Internet-based cognitive behavioral therapy intervention for youth with type 1 diabetes and depressive symptoms: a pilot and feasibility study

Puja Singh; Juan Mejia Otero; Carol Howe; Rebecca T Feinstein; Kushagra Gupta; Tracy R G Gladstone; Benjamin W Van Voorhees; Olga T Gupta

doi:10.21037/mhealth-23-33

Internet-based cognitive behavioral therapy intervention for youth with type 1 diabetes and depressive symptoms: a pilot and feasibility study

Mhealth. 2023 Dec 11:10:6. doi: 10.21037/mhealth-23-33. eCollection 2024.

Authors

Puja Singh¹, Juan Mejia Otero², Carol Howe³, Rebecca T Feinstein⁴, Kushagra Gupta⁵, Tracy R G Gladstone⁶, Benjamin W Van Voorhees⁷, Olga T Gupta^{1

8}

Affiliations

¹ Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
² Division of Pediatric Endocrinology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
³ Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, USA.
⁴ The AI.Health4All Center, University of Illinois at Chicago, Chicago, IL, USA.
⁵ Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
⁶ Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA.
⁷ Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.
⁸ Division of Pediatric Endocrinology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.

Abstract

Depression is more common in youth with type 1 diabetes (T1D) compared to youth without diabetes. This study aims to assess the efficacy of Competent Adulthood Transition with Cognitive Humanistic and Interpersonal Teaching (CATCH-IT), an internet-based cognitive behavioral therapy (CBT) intervention, in adolescents with T1D and depressive symptoms. Adolescents (13 to 17 years old) with T1D and mild (score 5-9) or moderate (score 10-14) depressive symptoms on Patient Health Questionnaire-Adolescent (PHQ-A) screening assessment were recruited to participate and received online access to the CATCH-IT modules for 6 months (requested to complete in 12 weeks). Statistical analyses included paired t-test for changes in Center for Epidemiologic Studies Depression Scale (CES-D), PHQ-A, Problem Areas in Diabetes-Teen version (PAID-T), and hemoglobin A1c (HbA1c). Nineteen patients were consented, 15 met inclusion criteria and received the intervention. In the seven participants that completed the modules, there was a trend towards improvements in PHQ-A, CES-D and HbA1c. Participants provided robust qualitative feedback on the modules and areas for improvement in subsequent iterations, such as inclusion of diabetes-related content. Given the prevalence of depression in diabetes, feasible, low resource interventions are needed. Internet programs such as CATCH-IT can serve as an effective first line intervention in this high-risk population. A modified version of CATCH-IT tailored for adolescents with T1D may be beneficial in this patient population.

Keywords: Type 1 diabetes (T1D); cognitive behavioral therapy (CBT); depression.