Recurrent depression relates to worse outcomes than single episode depression among Hispanic adolescents with diabetes.

BACKGROUND: Adolescents with type 1 diabetes (T1D) are at increased risk for depression. A history of recurrent depression (HRD) may relate to worse health outcomes than single-episode depression. However, no study has explored this issue among T1D adolescents. PARTICIPANTS AND PROCEDURE: We examined differences in psychosocial and diabetes-related outcomes between T1D adolescents with (G1; n = 33) and without (G2; n = 18) HRD. Participants were 51 youths (aged 12-17 years) enrolled in a depression treatment study. Youths and one caregiver each completed several measures. Using MANOVA, followed by individual ANOVAs, and chi-square tests, we compared groups in continuous and categorical variables, respectively. RESULTS: MANOVA results were significant, F(7, 43) = 3.97, p = .002. Adolescents from G1 obtained higher scores than youths in G2 in self-esteem/guilt problems, cognitive alterations, and sadness due to T1D. Their caregivers reported more burden and rated their offspring as having more internalizing problems, facing more barriers to complying with T1D treatment, and using a medical ID less frequently than their counterparts did. A higher percentage of G1 participants presented clinical anxiety and inadequate glycemic control, and reported a history of major depression. According to caregivers, a higher proportion of G1 members had experienced multiple diabetes-related hospitalizations, were non-compliant with insulin treatment, and lived in homes with a conflictive environment. CONCLUSIONS: Our study documents important differences in outcomes between T1D youths with vs. without any HRD. Clinicians may need an intensive and integrative approach to treat mental and physical aspects of health among these patients.

Diabetes-Related Stigma among Adolescents: Emotional Self-Efficacy, Aggressiveness, Self-Care, and Barriers to Treatment Compliance.

Recent studies indicate that over 60% of adolescents with type 1 diabetes (T1D) experience diabetes-related stigma (DRS). DRS may affect their emotional self-efficacy (ESE), behavior, and self-care while increasing barriers to comply with physical and mental health treatment. We examined differences in ESE, aggressiveness, self-care, and barriers to comply with treatment among 51 T1D youths (aged 12-17 years) with (G1; n = 35) and without (G2; n = 16) any history of DRS enrolled in a depression treatment study. Using a MANOVA followed by individual univariate analyses, we compared groups in continuous variables, and to conduct comparisons in categorical variables, we used Chi-square tests. MANOVA results were significant, F(5, 45) = 3.20, p = .015. G1 reported lower scores than G2 on ESE, perception of the potential therapeutic impact of group sessions, and family support to comply with insulin treatment. G1 caregivers perceived their offspring as more aggressive and affected by barriers to treatment adherence than their counterparts. G1 members showed a higher proportion of cases with body mass index problems, non-compliance with their meal plan, and multiple episodes of hypoglycemia. Compared to G2, a lower percentage of adolescents in G1 met the recommended glycemic control levels. Our findings support the relationship of DRS with a lower ESE, more behavioral problems, difficulties in food-related self-care, and more barriers to comply with the treatment of diabetes and emotional problems in adolescents. They suggest the need for large-scale education to prevent DRS and psychosocial interventions to combat its impact in adolescents.

Según estudios recientes, sobre 60% de las/os adolescentes con diabetes tipo 1 (DT1) experimentan estigma relacionado con la diabetes (ERD). Éste puede afectar la autoeficacia emocional (AE), el comportamiento y el autocuidado, aumentando las barreras para cumplir el tratamiento de salud física y mental. Examinamos diferencias en AE, agresividad, autocuidado y barreras para cumplir el tratamiento en 51 jóvenes con DT1 (12­17 años) con (G1; n = 35) y sin (G2; n = 16) antecedentes de ERD, inscritos/as en un estudio de tratamiento para la depresión. Utilizando el MANOVA y análisis de varianza individuales, comparamos los grupos en variables continuas. Utilizamos el Chi-cuadrado para variables categóricas. El MANOVA fue significativo, F(5, 45) = 3.20, p = .015. Quienes pertenecían al G1 reportaron puntuaciones menores que el G2 en AE, percepción del potencial terapéutico grupal y apoyo familiar con el tratamiento de insulina. Las/os cuidadoras/es del G1 percibieron una progenie más agresiva y con más barreras para cumplir el tratamiento que sus contrapartes. El G1 mostró mayor proporción de problemas del índice de masa corporal, incumplimiento del plan alimentario y episodios hipoglucémicos múltiples. Un porcentaje menor alcanzó el control glucémico recomendado, comparado con el G2. Nuestros hallazgos apoyan la asociación del ERD con una menor AE, más agresividad, dificultades en el autocuidado alimentario y más barreras para cumplir el tratamiento de la diabetes y los problemas emocionales en adolescentes. Estos sugieren la necesidad de educación a gran escala para prevenir el ERD e intervenciones psicosociales para combatir su impacto en jóvenes.

Comorbid Chronic Physical Illnesses in Type 1 Diabetes Adolescents: Personal, Caregiver, and Family Functioning.

Having diabetes and comorbid chronic physical illnesses (CCPIs) suggests a higher risk for depression and lower health-related quality of life and treatment adherence. Caring for these patients is often overwhelming. Although CCPIs affect youths with type 1 diabetes (T1D), no study has examined the psychosocial or health-related impact of CCPIs in this population. We examined individual, caregiver, and family functioning differences among T1D adolescents with (G1; n = 25) and without (G2; n = 26) CCPIs. Participants were 51 youth (aged 12-17 years) enrolled in a depression treatment study. We administered diagnostic interviews and rating scales to assess each domain of interest. Using MANOVA, followed by individual univariate analyses, and Chi-square tests, we compared groups in continuous and categorical variables, respectively. MANOVA results were significant, F(4, 46) = 2.62, p = .047. Participants from G1 obtained lower global functioning scores compared to G2. Caregivers whose offspring had CCPIs were more depressed and reported higher burden but lower family functioning scores than their counterparts did. A higher percent of youths with CCPIs needed reminders about insulin use and met the criteria for major depression, but a lower proportion had access to insulin pumps. Taking care of youths from G1 was associated with a lifetime history of depressive disorder or suicidality. Our findings support the existence of individual, caregiver, and family functioning differences between T1D adolescents with vs. without CCPIs. Psychosocial interventions should consider the incremental burden that CCPIs may pose over these youth and their families.

Tener diabetes y enfermedades físicas crónicas comórbidas (EFCCs) sugiere mayor riesgo de depresión, menor calidad de vida relacionada con la salud y menos adherencia al tratamiento. Cuidar tales pacientes suele ser agobiante. Aunque las EFCCs afectan a jóvenes con diabetes tipo 1 (DT1), no existen estudios sobre su impacto psicosocial o en la salud en esta población. Examinamos diferencias en funcionamiento individual, familiar y entre personas cuidadoras de 51 adolescentes (12­17 años) que presentaban DT1 con (G1; n = 25) y sin (G2; n = 26) EFCCs y participaron en un estudio de tratamiento para la depresión. Administramos entrevistas diagnósticas y cuestionarios para evaluar cada dominio de interés. Utilizando MANOVA, seguido de análisis univariados, y el Chi-cuadrado, comparamos los grupos en variables continuas y categóricas. El MANOVA fue significativo, F(4, 46) = 2.62, p = .047. El G1 mostró un funcionamiento global menor que el G2. Quienes cuidaban adolescentes del G1 reportaron más sintomatología depresiva, una carga parental mayor y un funcionamiento familiar menor que sus contrapartes. Un porcentaje mayor de jóvenes con EFCCs necesitó recordatorios para usar insulina y cumplió criterios de depresión mayor, pero una proporción menor accedió a bombas de insulina. Cuidar adolescentes del G1 se asoció con presentar un trastorno depresivo o tendencias suicidas alguna vez. Nuestros hallazgos respaldan que existen diferencias en funcionamiento individual, familiar y de personas cuidadoras de adolescentes con DT1 con y sin EFCCs. Las intervenciones psicosociales deben considerar la carga incremental que las EFCCs representan para tales jóvenes y familias.

Correlates and Predictors of Chronicity among Adolescents Living in Puerto Rico With a History of Depressive Symptoms.

Chronic depression (CD) among Hispanic/Latina(o) youths has been understudied, although chronicity is the biggest risk factor for treatment-resistant depression. We examined CD correlates and predictors among 291 youths (aged 12-18 years) living in Puerto Rico with a history of depressive symptoms. They completed the Children's Depression Inventory (CDI), the Depressive Symptoms Spectrum Assessment Inventory (DSSAI), and the Brief Structured Diagnostic Measure for Depression. We explored CD correlates using Odds Ratios adjusted for CDI-Total scores. With multiple logistic regression, we identified optimal predictors of a history of chronic depressive symptoms (HCDS) or any chronic depressive disorder (HACDD). Living zone (rural), history of depressive disorder, household size (< 4), age of onset of symptoms (< 13 years), death/suicidal thoughts at the first episode, antidepressants use, and scores ≥ 84th percentile in the DSSAI-Anhedonia subscale, accounted for 37% of HCDS variance. The latter five variables and socioeconomic status (lower-middle/low) best distinguished HACDD and episodic disorders (R 2 = .331). Identifying factors that distinguish chronic and episodic depression among Hispanic/Latina(o) youths may help to improve their diagnosis, access to and quality of care, as well as treatment selection, tailoring, and outcomes.

La depresión crónica (DC) juvenil se ha estudiado poco entre hispanas(os)/latinas(os), aun siendo factor de riesgo principal para la resistencia al tratamiento. Examinamos los correlatos y predictores de DC entre 291 jóvenes (de12­18 años) residentes en Puerto Rico con historial de síntomas depresivos. Estas(os) completaron el Children's Depression Inventory (CDI), el Inventario de Evaluación del Espectro de la Sintomatología Depresiva (INEESD) y la Evaluación Diagnóstica Estructurada Breve para la Depresión. Exploramos los correlatos de DC utilizando Odds Ratios ajustados por el CDI-Total. Utilizando regresión logística múltiple, identificamos predictores óptimos del historial de síntomas depresivos crónicos (HSDC) o cualquier trastorno depresivo crónico (HCTDC). Variables como zona de vivienda (rural), historial de trastornos depresivos, tamaño del hogar (< 4), edad de inicio de síntomas (< 13 años), pensamientos suicidas/mórbidos en el primer episodio, usar antidepresivos y puntuaciones ≥ al percentil 84 del INEESD-Subescala de Anhedonia explicaron 37% de la varianza del HSDC. Las últimas cinco variables y el nivel socioeconómico (medio-bajo/bajo) distinguieron mejor entre HCTDC y trastornos episódicos (R 2 = .331). Identificar factores discriminadores de DC vs. episódica entre jóvenes hispanas(os)/latinas(os) puede ayudar a mejorar su diagnóstico, acceso y calidad de servicios, así como la selección, adaptación y rendimiento del tratamiento.

Pilot Validation Study for the Spanish-language CDI-2 among Adolescents from Puerto Rico.

The Children's Depression Inventory-2 (CDI-2) was validated and standardized for U.S. children. Although some data is available on its Spanish-language 12-item short form, the psychometric properties of the Spanish full-length form (28-item) are unknown. We examined the internal consistency (alpha coefficient) and concurrent validity of the Spanish-language CDI-2 among 51 Puerto Rican youth (aged 12-18 years), recruited from a public school, a private school, and a local church. Scores on the Reynolds Adolescent Depression Scale-2 (RADS-2) were used as concurrent validity criteria. We found alpha coefficients of .84, .74 and .76 for the Total, Emotional Problems, and Functional Problems scores, respectively. Corrected item-total correlations from .13 (Arguments with friends) to .69 (Feeling lonely) were observed. Reliability coefficients for subscales ranged from .58 (Interpersonal Problems) to .65 (Ineffectiveness and Negative Self-Esteem). CDI-2 and RADS-2 scores correlated .87. Correlations between RADS-2 scores and CDI-2 subscales ranged from .66 to .70 (p ≤ .001). Similar validity coefficients were found for the short form (α = .68). Our initial report on the Spanish full-length CDI-2 suggest that its psychometric properties with Puerto Rican adolescents may be similar to those of the original Spanish CDI and those reported for Hispanics using the English-language CDI-2.

El Children's Depression Inventory-2 (CDI-2) fue validado y estandarizado para jóvenes de Estados Unidos. Aunque existen datos psicométricos de su forma corta (12 ítems) traducida al español, no hay datos similares sobre la estándar (28 ítems). Examinamos la consistencia interna (coeficiente alfa) y validez concurrente del CDI-2 en español en 51 jóvenes puertorriqueños/as de 12­18 años, reclutados/as en una escuela pública, una privada y una iglesia. Utilizamos el Reynolds Adolescent Depression Scale-2 (RADS-2) como criterio de validez. Encontramos coeficientes alfa de .84, .74 y .76 para el CDI-2 Total, los Problemas Emocionales y los Problemas Funcionales, respectivamente. Observamos correlaciones corregidas ítem-total entre .13 (Discusiones con amigos/as) y .69 (Sentirse solo/a). Los coeficientes alfa para las subescalas fueron de .58 (Problemas Interpersonales) a .65 (Inefectividad y Auto-estima Negativa). El CDI-2 y el RADS-2 correlacionaron .87. Las correlaciones entre el RADS-2 y las subescalas del CDI-2 fueron de .66 a .70 (p ≤ .001). Obtuvimos coeficientes de validez similares para la forma corta (α = .68). Nuestro estudio piloto sobre la forma estándar del CDI-2 en español sugiere propiedades psicométricas con adolescentes puertorriqueños/as similares a las del CDI original en español y a las reportadas para hispanos/as utilizando el CDI-2 en inglés.

Systematic Review on the Use of the Children's Depression Inventory-2 among Hispanics.

We systematically reviewed studies reporting the use of the Children's Depression Inventory-2 (CDI-2) in samples with at least 30 children and significant Hispanics enrollment (≥ 14.5% of the sample and at least 20 Hispanics completing the scale). We grouped studies by form (short or full-length) and language used, developmental stage, report of psychometric data (particularly for Hispanics), and other characteristics. From 252 full-texts revised, 22 met selection criteria. Six reported psychometric data for Hispanics, either for the English full-length (α = .86 to .92) and short form (α = .76 to .81) or for the Spanish short form (α = .69 to .80). Criterion-related validity was supported via correlation/regression or comparing group means, but not using another depression self-report scale. Current knowledge on the CDI-2 psychometrics among Hispanics is mostly based on studies with the English-language version. No study has reported the psychometrics of the full-length Spanish-language CDI-2 with Hispanics.

Psychometric properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA) among Latino youth with type 1 diabetes.

Type 1 Diabetes (T1D) adolescents have higher depression rates than controls. Self-efficacy has been proposed as a mediator of therapeutic changes. Few scales assess emotional self-efficacy in adolescents. None have been validated with T1D youth. We examined the psychometric properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA) with 51 T1D youth (aged 12-17 years), enrolled in a depression treatment study. Adolescents and one parent each completed several measures. Youth completed the EADA. We used alpha coefficient to estimate its internal consistency and Pearson correlation to assess its concurrent and construct validity. We found an internal consistency of 0.93 for the EADA total score, with alpha values ranging from 0.71 to 0.85 for its subscales. EADA scores significantly (p ≤ 0.05) diverged from self-reports of depression, hopelessness/helplessness, suicidal ideation, self-esteem/guilt problems, depression-related cognitive alterations, hypoglycemic symptoms, and problems in quality of life. Its scores converged with youth's life satisfaction, self-efficacy for diabetes, self-care behaviors, and perceptions about the quality of group therapy climate and family social support. Our findings document EADA's reliability and validity when used with T1D youth and extend the supporting evidence on its psychometric properties to a clinical sample of Latino adolescents.

Can Cognitive-Behavioral Therapy Be Optimized With Parent Psychoeducation? A Randomized Effectiveness Trial of Adolescents With Major Depression in Puerto Rico.

This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive-behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre- to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1-year follow-up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT-alone showed an increase. The implication of these findings is discussed.

Este es un ensayo clínico longitudinal aleatorizado y controlado sobre el efecto de agregar una intervención psicoeducativa para los padres (TEPSI, en inglés) como parte de la terapia cognitivo-conductual (TCC) para adolescentes con trastorno depresivo mayor (TDM) en una muestra puertorriqueña. Evaluamos la eficacia de agregar 8 sesiones grupales de TEPSI a 12 sesiones de TCC individual en la reducción de síntomas depresivos, en el diagnóstico de TDM y en la mejora del funcionamiento familiar. Los participantes (n = 121) fueron distribuidos al azar a la TCC individual con o sin TEPSI. No se encontraron efectos grupales principales en la mayoría de las áreas de los pacientes, como en los síntomas de depresión ni en la presencia de un diagnóstico de TDM en los adolescentes después del tratamiento. Los resultados sí demostraron un efecto principal de la TCC con el tiempo para los síntomas de depresión, las ideas suicidas, la crítica familiar y la presencia de un diagnóstico de TDM que disminuye desde antes hasta después de la intervención. Un año después del final del tratamiento, casi el 70 % de los adolescentes en ambas condiciones (TCC y TCC + TEPSI) se mantuvo en remisión. Se obtuvo un efecto principal del tratamiento en la percepción de los adolescentes del familismo y la implicación emocional familiar. No se respaldó la hipótesis principal de que la psicoeducación familiar optimizaría la TCC para la depresión en los adolescentes. Ambas condiciones dieron variables clínicas similares. Se descubrió que la TCC culturalmente adaptada fue eficaz con los adolescentes latinos, ya que demostró mejoras clínicas considerables desde antes del tratamiento hasta después del tratamiento y permaneció estable un año después al momento del seguimiento. Con respecto a los resultados familiares, los adolescentes de la TCC + TEPSI se mantuvieron estables desde antes del tratamiento hasta después del tratamiento en la implicación emocional familiar, mientras que los adolescentes de la TCC sola demostraron un aumento. Se debaten las implicancias de estos resultados.

Family Environment Scale Parental Ratings of Conflict among Latino Families of Depressed Adolescents with Type 1 Diabetes.

OBJECTIVE: Family conflict is related to depression, difficulties with treatment adherence and glycemic control, in adolescents with type 1 diabetes (T1D). We examined the psychometric properties of a parent-rated family conflict measure and the most frequent behaviors endorsed by caregivers of these youths. METHODS: Participants were 51 caregivers (86.27% women) of adolescents (aged 12-17) with T1D, recruited during a psychotherapy study for youth depression. Both (caregivers and youths) completed questionnaires during the eligibility evaluation. Caregivers completed the Conflict subscale of the Family Environment Scale, considering to what extent its items described their whole family or its majority. RESULTS: The most frequent indicators of conflict where becoming upset, displaying anger openly, believing that something can be achieved by speaking loudly, and criticizing and fighting, although not physically. Internal consistency for the subscale when rating conflict indicators in a dichotomous format was .69 and .76 when rated in an ordinal format. Conflict scores correlated moderately and significantly (p less than or equal .05) with other measures completed by youths and caregivers. Caregivers of youths with the worst glycemic control reported the highest levels of conflict. The subscale also showed a satisfactory sensitivity to change by reflecting a significant reduction in caregivers' reports of family conflict after adolescent group treatment. CONCLUSION: Our results confirm the frequent occurrence of conflict (especially verbal conflict) in these families and document the psychometric properties of a measure for its assessment, which may be useful in studies that examine the impact of family conflict in both youth depression and diabetes.

Factors Associated with Suicidal Ideation and Quality of Life in Adolescents from Puerto Rico with Type 1 Diabetes.

OBJECTIVE: People with type 1 diabetes (T1D) may experience significant changes in their daily routines due to this condition, which frequently results in depressive symptoms and the deterioration of their quality of life. We examined the factors associated with suicidal ideation (SI) and diabetes-related quality of life (DRQOL) in adolescents (aged 12 to 17) with T1D. METHODS: The sample consisted of 51 youths (29 girls) recruited during a treatment study for depression. They completed the Diabetes Quality of Life for Youth questionnaire, the Suicidal Ideation Questionnaire Junior, and other measures that explore emotional, cognitive, somatic, behavioral, and relational aspects. Their caregivers completed the Barriers to Adherence Questionnaire and the Somatic Complaints subscale of the Child Behavior Checklist, among other measures. We used correlation and multiple linear regression analyses to identify the factors associated with the dependent variables. RESULTS: The variables associated with SI were depression, somatic complaints, perceived family emotional support, self care for diabetes, self-deprecation, helplessness, and hopelessness, among others. In a multiple regression analysis, the first 3 accounted for 46% of the variance. Those related to DRQOL included cognitive alterations, barriers to adherence, perceived family emotional support, self-efficacy for diabetes and for depression, helplessness, anxiety, and self-deprecation, among others. The first 4 accounted for 61% of the variance. CONCLUSION: Our findings highlight the impact of emotional, cognitive, somatic, behavioral, and relational aspects on the quality of mental health and the DRQOL of youth with T1D, as well as their pertinence for the development of psychosocial interventions for this population.

"They called me a terrorist": Social and Internalized Stigma in Latino Youth with Type 1 Diabetes.

BACKGROUND: Diabetes-related stigma (DRS) globally affects patients' lives. Over a third of adolescents with type 1 diabetes (T1D) in Puerto Rico reported concerns of others knowing about their diabetes and about being different. PARTICIPANTS AND PROCEDURES: We examined DRS among 65 T1D Latino youth (aged 12-17). During a depression-treatment study screening, they answered open-ended questions about diabetes-related concerns/difficulties and issues bothering them while interacting with peers, family, and healthcare professionals because of T1D. Using content analysis, we classified responses into Social Stigma (SS), Internalized Stigma (IS), and No Stigma. Four SS and IS sub-categories were developed. RESULTS: After coding, inter-rater reliability (Cohen's kappa) ranged from .73 to .1.00 (p≤.001). Forty-four youth (67.69%) reported at least one DRS verbalization, and 25 reported more than one. Both SS and IS were identified in 32 (49.23%) adolescents. Among SS experiences were: "they call me a junkie [because of insulin shots]"; "they call me a terrorist [because of insulin pump]". IS verbalizations included: "I've never wanted to accept that I have T1D, so I don't practice good self-care"; "at times I do not feel the same as others". We found more stigma-related verbalizations among those from urban zones or larger families. DRS was related to increased depressive symptoms and risk of a depressive disorder. Peers were the main source of SS. CONCLUSION: DRS was common, pervasive, and linked to depression. This study innovatively examines DRS in an exclusively T1D Latino and adolescent sample. Understanding its extent and nature is essential for developing interventions to address DRS.

Cognitive-Behavioral Group Therapy for Latino youth with Type 1 Diabetes and depression: A case study.

This group case study describes the course of a 14-session Cognitive Behavioral Therapy (CBT) for Latino adolescents with Type 1 Diabetes Mellitus (T1DM) and depressive symptoms. The intervention, known as CBT-DM, is an adaptation of an efficacious group intervention for adolescent depression. The treatment rationale and cultural adaption model are described as well as procedures used to achieve sensitivity to the characteristics of the T1DM culture as experienced by Latino youth from Puerto Rico. Session-by-session protocol is reviewed and treatment gains on the group as a whole and on its individual members are presented, providing quantitative and qualitative data. Treatment feasibility, clients' acceptance and satisfaction with treatment, and follow-up data up to 6 months post-treatment are also examined, considering cognitive, behavioral, emotional, relational, medical, and functional outcomes. Complicating factors, barriers to care, and treatment implications are discussed in the context of treating clients with comorbid chronic physical illness and emotional problems also embedded in a Latino culture. Translation of evidence-based treatments for depression into primary care settings and adapting protocols to youth populations with other medical illnesses is proposed. Recommendations for clinicians are provided, emphasizing the establishment of collaborative relationships with clients, assessing their stage in the process of accepting their chronic illness, as well as understanding their overall context to avoid unnecessary attributions of pathology to their thoughts, behaviors, and feelings.

Research Program on Type 1 Diabetes and Youth Depression in Puerto Rico.

This work reviews the progress and current state of a research program on Diabetes and youth depression in Puerto Rico. Given the high depression rate, its impact in youth with Type 1 Diabetes (T1D), and the lack of interventions to target this link in an integrative way, the manual titled Cognitive-Behavioral Treatment for Depression in Adolescents with T1D was developed. After its first use in an Open Trial, we currently assess the initial efficacy of its revised version to reduce depression and improve glycemic control, self-care, and quality of life. We present its approach, and initial data on its feasibility, acceptability and potential to reduce emotional problems in T1D youth. We discuss implications of this line of research for health psychology, and its utility to model the development of interventions alike focused on other chronic illnesses.

Este trabajo reseña el progreso y estado actual de un programa investigativo sobre la Diabetes y la depresión juvenil en Puerto Rico. Ante la alta prevalencia y el impacto de la depresión en menores con Diabetes Tipo 1 (DT1) y la falta de intervenciones que atiendan de modo integrado este vínculo, se desarrolló el Manual para el Tratamiento Cognitivo-Conductual de la Depresión en Adolescentes con DT1. Tras su uso original en un ensayo clínico abierto, evaluamos ahora la eficacia inicial de su versión revisada para reducir la depresión y mejorar el control glucémico, el autocuidado, y la calidad de vida. Presentamos su enfoque junto a datos iniciales que apoyan su viabilidad, aceptación y potencial para reducir los problemas emocionales en jóvenes con DT1. Discutimos algunas implicaciones de esta línea investigativa para la psicología de la salud y su utilidad para modelar el diseño de intervenciones similares para otras enfermedades crónicas.

Factor Structure of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA).

The current concept and measures of self-efficacy for depression in adolescents do not consider developmental and cultural aspects essential to understand and assess this construct in Latino youth. We examined the factor structure of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA): a Spanish instrument designed to assess this construct as experienced by this population. Participants were 116 Puerto Rican adolescents aged 13 to 17 years who completed the EADA and two other self-report measures. An exploratory factor analysis yielded a two-factor solution (Personal Self-Efficacy for Depression and Interpersonal Self-Efficacy for Depression) accounting for 37.57% of the total variance. Results revealed that EADA factors have excellent internal consistency as well as concurrent and construct validity, supporting its adequacy to assess Latino adolescents' self-efficacy for depression. The conceptual meaning of the factors was consistent with the distinction between aspects of this construct hypothesized to be important among Latino youth.

Experiencias atípicas psicóticas y cuasi-psicóticas en adolescentes puertorriqueños/as deprimidos/as: prevalencia y factores asociados / Psychotic and quasi-psychotic atypical experiences in Puerto Rican depressed adolescents: prevalence and related factors

Se examinó la prevalencia de experiencias atípicas psicóticas y cuasi-psicóticas y se identificaron factores asociados a éstas en 162 jóvenes puertorriqueños/as entre 13 y 17.5 años. Se evaluó la sintomatología depresiva, la ideación suicida, así como la presencia o historia de experiencias atípicas, eventos traumáticos y maltrato o abuso. Las experiencias atípicas estuvieron asociadas a ser fémina, a tener enfermedades físicas, a experimentar eventos traumáticos, a haber recibido tratamiento para la depresión, y a una sintomatología depresiva e ideación suicida elevada. Los eventos traumáticos, el tratamiento farmacológico para la depresión y la severidad de la ideación suicida fueron predictores significativos del número de experiencias reportadas. Los resultados confirman que la mayoría de las experiencias no son psicóticas. Se discuten las implicaciones para la evaluación y el tratamiento de jóvenes deprimidos/as.(AU)

The prevalence of psychotic and quasi-psychotic atypical experiences was estimated and its correlates were identified in 162 Puerto Rican adolescents (13 to 17.5 years old). Depressive symptoms, suicidal ideation, as well as the presence or history of atypical experiences, traumatic events and maltreatment or abuse were evaluated. Atypical experiences were related to gender (female), physical illness, history of traumatic events, history of treatment for depression, as well as to high depressive symptomatology and suicidal ideation. Traumatic events, pharmacological treatment for depression, and severity of suicidal ideation were significant predictors of the total experiences reported. Findings confirm that most experiences reported were definitely non-psychotic. The implications for the assessment and treatment of depressed youth are discussed.(AU)

[Psychotic and quasi-psychotic atypical experiences in Puerto Rican depressed adolescents: Prevalence and related factors]. / Experiencias atípicas psicóticas y cuasi-psicóticas en adolescentes puertorriqueños/as deprimidos/as: Prevalencia y factores asociados.

The prevalence of psychotic and quasi-psychotic atypical experiences was estimated and its correlates were identified in 162 Puerto Rican adolescents (13 to 17.5 years old). Depressive symptoms, suicidal ideation, as well as the presence or history of atypical experiences, traumatic events and maltreatment or abuse were evaluated. Atypical experiences were related (p<.05) to gender (female), physical illness, history of traumatic events, history of treatment for depression, as well as to high depressive symptomatology and suicidal ideation. Traumatic events, pharmacological treatment for depression, and severity of suicidal ideation were significant predictors of the total experiences reported. Findings confirm that most experiences reported were definitely non-psychotic. The implications for the assessment and treatment of depressed youth are discussed.

Desarrollo y propiedades psicométricas de la escala de autoeficacia para la depresión en adolescentes (EADA) / Development and psychometric properties of the escala de autoeficacia para la depresión en adolescentes (EADA)

Los instrumentos que miden autoeficacia en jóvenes son mayormente escalas para adultos adaptadas para evaluar adolescentes o escalas de autoeficacia general. El propósito de este estudio fue desarrollar y evaluar las propiedades psicométricas de la Escala de Autoeficacia para la Depresión en Adolescentes (EADA). Además, administramos la versión en español de la subescala de Autoeficacia Emocional del Self-Efficacy Questionnaire for Children, así como el Inventario de Depresión en Niños/as-Versión Corta, para evaluar la validez concurrente entre estas medidas. Participaron 116 adolescentes entre 13 a 17 años. Los resultados indican que la EADA posee una consistencia interna y una validez concurrente excelente. Los mismos apoyan su adecuación como instrumento que evalúa la auto-percepción de confianza del/de la adolescente al enfrentar situaciones típicas del Trastorno Depresivo Mayor.(AU)

Self-efficacy questionnaires used with adolescents are mostly youth-adapted adult measures or scales developed to assess general perceived self-efficacy. The purpose of this study was to develop and assess the psychometric properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA). Additionally, the Emotional Self-efficacy subscale from the Self-Efficacy Questionnaire for Children and the Children’s Depression Inventory-Short Version were administered to evaluate concurrent validity among these three measures. Participants were 116 adolescents between 13 and 17 years old. Results revealed that EADA has excellent internal consistency and concurrent validity, and support its adequacy as a measure to assess youth self-perception of confidence when confronting situations related to Major Depressive Disorder.(AU)

[Development and psychometric properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA)]. / Desarrollo y propiedades psicométricas de la Escala de Autoeficacia para la Depresión en Adolescentes (EADA).

Self-efficacy questionnaires used with adolescents are mostly youth-adapted adult measures or scales developed to assess general perceived self-efficacy. The purpose of this study was to develop and assess the psychometrics properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA). Additionally, the Emotional Self-efficacy subscale from the Self-Efficacy Questionnaire for Children and the Children's Depression Inventory-Short Version were administered to evaluate concurrent validity among these three measures. Participants were 116 adolescents between 13 and 17 years old. Results revealed that EADA has excellent internal consistency and concurrent validity, and support its adequacy as a measure to assess youth self-perception of confidence when confronting situations related to Major Depressive Disorder.