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Tilov BG, Stanchev P, Orbetsova M, Becheva E, Antonov P, Ivanov AS. A Study of Psychological Features in Patients With Type 2 Diabetes Mellitus. Cureus 2024; 16:e70782. [PMID: 39372377 PMCID: PMC11451308 DOI: 10.7759/cureus.70782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2024] [Indexed: 10/08/2024] Open
Abstract
AIM There is a lack of multidisciplinary studies examining the link between psychological factors and glycemic control in individuals with chronic illnesses. The aim of this study is to investigate the relationship between psychological factors such as resilience, perceived stress, emotional regulation, aggressiveness, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes. Additionally, the study seeks to determine the predictive value of perceived stress and resilience on HbA1c levels and to explore the role of anger expression and emotion regulation strategies in glycemic control, comparing diabetic patients to healthy controls. MATERIALS AND METHODS The study was conducted between November 2021 and November 2023 at the Clinic of Endocrinology and Metabolic Diseases at the St. George University Hospital, Bulgaria, and the Department of Science and Research at the Medical University of Plovdiv, Bulgaria. Of these 84 individuals were diagnosed with type 2 diabetes, divided into two groups of 42 individuals each, who had poor and fair glycated hemoglobin. The third group was a healthy control consisting of 42 individuals in the same age group who had no established chronic diseases. RESULTS When comparing the study groups on HbA1c and individual psychological characteristics, there were statistically significant differences in resilience, perceived stress, emotion regulation suppression, and anger expression. When comparing the mean values of mental resilience with glycated hemoglobin levels, we find that there are statistically significantly higher mean values between the poor HbA1c control and the healthy group. From the regression analysis, we conclude that the psychological characteristics positively associated with perceived stress (β=0.502; p<0.001) and inversely associated with mental resilience (β=-0.359; p<0.001) are the most predictive. Less influential was the straight correlation with emotion regulation-expressive inhibition (β=0.226; p<0.05), the positive correlation with anger (β=0.170; p<0.001), and general aggressiveness (β=0.151; p<0.05). CONCLUSION From the present study, we note that glycated hemoglobin level is strongly influenced by two psychological predictors, namely subjective perception of stressful situations and resilience level.
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Affiliation(s)
- Boris G Tilov
- Department of Psychology, Medical University of Plovdiv, Plovdiv, BGR
| | - Pavel Stanchev
- Department of Endocrinology, Medical University of Plovdiv, Plovdiv, BGR
| | - Maria Orbetsova
- Department of Endocrinology, Medical University of Plovdiv, Plovdiv, BGR
| | - Elena Becheva
- Department of Endocrinology, Medical University of Plovdiv, Plovdiv, BGR
| | - Petar Antonov
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, BGR
| | - Atanas S Ivanov
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, BGR
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Bakan G, Inci FH. Predictor of self-efficacy in individuals with chronic disease: Stress-coping strategies. J Clin Nurs 2021; 30:874-881. [PMID: 33400329 DOI: 10.1111/jocn.15633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/09/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study aims to investigate the relationship between stress-coping strategies of individuals with chronic diseases and their self-efficacy. BACKGROUND Self-efficacy and coping with stress in chronic diseases affect the course of the disease. DESIGN The sample of this methodological study consisted of 178 patients who were hospitalised in a university hospital between November 2017 and November 2018. METHODS Data were collected by the face-to-face interview method using a Patient Information Form, Stress-Coping Styles Scale and Self-Efficacy Scale. This study followed STROBE checklist for cross-sectional studies. RESULTS The study found that there was a strong relationship between patients' coping strategies and their self-efficacies and that the variables that predict self-efficacy in order of importance were self-confident approach (β = .41), the helpless approach (β = -0.24) and the submissive approach (β = -0.15), respectively. The study also found that the optimistic approach and the seeking social support approach had no significant contribution to the model. CONCLUSIONS The most important predictor of self-efficacy in individuals with chronic disease was the self-confident approach, which was one of the problem-oriented coping strategies. Therefore, patients should be taught to use effective methods to cope with stress to increase their self-efficacy, and their self-confidence should be supported. RELEVANCE TO CLINICAL PRACTICE In individuals with chronic disease, self-efficacy has an important role to get better psycho-social adaptation. To determine patients' self-efficacy levels and predictors will guide nursing initiatives.
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Affiliation(s)
- Gulcan Bakan
- Internal Medicine Nursing Department, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
| | - Fadime Hatice Inci
- Department of Public Health Nursing, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
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Chan VWY, Kong APS, Lau JTF, Mak WWS, Cameron LD, Mo PKH. An Intervention to Change Illness Representations and Self-Care of Individuals With Type 2 Diabetes: A Randomized Controlled Trial. Psychosom Med 2021; 83:71-84. [PMID: 33141790 DOI: 10.1097/psy.0000000000000883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Suboptimal self-care by individuals with diabetes mellitus (DM) is a significant public health concern. The common-sense model (CSM) proposes that illness representations are associated with coping and health outcomes across various conditions. The present study examined the efficacy of a CSM-based intervention in improving illness representations, self-care, self-care self-efficacy, use of adaptive coping strategies, and glycated hemoglobin among individuals with type 2 DM (T2DM). METHODS A two-arm randomized controlled trial was used. A total of 455 T2DM patients were recruited from an outpatient DM clinic and randomized to an intervention group that consisted of five weekly group-based education sessions or a control group that received five weekly educational booklets. Evaluation was conducted at baseline and at 1- and 6-month follow-up. RESULTS The 2 × 3 linear mixed-model analysis using a modified intention to treat revealed a significant time by condition interaction effect on level of self-care (F(2,840) = 7.78, p < .001), self-care self-efficacy (F(1.89,794.57) = 14.40, p < .001), and use of adaptive coping strategies (F(1.94,812.93) = 4.75, p = .010) in which participants in the intervention group reported greater improvement in such aspects compared with those in the control group. A significant time effect was observed in some dimensions of illness representations. No significant effect was found in glycated hemoglobin. Participants reported positive feedback to the intervention and perceived improvement in various domains. CONCLUSIONS The CSM-based intervention was effective in improving self-care and coping among DM patients. The intervention also demonstrated high feasibility and acceptability. Findings provided important insights in improving health-related outcomes for patients with T2DM using the CSM framework.
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Affiliation(s)
- Virginia W Y Chan
- From the Centre for Health Behaviours Research, School of Public Health and Primary Care (Chan, Lau, Mo), and Departments of Medicine and Therapeutics (Kong) and Psychology (Mak), the Chinese University of Hong Kong, Shatin, Hong Kong; and Department of Psychological Sciences (Cameron), University of California Merced, Merced, California
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The predictors of perceived stress in patients with type 2 diabetes in Turkey: styles of coping with stress and metabolic variables. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kwon CY, Kim JW, Chung SY. Liver-associated patterns as anger syndromes in traditional Chinese medicine: A preliminary literature review with theoretical framework based on the World Health Organization standards of terminologies and pattern diagnosis standards. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wisting L, Rø A, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control. J Health Psychol 2019; 26:688-700. [DOI: 10.1177/1359105319840688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes ( n = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females ( β = 0.40, p < 0.001 and β = −0.22, p < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c ( β = 0.37, p < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Oslo Diabetes Research Centre, Norway
| | - Astrid Rø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Norway
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Crangle CE, Bradley C, Carlin PF, Esterhay RJ, Harper R, Kearney PM, McCarthy VJC, McTear MF, Savage E, Tuttle MS, Wallace JG. Exploring patient information needs in type 2 diabetes: A cross sectional study of questions. PLoS One 2018; 13:e0203429. [PMID: 30444868 PMCID: PMC6239280 DOI: 10.1371/journal.pone.0203429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/21/2018] [Indexed: 01/02/2023] Open
Abstract
This study set out to analyze questions about type 2 diabetes mellitus (T2DM) from patients and the public. The aim was to better understand people's information needs by starting with what they do not know, discovered through their own questions, rather than starting with what we know about T2DM and subsequently finding ways to communicate that information to people affected by or at risk of the disease. One hundred and sixty-four questions were collected from 120 patients attending outpatient diabetes clinics and 300 questions from 100 members of the public through the Amazon Mechanical Turk crowdsourcing platform. Twenty-three general and diabetes-specific topics and five phases of disease progression were identified; these were used to manually categorize the questions. Analyses were performed to determine which topics, if any, were significant predictors of a question's being asked by a patient or the public, and similarly for questions from a woman or a man. Further analysis identified the individual topics that were assigned significantly more often to the crowdsourced or clinic questions. These were Causes (CI: [-0.07, -0.03], p < .001), Risk Factors ([-0.08, -0.03], p < .001), Prevention ([-0.06, -0.02], p < .001), Diagnosis ([-0.05, -0.02], p < .001), and Distribution of a Disease in a Population ([-0.05,-0.01], p = .0016) for the crowdsourced questions and Treatment ([0.03, 0.01], p = .0019), Disease Complications ([0.02, 0.07], p < .001), and Psychosocial ([0.05, 0.1], p < .001) for the clinic questions. No highly significant gender-specific topics emerged in our study, but questions about Weight were more likely to come from women and Psychosocial questions from men. There were significantly more crowdsourced questions about the time Prior to any Diagnosis ([(-0.11, -0.04], p = .0013) and significantly more clinic questions about Health Maintenance and Prevention after diagnosis ([0.07. 0.17], p < .001). A descriptive analysis pointed to the value provided by the specificity of questions, their potential to disclose emotions behind questions, and the as-yet unrecognized information needs they can reveal. Large-scale collection of questions from patients across the spectrum of T2DM progression and from the public-a significant percentage of whom are likely to be as yet undiagnosed-is expected to yield further valuable insights.
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Affiliation(s)
- Colleen E. Crangle
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Paul F. Carlin
- South Eastern Health and Social Care Trust, Research Office, Dundonald, Northern Ireland, United Kingdom
| | - Robert J. Esterhay
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Roy Harper
- Department of Endocrinology & Diabetes, The Ulster Hospital, South Eastern Health and Social Care Trust, Dundonald, Northern Ireland, United Kingdom
| | - Patricia M. Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | | | - Michael F. McTear
- School of Computing and Mathematics, University of Ulster at Jordanstown, Jordanstown, Northern Ireland, United Kingdom
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mark S. Tuttle
- Board of Directors, Apelon Inc., Hartford, Connecticut, United States of America
| | - Jonathan G. Wallace
- School of Computing and Mathematics, University of Ulster at Jordanstown, Jordanstown, Northern Ireland, United Kingdom
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Fincham FD, Seibert GS, May RW, Wilson CM, Lister ZD. Religious Coping and Glycemic Control in Couples with Type 2 Diabetes. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:138-149. [PMID: 28589560 DOI: 10.1111/jmft.12241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This study examines the role of religious coping in couples' diabetes management processes. Eighty-seven couples where one spouse had type 2 diabetes were surveyed. The relationships between religious coping (positive and negative), shared glycemic control activities (e.g., planning a healthy diet), and glycemic control were examined using repeated measures ANOVA and SEM. Findings show spousal engagement in shared activities is significantly associated with glycemic control. Furthermore, the use of negative religious coping by the diabetic spouse, and positive religious coping by the nondiabetic spouse, related to lower levels and higher levels of shared glycemic control activities, respectively. Religious coping and shared glycemic control activities appear integral to couples managing type 2 diabetes and, may serve as useful points of intervention.
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Affiliation(s)
| | | | - Ross W May
- Family Institute, The Florida State University, Florida
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Gagnon C, Aimé A, Bélanger C. Predictors of Comorbid Eating Disorders and Diabetes in People with Type 1 and Type 2 Diabetes. Can J Diabetes 2017; 41:52-57. [DOI: 10.1016/j.jcjd.2016.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/28/2016] [Accepted: 06/24/2016] [Indexed: 01/29/2023]
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10
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Colson MH. Dysfonctions sexuelles de la maladie chronique, l’état des lieux. Première partie : fréquence, impact et gravité. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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11
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Colson MH. Sexual dysfunction and chronic illness. Part 1. Epidemiology, impact and significance. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Yi-Frazier JP, Cochrane K, Mitrovich C, Pascual M, Buscaino E, Eaton L, Panlasigui N, Clopp B, Malik F. Using Instagram as a Modified Application of Photovoice for Storytelling and Sharing in Adolescents With Type 1 Diabetes. QUALITATIVE HEALTH RESEARCH 2015; 25:1372-82. [PMID: 25904674 PMCID: PMC5565207 DOI: 10.1177/1049732315583282] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Photovoice is a research method developed to help communities share images as a tool for discussion of key issues. Although this may be useful to promote healthy behavior, using Photovoice in adolescents has been logistically challenging. Given adolescents' engagement in social media, our study explored the feasibility of using a photo-sharing mobile phone application, Instagram, to accomplish the principles of Photovoice. Twenty adolescents 14 to 18 years old with type 1 diabetes were asked to use Instagram to post any diabetes-related photo for 3 weeks. Individual interviews and a focus group were also offered, and recruitment and retention statistics were tracked. Of those approached (n = 47), 43% agreed to participate. Twelve were actively engaged. Shared photos were most likely to fall into the categories of diabetes care, humor, or food. Engaged participants universally reported the project to be a positive experience; however, there were technological and personal factors to consider for widespread implementation.
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Affiliation(s)
- Joyce P Yi-Frazier
- University of Washington, Seattle, Washington, USA Seattle Children's Research Institute, Seattle, Washington, USA
| | | | | | - Michael Pascual
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Emil Buscaino
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Lauren Eaton
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Neil Panlasigui
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bailey Clopp
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Faisal Malik
- Seattle Children's Research Institute, Seattle, Washington, USA
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Kruger J, Pollard D, Basarir H, Thokala P, Cooke D, Clark M, Bond R, Heller S, Brennan A. Incorporating Psychological Predictors of Treatment Response into Health Economic Simulation Models: A Case Study in Type 1 Diabetes. Med Decis Making 2015; 35:872-87. [PMID: 26377675 DOI: 10.1177/0272989x15590143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND . Health economic modeling has paid limited attention to the effects that patients' psychological characteristics have on the effectiveness of treatments. This case study tests 1) the feasibility of incorporating psychological prediction models of treatment response within an economic model of type 1 diabetes, 2) the potential value of providing treatment to a subgroup of patients, and 3) the cost-effectiveness of providing treatment to a subgroup of responders defined using 5 different algorithms. METHODS . Multiple linear regressions were used to investigate relationships between patients' psychological characteristics and treatment effectiveness. Two psychological prediction models were integrated with a patient-level simulation model of type 1 diabetes. Expected value of individualized care analysis was undertaken. Five different algorithms were used to provide treatment to a subgroup of predicted responders. A cost-effectiveness analysis compared using the algorithms to providing treatment to all patients. RESULTS . The psychological prediction models had low predictive power for treatment effectiveness. Expected value of individualized care results suggested that targeting education at responders could be of value. The cost-effectiveness analysis suggested, for all 5 algorithms, that providing structured education to a subgroup of predicted responders would not be cost-effective. LIMITATIONS . The psychological prediction models tested did not have sufficient predictive power to make targeting treatment cost-effective. The psychological prediction models are simple linear models of psychological behavior. Collection of data on additional covariates could potentially increase statistical power. CONCLUSIONS . By collecting data on psychological variables before an intervention, we can construct predictive models of treatment response to interventions. These predictive models can be incorporated into health economic models to investigate more complex service delivery and reimbursement strategies.
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Affiliation(s)
- Jen Kruger
- School of Health and Related Research, University of Sheffield, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, UK
| | - Hasan Basarir
- School of Health and Related Research, University of Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, UK
| | - Debbie Cooke
- School of Health and Related Research, University of Sheffield, UK
| | - Marie Clark
- School of Health and Related Research, University of Sheffield, UK
| | - Rod Bond
- School of Health and Related Research, University of Sheffield, UK
| | - Simon Heller
- School of Health and Related Research, University of Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, UK
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Kidwell KM, Van Dyk TR, Guenther KD, Nelson TD. Anger and children’s health: Differentiating role of inward versus outward expressed anger on sleep, medical service utilization, and mental health. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2015.1038680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Gross R, Groer M, Thomas SP. Relationship of trait anger and anger expression to C-reactive protein in postmenopausal women. Health Care Women Int 2013; 35:580-95. [PMID: 24279678 DOI: 10.1080/07399332.2013.862798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Coronary heart disease (CHD) is the leading cause of death for women worldwide. Chronic inflammation and risk factors, such as obesity, smoking, and high cholesterol, are well-established risk factors for CHD. Little is known, however, about the mechanisms by which psychosocial factors, such as general anger proneness (trait anger) and anger expression style, may be associated with proinflammatory processes that contribute to cardiovascular morbidity and mortality in women. Our purpose in conducting this study was to examine the relationship of trait anger and anger expression to the proinflammatory biomarker C-reactive protein (CRP). A cross-sectional between-groups design was used to determine differences in serum levels of CRP in 42 American postmenopausal women, ages 45 to 65, who scored high on the selected anger characteristics, compared with women with lower scores. We did not find differences between high anger women and low anger women in mean levels of CRP, but we did find significant inverse relationships between CRP and some anger control characteristics. Specific health-promoting anger coping behaviors could minimize the deleterious effects of inflammatory responses in postmenopausal women.
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Affiliation(s)
- Rosalyn Gross
- a Department of Nursing , University of South Florida , Tampa , Florida , USA
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Yi-Frazier JP, Yaptangco M, Semana S, Buscaino E, Thompson V, Cochrane K, Tabile M, Alving E, Rosenberg AR. The association of personal resilience with stress, coping, and diabetes outcomes in adolescents with type 1 diabetes: variable- and person-focused approaches. J Health Psychol 2013; 20:1196-206. [PMID: 24271691 DOI: 10.1177/1359105313509846] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This study explored the association between personal resilience and distress, coping, and diabetes outcomes in 50 adolescents with type 1 diabetes. Resilience was defined by a factor score derived from validated instruments measuring self-efficacy, optimism, and self-esteem. Variable- and person-focused methodologies were used to explore these associations. Low resilience was associated with higher distress, poor quality of life, and poor glycemic control. Participants with low resilience used more maladaptive coping strategies and were at greatest risk of poor outcomes. Findings suggest that resilience is a promising candidate for interventions designed to reduce distress and improve outcomes for adolescents with type 1 diabetes.
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Affiliation(s)
- Joyce P Yi-Frazier
- University of Washington School of Medicine, USA Seattle Children's Research Institute, USA
| | | | | | | | | | | | | | | | - Abby R Rosenberg
- University of Washington School of Medicine, USA Seattle Children's Research Institute, USA
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Penckofer SM, Ferrans C, Mumby P, Byrn M, Emanuele MA, Harrison PR, Durazo-Arvizu RA, Lustman P. A psychoeducational intervention (SWEEP) for depressed women with diabetes. Ann Behav Med 2013; 44:192-206. [PMID: 22777878 DOI: 10.1007/s12160-012-9377-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Clinically significant depression is present in 25 % of individuals with type 2 diabetes, its risk being doubled in women. PURPOSE To examine the effectiveness of the Study of Women's Emotions and Evaluation of a Psychoeducational (SWEEP), a group therapy for depression treatment based on cognitive behavioral therapy principles that was developed for women with type 2 diabetes was conducted. METHODS Women with significantly elevated depression symptoms (Center for Epidemiologic Studies Depression Scale ≥16) were randomized to SWEEP (n = 38) or usual care (UC, n = 36). RESULTS Multilevel modeling indicated that SWEEP was more effective than UC in reducing depression (mean difference of -15 vs. -7, p < .01), decreasing trait anxiety (mean difference of -15 vs. -5, p < .01), and improving anger expression (mean difference of -12 vs. -5, p < .05). Although SWEEP and UC had improvements in fasting glucose (mean difference of -24 vs. -1 mg/dl) and HbA1c (mean difference of -0.4 vs. -0.1 %), there were no statistically significant differences between groups. CONCLUSIONS SWEEP was more effective than UC for treating depressed women with type 2 diabetes. Addition of group therapy for depression meaningfully expands the armamentarium of evidence-based treatment options for women with diabetes.
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Affiliation(s)
- Sue M Penckofer
- School of Nursing, Loyola University Chicago, Maywood, IL, USA.
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Reddy J, Wilhelm K, Campbell L. Putting PAID to Diabetes-Related Distress: The Potential Utility of the Problem Areas in Diabetes (PAID) Scale in Patients with Diabetes. PSYCHOSOMATICS 2013; 54:44-51. [DOI: 10.1016/j.psym.2012.08.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 08/12/2012] [Accepted: 08/13/2012] [Indexed: 11/26/2022]
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Tsenkova VK, Carr D, Coe CL, Ryff CD. Anger, adiposity, and glucose control in nondiabetic adults: findings from MIDUS II. J Behav Med 2012; 37:37-46. [PMID: 23065351 DOI: 10.1007/s10865-012-9460-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 09/26/2012] [Indexed: 11/28/2022]
Abstract
Anger has been linked to cardiovascular disease, but few studies have examined the relationship between anger and type 2 diabetes. The aim was to investigate associations among different indicators of anger expression, adiposity, and nondiabetic glucose metabolism in a national survey of adults. Participants were 939 adults without diabetes in the Midlife in the US study (MIDUS II). Glucose metabolism was characterized by fasting glucose, insulin, insulin resistance, and glycosylated hemoglobin (HbA1c). Spielberger's Anger Expression inventory was used to measure suppressed anger (anger-in), expressed anger (anger-out), and controlled anger (anger-control). We investigated the relationship between anger and glucose metabolism, and whether anger amplified the adverse relationship between body weight distribution (body mass index = BMI and waist-to-hip ratio = WHR) and glucose metabolism. Multivariate-adjusted analyses revealed an association between anger-out and both insulin and insulin resistance. As predicted, anger-in amplified the relationships between BMI and insulin and insulin resistance, while anger-out amplified the association between WHR and insulin and insulin resistance. Low anger-control was associated with higher glucose. None of the three anger measures was significantly associated with HbA1c. Our findings extend previous research on anger as a potential risk factor for type 2 diabetes by demonstrating that anger expression is associated with clinical indicators of glycemic control, especially among those with pre-existing risk due to obesity and high central adiposity.
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Affiliation(s)
- Vera K Tsenkova
- Center for Women's and Health Disparities Research, University of Wisconsin-Madison, 310N. Midvale Blvd, Madison, WI, 53706, USA,
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Penckofer S, Quinn L, Byrn M, Ferrans C, Miller M, Strange P. Does glycemic variability impact mood and quality of life? Diabetes Technol Ther 2012; 14:303-10. [PMID: 22324383 PMCID: PMC3317401 DOI: 10.1089/dia.2011.0191] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Diabetes is a chronic condition that significantly impacts quality of life. Poor glycemic control is associated with more diabetes complications, depression, and worse quality of life. The impact of glycemic variability on mood and quality of life has not been studied. METHODS A descriptive exploratory design was used. Twenty-three women with type 2 diabetes wore a continuous glucose monitoring system for 72 h and completed a series of questionnaires. Measurements included (1) glycemic control shown by glycated hemoglobin and 24-h mean glucose, (2) glycemic variability shown by 24-h SD of the glucose readings, continuous overall net glycemic action (CONGA), and Fourier statistical models to generate smoothed curves to assess rate of change defined as "energy," and (3) mood (depression, anxiety, anger) and quality of life by questionnaires. RESULTS Women with diabetes and co-morbid depression had higher anxiety, more anger, and lower quality of life than those without depression. Certain glycemic variability measures were associated with mood and quality of life. The 24-h SD of the glucose readings and the CONGA measures were significantly associated with health-related quality of life after adjusting for age and weight. Fourier models indicated that certain energy components were significantly associated with depression, trait anxiety, and overall quality of life. Finally, subjects with higher trait anxiety tended to have steeper glucose excursions. CONCLUSIONS Data suggest that greater glycemic variability may be associated with lower quality of life and negative moods. Implications include replication of the study in a larger sample for the assessment of blood glucose fluctuations as they impact mood and quality of life.
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Affiliation(s)
- Sue Penckofer
- Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA.
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Vedhara K, Miles JNV, Wetherell MA, Dawe K, Searle A, Tallon D, Cullum N, Day A, Dayan C, Drake N, Price P, Tarlton J, Weinman J, Campbell R. Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence. Diabetologia 2010; 53:1590-8. [PMID: 20411235 DOI: 10.1007/s00125-010-1743-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms. METHODS For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed. RESULTS After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95% CI 0.704-0.929, p = 0.003; model including anxiety: OR 0.810, 95% CI 0.704-0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response. CONCLUSIONS/INTERPRETATION Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.
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Affiliation(s)
- K Vedhara
- Institute of Work, Health and Organisations, International House, University of Nottingham, Jubilee Campus, Nottingham NG8 1BB, UK.
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22
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Skocić M, Rudan V, Brajković L, Marcinko D. Relationship among psychopathological dimensions, coping mechanisms, and glycemic control in a Croatian sample of adolescents with diabetes mellitus type 1. Eur Child Adolesc Psychiatry 2010; 19:525-33. [PMID: 19777286 DOI: 10.1007/s00787-009-0066-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/16/2009] [Indexed: 11/25/2022]
Abstract
Psychopathological factors associated with metabolic control in juvenile insulin-dependent diabetes mellitus (IDDM) deserve further investigation. This study assessed the relationship among specific psychopathological dimensions, coping mechanisms, and metabolic control in a Croatian clinical sample of adolescents with IDDM. One-hundred and one adolescents (aged 11-18) with IDDM filled out the youth self report (YSR) assessing psychopathological dimension and the scale of coping with stress (SCS). Glycemic control was estimated by the percentage of glycated hemoglobin (HbA1c). Subjects were divided into three groups according to HbA1C values: "optimal", "suboptimal control", and "at high risk". Subjects in optimal glycemic control presented with significantly lower scores in most of YSR scales compared to subjects at high risk. Moreover, they had significantly lower scores in avoidance and emotional reactivity and significantly higher scores in cognitive restructuring and problem solving SCS subscales. Regression models revealed that both internalizing and externalizing YSR scores, as well as emotional reactivity coping scores, independently contributed to explain variability of HbA1C values. Both internalizing and externalizing psychopathological dimensions, as well as emotion-oriented coping strategies, are independently associated with poor metabolic control in both boys and girls with IDDM, thus representing potential interest targets of psychotherapeutic interventions aimed at improving glycemic control in this population.
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Affiliation(s)
- Milena Skocić
- Department for Psychiatry and Psychological Medicine, University of Zagreb, Croatia.
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Ghanizadeh A, Haghighi HB. How do ADHD children perceive their cognitive, affective, and behavioral aspects of anger expression in school setting? Child Adolesc Psychiatry Ment Health 2010; 4:4. [PMID: 20205823 PMCID: PMC2824670 DOI: 10.1186/1753-2000-4-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 01/25/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anger is an ignored research area in children and young adolescents with Attention deficit hyperactivity disorder (ADHD) in the school setting. This study compares school anger dimensions in children and young adolescents with ADHD and a control group. METHODS The subjects were a clinical sample of 67 children and young adolescents with ADHD and their parents, with a sample of 91 children from the community of similar age and gender as control group. Anger was measured by the Farsi version of the Multidimensional School Anger Inventory (MSAI). RESULTS The scores of the two components of "Hostile Outlook" and "Positive Coping" were different between the groups. The mean scores for the Anger components did not statistically differ between the children with ADHD and ODD and ADHD without ODD, boys and girls, or different types of ADHD. CONCLUSION Children with ADHD do not report higher rates of experience of anger and they do not apply destructive strategies more than the control group. However, children with ADHD appear to have a more hostile outlook toward school and their coping strategy is weaker than that of the control group.
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Affiliation(s)
- Ahmad Ghanizadeh
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran.
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Yi-Frazier JP, Smith RE, Vitaliano PP, Yi JC, Mai S, Hillman M, Weinger K. A Person-Focused Analysis of Resilience Resources and Coping in Diabetes Patients. Stress Health 2010; 26:51-60. [PMID: 20526415 PMCID: PMC2880488 DOI: 10.1002/smi.1258] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigated the resilience resources and coping profiles of diabetes patients. A total of 145 patients with diabetes completed a questionnaire packet including two measurements of coping (COPE and Coping Styles questionnaires), and personal resources. Glycosylated hemoglobin (HbA(1c)) was also assessed. Resilience was defined by a factor score derived from measures of self-esteem, self-efficacy, self-mastery, and optimism. All of the maladaptive coping subscales were negatively associated with resilience (r's range from -.34 to -.56, all p's <.001). Of the adaptive coping subscales, only acceptance, emotional support, and pragmatism were positively associated with resilience. The upper, middle, and lower tertiles of the resilience factor were identified and the coping profiles of these groups differed significantly, with low resilience patients favoring maladaptive strategies much more than those with high or moderate resilience resources. Resilience groups did not differ in HbA(1c) levels; correlation coefficients of the coping subscales with HbA(1c) were explored. This study demonstrates a link between maladaptive coping and low resilience, suggesting that resilience impacts one's ability to manage the difficult treatment and lifestyle requirements of diabetes.
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Affiliation(s)
- Joyce P Yi-Frazier
- Department of Endocrinology/Diabetes, Seattle Children's Research Institute, Seattle, WA
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