Human Development & Family Studies, Colorado State University, Campus Delivery 1570, Fort Collins, CO 80523, USA; Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO 80045, USA.
Human Development & Family Studies, Colorado State University, Campus Delivery 1570, Fort Collins, CO 80523, USA; Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO 80045, USA; Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA.
J Psychosom Res. 2022 Jun;157:110781. doi: 10.1016/j.jpsychores.2022.110781. Epub 2022 Mar 10.
Depression in adolescence is linked to risk for type 2 diabetes (T2D). In this secondary data analysis of a randomized controlled trial comparing cognitive-behavioral therapy (CBT) to a control program to ameliorate insulin resistance via reducing depression symptoms, we examine which CBT change mechanisms (e.g., behavioral activation, cognitive restructuring) contributed to decreased depression and subsequent improvements in body mass index (BMI), percent body fat, and insulin resistance.
Girls 12-17y with overweight/obesity and family history of T2D were randomized to six-week group CBT (n = 61) or health education (HealthEd; n = 58). At baseline and post-treatment, adolescents completed questionnaires assessing activities, thoughts, and depression symptoms. At baseline, post-treatment, and one-year, BMI was calculated and insulin outcomes were derived from two-hour oral glucose tolerance testing. At baseline and one-year, percent body fat was assessed with dual-energy x-ray absorptiometry. Indirect effects of CBT components were tested on one-year changes in BMI, percent body fat, and insulin indices through decreases in depression symptoms during treatment. Intervention was tested as a moderator.
In CBT, but not HealthEd, there was an indirect effect of increased physical activity during treatment on decreased one-year BMI via reductions in depression symptoms during treatment. Also, there were conditional indirect effects in CBT of increased pleasantness of physical and social activity during treatment on decreased one-year BMI via decreased depression symptoms during treatment.
Behavioral activation may be a useful intervention to decrease depression and reduce excess weight gain in the targeted prevention of T2D in at-risk adolescent girls. NCT01425905, clinicaltrials.gov.
青少年抑郁与 2 型糖尿病（T2D）风险相关。在一项比较认知行为疗法（CBT）与对照方案以通过减轻抑郁症状改善胰岛素抵抗的随机对照试验的二次数据分析中，我们研究了哪些 CBT 变化机制（例如行为激活、认知重构）有助于降低抑郁，并随后改善体重指数（BMI）、体脂百分比和胰岛素抵抗。
患有超重/肥胖症且有 T2D 家族史的 12-17 岁女孩被随机分为六周的小组 CBT（n=61）或健康教育（HealthEd；n=58）。在基线和治疗后，青少年完成了评估活动、思维和抑郁症状的问卷。在基线、治疗后和一年时，计算 BMI，并从两小时口服葡萄糖耐量试验中得出胰岛素结果。在基线和一年时，使用双能 X 射线吸收法评估体脂百分比。通过治疗期间抑郁症状的减少，测试 CBT 成分对 BMI、体脂百分比和胰岛素指数一年变化的间接影响。干预作为调节变量进行了测试。
在 CBT 中，但不在 HealthEd 中，治疗期间身体活动增加与治疗期间抑郁症状减少对一年 BMI 降低有间接影响。此外，在 CBT 中，治疗期间身体和社会活动的愉悦度增加与治疗期间抑郁症状减少对一年 BMI 降低有条件间接影响。
行为激活可能是一种有用的干预措施，可降低抑郁并减少有风险的青春期女孩 T2D 靶向预防中的体重增加。NCT01425905，clinicaltrials.gov。
