Teams Engaged in Accessible Mental Health Interventions for Lupus Erythematosus and Dermatomyositis Stress

Duke University, Durham NC

Investigators

Abstract

ABSTRACT: Young adults with juvenile systemic lupus erythematosus (JSLE) and dermatomyositis (JDM) have greater risk of cardiovascular disease (CVD) than the general population. Increased CVD risk in JSLE/JDM starts in childhood. Suboptimal cardiovascular health (CVH), defined by the American Heart Association (AHA) as protective factors against CVD, is common in adolescents and young adults with JSLE/JDM (AYA-JSLE/JDM), with >95% non-ideal CVH behaviors (i.e. physical activity, diet, sleep). Psychological stress further increases long-term CVD risk via associations with worse CVH behaviors and elevated inflammation. Roughly 50% of JSLE/JDM patients report moderate-to-severe stress even when disease activity is low, yet most do not receive formal treatment due to treatment access barriers. Given the prevalence of unmitigated stress and CVD risk, there is a critical need to develop accessible JSLE/JDM-tailored interventions for stress reduction and CVH behavior promotion. The overall research objective of this proposal is to use a culturally sensitive intervention adaptation framework (Formative Method for Adapting Psychotherapy [FMAP]) to engage AYA- JSLE/JDM as partners in developing, piloting, and refining an online, self-administered intervention for stress reduction and CVH behavior promotion in AYA-JSLE/JDM, i.e. Teams Engaged in Accessible Mental Health Interventions for Lupus Erythematosus and Dermatomyositis Stress (TEAM-LEADS) intervention. Dr. Ardalan’s long-term career goal is to develop interventions to improve mental and physical health outcomes in JSLE/JDM and other rheumatic diseases. His mentoring team has expertise in clinical trials, CVD, and stress (Dr. Schanberg), pediatric mental health and remote pediatric behavioral interventions (Dr. Connelly), trial design and biostatistics (Dr. Hornik), and the application of health behavior change theory and partner engagement methods for behavioral intervention adaptation (Dr. Gierisch), facilitating Dr. Ardalan’s acquisition of skills in partner-engaged research methods, pediatric mental health and health behavior change, contemporary clinical trial design, and remotely delivered behavioral interventions. The following aims are proposed: Aim 1) Partner with AYA-JSLE/JDM patients, parents, and health care providers to develop TEAM-LEADS via co-design sessions; Aim 2) Determine feasibility, acceptability, adherence, and impact on stress and CVH behaviors of the initial TEAM-LEADS intervention for AYA-JSLE/JDM in an open-label, single-arm successive cohort design pilot trial; Aim 3) Refine the TEAM-LEADS intervention by addressing facilitators and barriers identified by AYA-JSLE/JDM pilot trial participants in exit interviews. Completion of these aims and training goals will lead to an R01 application to conduct a larger efficacy trial of TEAM-LEADS. Future research directions include determination of optimal combinations and sequences of TEAM-LEADS components via novel trial designs and adaptation of TEAM-LEADS for other chronic pediatric and adult conditions.