“It just kind of feels like a different world now:” Stress, coping, and resilience for adolescents with type 1 diabetes (T1D) in the era of COVID-19

ABSTRACT

Introduction: The COVID-19 pandemic has been a major stressor for adolescents with T1D, a group already at risk for elevated mood concerns. Objectives: We aimed to describe teens' perspectives on pandemicrelated stress and their coping strategies and resilience resources. Methods: In a 2-site clinical trial of a psychosocial resiliencepromotion intervention, enrolled adolescents were 13-18 years old with T1D ≥ 1 year and diabetes distress (PAID-T) ≥30. Participants enrolled August 2020-June 2021 were asked to write responses to 2 open-ended prompts about 1) how COVID-19 affected their lives and 2) what was helping them through the pandemic. Qualitative analysis included conventional content analysis by 3 coders to develop code categories and thematic analysis to identify overarching themes reflecting pandemic-related stress and resilience. Themes were subsequently mapped onto 3 domains of resilience. Results: Adolescents (n=120) were 56% female, 75% White race, 18% Hispanic with mean A1C of 8.5% ± 2.1%. Adolescents described numerous negative effects of COVID-19 cutting across many major domains of life Family, Social, School, Medical/Physical, and Mental Health. They also described numerous resources and strategies consistent with stress, coping and resilience theories. Note 6 participants reported nothing was helping them through the pandemic. Conclusions: Adolescents' responses underscore the pervasive stress impact of COVID-19 across nearly all major life domains. Coping strategies align with theory and suggest likely resilience in the face of pervasive stress. Given the elevated risks for distress in this population, there is a need for interventions to offer diverse stress management tools and resilience resources for adolescents with T1D. (Table Presented).