Children's Depression Inventory (CDI) has been used in different scenarios for the screening of pediatric depression and to assess its treatment. Since the second edition (CDI-2) was published, including an authorized Spanish version by the publisher, the use of the original version is expected to decline. Although validated and standardized for the United States, the CDI-2 will not be considered as valid and reliable for Puerto Rico until the relevant studies are conducted.  During a pilot validation study, we analyzed its internal consistency, its concurrent validity and its relation with demographic variables in a sample of 51 Puerto Rican adolescents, aged 12 to 18 years (50.98% females), and recruited by availability and mostly from a public school (Metro area), a private school (South area) and a local church (Northeast area). They completed the CDI-2 and the Reynolds Adolescent Depression Scale-2 (RADS-2) in an assessment session of less than 20 minutes. We used Cronbach's alpha and corrected correlations between each item and CDI-2 total scores (CITC) to evaluate its internal consistency. With the Pearson coefficient, we examine its concurrent validity using RADS-2 scores as a criterion. We found a reliability of .84 for the CDI-2 total score, with CITC that ranged from .13 (Arguments with friends) and .69 (Feelings of loneliness). The Emotional Problems and Functional Problems scales showed reliability indices of .74 and .76, respectively, while reliability for specific subscales ranged from .58 (Interpersonal Problems) and .65 (Ineffectiveness and Negative Self-Esteem). Total CDI-2 and RADS-2 scores correlated .86. The correlation of RADS-2 total scores with the CDI-2 subscales (p≤.001) ranged from .66 (Negative Mood / Physical Symptoms) and .70 (Negative Self-Esteem and Interpersonal Problems). In general, the (sub) scales of the CDI-2 correlated significantly with the (sub) scales of the RADS-2 in a range between .27 (p ≤ .05) to .78 (p≤.001). CDI-2 scores were not related to youth’s age or educational level, their type of school, urban or rural environment, socioeconomic status, or the number of people living in the participants’ household, but did correlated with being from female gender. Although preliminary in nature, our findings suggest that the psychometric properties of the CDI-2 are as appropriate as those of its predecessor, and that they also share the same limitations when used uncritically in Puerto Rico.  We are currently recruiting participants for a formal validation study. Our goal is to recruit 400 from private and public schools and conducted similar analyses as in the pilot study, but also to perform test-retest analyses with an estimated sample of 150 adolescents who agree to complete the CDI-2 a second time.  Preliminary findings for this phase reflect similar internal consistency indices for the CDI-2 as in the pilot phase, with alpha values of .88, .81 and .77 for the Total Score, the Emotional Problems and the Functional Problems scales, respectively.  Internal reliability for the subscales ranges from .64 (Ineffectiveness) to .76 (Negative Self-Esteem). Current estimates of its temporal reliability (N=48) are of .86 from the Total Score, .76 for the Emotional Problems scale, and .86 for the Functional Problems scale.  Test-retest reliability for the specific CDI-2 subscales ranges from .66 (Negative Self-Esteem) and .77 (Ineffectiveness and Interpersonal Problems).  Regarding its concurrent validity, a correlation of .86 (p≤.001) has been observed between total scores of the CDi-2 and the RADS-2.  Subscales from the CDI-2 correlate with RADS-2 total scores in range from .71 (Ineffectiveness) to .77 (Negative Self-Esteem).


INVESTIGADOR: 

Eduardo Cumba-Avilés, Ph.D. - ecumba@ipsi.uprrp.edu


 

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