The Prevalence and Correlates of Mental and Emotional Health Among American Indian Adults With Type 2 Diabetes

Alleviation of Fufang Fanshiliu decoction on type II diabetes mellitus by reducing insulin resistance: A comprehensive network prediction and experimental validation

ETHNOPHARMACOLOGICAL RELEVANCE

Fufang Fanshiliu decoction (FFSLD) is a Chinese herbal medicine prescription that has been used in type 2 diabetes mellitus (T2DM), while the underlying mechanism remains unclear.

AIM OF THE STUDY

To validate the efficacy and explore the potential mechanisms of FFSLD in treating T2DM via integrating a network pharmacological approach and experimental evaluation.

MATERIALS AND METHODS

T2DM mice model induced by high-fat diet feeding combined with streptozotocin injection was selected to investigate the alleviation of FFSLD against T2DM, via detecting the levels of glucose, insulin, glucagon (GC), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Network pharmacological analysis was used to predict the potential mechanisms, including the pharmacokinetics and drug-likeness screening, active ingredients and potential targets prediction, network analysis, and enrichment analysis. The candidate bioactive molecules of FFSLD, and targets information excavated through TCMSP, Uniprot, GeneCards, OMIM databases, were combined for comprehensive analysis by constructing "drug-compound-target-disease" and "protein-protein interaction" networks. Enrichment analysis was performed via Gene Ontology (GO) and Koto Encyclopedia of Genes and Genomes (KEGG) databases. HepG2 insulin-resistance (IR) cells model induced by high glucose was used to verify the potential mechanisms of FFSLD against T2DM which were predicted by the network pharmacology.

RESULTS

The animal study showed that FFSLD significantly decreased the blood glucose, and reversed the abnormal levels of insulin, GC, TG, TC, HDL-C, and LDL-C in T2DM mice. Network pharmacological analysis indicated that 106 active compounds of FFSLD might be correlated with 628 targets in treating T2DM, and the mechanism would probably be related to insulin resistance that harbored a high response value (P = 5.88844 E^-33) though regulating Akt1, ESR1, oxidoreductase activity, and JAK/STAT signalings. Experimental validation showed that FFSLD reduced the ROS level, up-regulated the expressions of p-AKT, Nrf-2, and ESR1, and down-regulated the expressions of JAK2, STAT3, and Keap-1 in the HepG2-IR cells model.

CONCLUSIONS

This study demonstrated that the therapeutic effect of FFSLD on T2DM was related to IR alleviation. The underlying mechanisms were associated with the regulation of PI3K/AKT, JAK/STAT, oxidative stress, and ESR signaling pathways.

Centering the Strengths of American Indian Culture, Families and Communities to Overcome Type 2 Diabetes

Type 2 diabetes (T2D) is a critical Indigenous health inequity rooted in experiences of colonization and marginalization including disproportionate exposure to stressors, disruption of traditional family and food systems, and attacks on cultural practices that have led to more sedentary lifestyles. Thus, an important step in redressing inequities is building awareness of and interventions attuned to unique Indigenous contexts influencing T2D and Indigenous culture as a pathway to community wellbeing. Using a dynamic, stage-based model of intervention development and evaluation, we detail the creation and evolution of a family-based, culturally centered T2D preventive intervention: Together on Diabetes (later Together Overcoming Diabetes) (TOD). The TOD program was built by and for Indigenous communities via community-based participatory research and has been implemented across diverse cultural contexts. The TOD curriculum approaches health through a holistic lens of spiritual, mental, physical and emotional wellness. Preliminary evidence suggests TOD is effective in reducing diabetes risk factors including lowering BMI and depressive symptoms, and the program is viewed favorably by participants and community members. We discuss lessons learned regarding collaborative intervention development and adaptation across Indigenous cultures, as well as future directions for TOD.

Spiritual connectedness through prayer as a mediator of the relationship between Indigenous language use and positive mental health

OBJECTIVE

The objective of this study is to understand how Indigenous language and spirituality revitalization efforts may affect mental health within Indigenous communities. Although Indigenous communities experience disproportionate rates of mental health problems, research supporting language and spirituality's role in improving mental health is under-researched and poorly understood.

METHOD

Data for this study are from a Community-based Participatory Research Project involving five Anishinaabe tribes in Minnesota and Wisconsin. Participants were sampled from clinic records of adults with a diagnosis of type 2 diabetes, living on or near the reservation, and self-identifying as American Indian (mean age = 46.3; n = 191).

RESULT

Structural equation modeling illustrates that language use in the home is associated with positive mental health through spiritual connectedness.

CONCLUSION

Results support tribal community expressions of the positive effects of cultural involvement for Indigenous wellbeing, and improve what is known about the interconnectedness of language and spirituality. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Momentum and Longevity for Tribally Driven Health Equity Science: Evidence from the Gathering for Health Project

American Indian health disparities have reached crisis levels, and there is a need to develop culturally congruent interventions through meaningful tribal involvement and ethical community-oriented approaches. Hence, it is imperative that researchers and university administrators better understand how research translation occurs for tribally driven health-equity research projects. Utilizing thematic analysis methods, the authors examined documents from a 12-year community-based participatory research partnership to elucidate factors that ignite momentum and support partnership longevity. The overarching finding was that trust and respect provide a foundation for momentum and longevity and are closely intertwined with other themes identified in analyses. Seven themes were extrapolated and classified into two domains: (1) investments, which are catalyzing factors that advance research, and (2) intermediate processes, which link investments to success. Investment themes include Indigenous scholar involvement, time and effort, establishing rapport, and clear and appropriate communication. Intermediate process themes include generative colearning, active participation, and recognition and celebration. Community-based participatory research principles were reflected in these findings. This study also upholds prior published work on Indigenous research methodologies, promotes the lived experiences of Indigenous people, and contributes to Indigenous theory building and science.

Culture, Social Support, and Diabetes Empowerment Among American Indian Adults Living With Type 2 Diabetes

OBJECTIVE | Type 2 diabetes represents a major health disparity for many American Indian/Alaska Native (AIAN) communities, in which prevalence rates are more than double that of the general U.S. population. Diabetes is a major indicator for other comorbidities, including the leading cause of death for AIANs (i.e., cardiovascular disease). This study investigated associations between protective factors (social support and cultural factors) and self-reported empowerment to manage illness. DESIGN AND METHODS | Participants were drawn from a random sample of tribal clinic records. Data included results from computer-assisted personal interviews with 192 American Indian adults with a diagnosis of type 2 diabetes living on or near a reservation. Community Research Councils, developed at each of the five partnering Anishinaabe reservations, oversaw protocols and procedures in this community-based participatory research collaboration. RESULTS | Multiple ordinary least squares regression models determined that general social support and diabetes-specific social support are positively related to diabetes empowerment. These associations persisted when both social support measures were added to the model, indicating independent effects of different types of social support. Cultural identity and cultural practices were positively related to diabetes empowerment in bivariate analyses; however, both measures dropped from statistical significance after accounting for all other covariates. An interaction term revealed a moderation effect through which cultural identity amplified the positive relationship between social support and diabetes empowerment. CONCLUSION | Results moderately support policy and risk-reduction efforts aiming at expanding social support networks into multiple domains and reinforcing cultural identity and cultural practices.

Depressive Symptoms and All-Cause Mortality in Older American Indians with Type 2 Diabetes Mellitus

OBJECTIVES

American Indians experience disproportionately high rates of poor mental health and type 2 diabetes mellitus (T2DM). We examined the association between depressive symptoms and all-cause mortality in older American Indians with T2DM.

DESIGN

We used the Native Elder Care Study survey data from community-dwelling American Indians aged 55 years or older, linked to data extracted from participants' electronic health records. We focused on those who had an International Classification of Diseases-Ninth Revision diagnosis of T2DM in their electronic health records.

SETTING

The study was conducted with a federally-recognized tribe with approximately 16,000 enrolled members, most of whom reside on or near tribally-owned lands that span several rural counties.

PARTICIPANTS

Participants were among the Native Elder Care Study participants with a final analytic sample of 222.

MEASUREMENTS

We measured depressive symptoms with the Centers for Epidemiologic Studies-Depression (CES-D) scale. We used Cox proportional hazard models to examine the association between depressive symptoms and all-cause mortality in the final analytic sample of 222 subjects.

RESULTS

Survival curves revealed that individuals in the third and fourth CES-D scale categories had higher mortality than those in the first and second categories. Mortality risk was significantly higher for participants with CES-D scale scores in the third highest compared with the lowest category (hazard ratio = 2.07; 95% confidence interval = 1.07-4.04), after adjustment for demographic characteristics, health behaviors, obesity, and prevalent T2DM complications. Analyses with the CES-D scale as a continuous variable also showed a positive association with mortality.

CONCLUSION

The impact of mental health on older American Indians with T2DM is often overlooked, yet it is vital to clinical and public health practice. Our findings underscore the importance of addressing the mental health needs of this population, particularly because depression in older patients is often undetected or inadequately treated. J Am Geriatr Soc 67:1940-1945, 2019.

Self-reported eye diseases among American Indian individuals with type 2 diabetes from the northern Midwest

PURPOSE

To determine the prevalence of eye diseases and utilization of dilated eye exams among a sample of American Indian (AI) individuals with type 2 diabetes.

METHODS

AI adults with type 2 diabetes utilizing health care at two reservation clinics were randomly sampled and recruited for interviewer-assisted paper surveys. The prevalence of eye diseases was compared across gender, age, income, and educational attainment.

RESULTS

The prevalence of retinopathy, cataracts, macular degeneration, and glaucoma were 9.4%, 26.7%, 5.2%, and 10.6% respectively, and 59.2% reported past year dilated eye exams. Older participants were more likely to report cataracts (p < 0.001) and glaucoma (p = .003). Those with lower income were more likely to report cataracts (p = 0.001).

CONCLUSIONS

Rates of self-reported eye diseases in this sample were higher, and dilated eye exams lower than other samples of the general United States population with diabetes, suggesting improvement can be made to improve the provision of care for AI individuals with type 2 diabetes.

Association of depressive symptomology and psychological trauma with diabetes control among older American Indian women: Does social support matter?

AIMS

Among older American Indian women with type 2 diabetes (T2DM), we examined the association between mental health and T2DM control and if social support modifies the association.

METHODS

Survey data were linked to T2DM medical record information. Mental health measures were the Center for Epidemiologic Studies - Depression Scale and the National Anxiety Disorders Screening Day instrument. T2DM control was all HbA1c values taken post mental health measures.

RESULTS

There was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support. There was a significant association between psychological trauma and higher HbA1c values 12months [mean 7.5, 95% CI 7.0-8.0 for no trauma vs. mean 7.0, 95% CI 6.3-7.6 for trauma with no symptoms vs. mean 8.4, 95% CI 7.7-9.1 for trauma with ≥1 symptom(s)] and 6months later [mean 7.2, 95% CI 6.7-7.7 for no trauma vs. mean HbA1c 6.8, 95% CI 6.2-7.4 for trauma with no symptoms vs. mean 8.4, 95% CI 7.6-9.2 for trauma with ≥1 symptom(s)]. High social support attenuated the association between psychological trauma and HbA1c values.

CONCLUSIONS

T2DM programs may consider activities that would strengthen participants' social support and thereby building on an intrinsic community strength.

Emotional and Behavioral Aspects of Diabetes in American Indians/Alaska Natives

American Indians and Alaska Natives (AI/ANs) bear a disproportionate burden of diabetes and associated long-term complications. Behavioral interventions play a vital role in promoting diabetes medical and psychological outcomes, yet the development of interventions for AI/AN communities has been limited. A systematic review was conducted of studies focused on the psychosocial and behavioral aspects of diagnosed diabetes among AI/ANs. Ovid and PubMed databases and published reference lists were searched for articles published between 1987 and 2014 that related to the psychosocial and behavioral aspects of type 1 or type 2 diabetes in the AI/AN population. Twenty studies were identified that met the inclusion criteria. Nineteen studies were observational and one study was intervention based. Two of the studies used community-based participatory research methodology. Of the 20 studies, 2 discussed cultural influences associated with diabetes self-management and 10 identified the specific tribes that participated in the study. Tribal affiliations among the studies were broad with the number of AI/AN participants in each study ranging from 30 to 23,529 participants. Emotional and behavioral topics found in the literature were adherence ( n = 2), depression ( n = 9), physical activity ( n = 3), psychosocial barriers ( n = 1), social support ( n = 3), and stress ( n = 2). Relatively few studies were identified using AI/AN populations over a 27-year period. This is in stark contrast to what is known about the prevalence and burden that type 1 and type 2 diabetes mellitus place on AI/AN communities. Future research should promote community engagement through the use of community-based participatory research methodologies, seek to further understand and describe the emotional and behavioral context for diabetes self-management in this population, and develop and test innovative interventions to promote the best possible diabetes outcomes.

Language as a Facilitator of Cultural Connection

Understanding culture as a means of preventing or treating health concerns is growing in popularity among social behavioral health scientists. Language is one component of culture and therefore may be a means to improve health among Indigenous populations. This study explores language as a unique aspect of culture through its relationship to other demographic and cultural variables. Participants (n = 218) were adults who self-identified as American Indian, had a type 2 diabetes diagnosis, and were drawn from two Ojibwe communities using health clinic records. We used chi-squared tests to compare language proficiency by demographic groups and ANOVA tests to examine relationships between language and culture. A higher proportion of those living on reservation lands could use the Ojibwe language, and fluent speakers were most notably sixty-five years of age and older. Regarding culture, those with greater participation and value belief in cultural activities reported greater language proficiency.

Apathy and Type 2 Diabetes among American Indians: Exploring the Protective Effects of Traditional Cultural Involvement

In this study we examine relationships between traditional cultural factors, apathy, and health-related outcomes among a sample of American Indian adults with type 2 diabetes. Participants completed cross-sectional interviewer-assisted paper and pencil surveys. We tested a proposed model using latent variable path analysis in order to understand the relationships between cultural participation, apathy, frequency of high blood sugar symptoms, and health-related quality of life. The model revealed significant direct effects from cultural participation to apathy, and apathy to both health-related outcomes. No direct effect of cultural participation on either health-related outcome was found; however, cultural participation had a negative indirect effect through apathy on high blood sugar and positive indirect effects on health-related quality of life. This study highlights a potential pathway of cultural involvement to positive diabetes outcomes.

Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes

This study examined the prevalence of screened posttraumatic stress disorder (PTSD) and associated diabetes-related outcomes. A sample of American Indian adults with type 2 diabetes (n = 218) participated in interviewer-administered surveys. Using a cutoff of 3 on the Primary Care PTSD screener, 21.8 % of participants screened positive for PTSD. PTSD symptoms were negatively associated with self-rated health status and positively associated with past year hospitalization after controlling for several demographic factors, but not after controlling for depressive symptoms. Past month frequency of hyperglycemia symptoms was not related to PTSD symptoms. When grouped by mental health conditions (neither screened PTSD nor depressive symptoms, screened PTSD only, depressive symptoms only, and both), those with both screened PTSD and depressive symptoms reported the highest proportion of any past month hyperglycemia, past year hospitalization, and low self-rated health status. Screened PTSD, especially in those with comorbid depressive symptoms, is an important consideration in diabetes care.

Mental health service and provider preference among American Indians with type 2 diabetes

In this study, we investigated mental health service and provider preferences of American Indian adults with type 2 diabetes from two tribes in the northern Midwest. Preferences were determined and compared by participant characteristics. After controlling for other factors, living on reservation lands was associated with increased odds of Native provider preference, and decreased odds of biomedical service preference. Anxiety also was associated with decreased odds of biomedical service preference. Spiritual activity engagement and past health care discrimination were associated with increased odds of traditional service preference. We discuss implications for the types of mental health services offered and characteristics of providers who are recruited for tribal communities.

Mental Health in Diabetes Prevention and Intervention Programs in American Indian/Alaska Native Communities

American Indian and Alaska Natives youth and adults experience higher rates of type 2 diabetes and mental health problems than the general United States population. Few studies have explored the relationship other than detail the two issues independently. The present review aims to identify programs that seek to prevent/treat type 2 diabetes and mental health disorders in the American Indian and Alaska Native population. Available programs were reviewed for AI/AN adults and youth who suffer with both. As part of the review process, databases were searched for peer reviewed published studies. It was found that very few programs effectively incorporate mental health into the existing diabetes program. Four recommendations for future research are offered based on this literature review.