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Minto LR, Ellis R, Cherry KE, Wood RH, Barber SJ, Carter S, Dotson VM. Impact of cardiovascular risk factors on the relationships of physical activity with mood and cognitive function in a diverse sample. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:654-667. [PMID: 35510295 PMCID: PMC10461536 DOI: 10.1080/13825585.2022.2071414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/22/2022] [Indexed: 05/10/2023]
Abstract
Physical activity has well-known benefits for older adults' mood and cognitive functioning; however, it is not clear whether risk factors for cardiovascular disease (CVD) affect the relationships of physical activity with these health outcomes among diverse older adults. This study investigated the impact of CVD risk burden on the relationships among self-reported physical activity, mood, and cognitive functioning in a diverse sample of 62 adults age 45 and older. We found that higher physical activity was associated with better attention and verbal working memory at lower CVD risk, but with worse attention and verbal working memory at higher CVD risk levels. Thus, higher CVD risk might limit the effectiveness of exercise interventions for mood and cognitive functioning. Future studies are needed to further clarify individual differences that impact the relationships among physical activity, CVD risk, and cognitive outcomes.
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Affiliation(s)
- Lex R. Minto
- Department of Psychology, Georgia State University
| | - Rebecca Ellis
- Department of Kinesiology & Health, Georgia State University
| | | | | | - Sarah J. Barber
- Department of Psychology, Georgia State University
- Gerontology Institute, Georgia State University
| | | | - Vonetta M. Dotson
- Department of Psychology, Georgia State University
- Gerontology Institute, Georgia State University
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Sharifian N, Sol K, Zaheed AB, Morris EP, Palms JD, Martino AG, Zahodne LB. Depressive Symptoms, Leisure Activity Engagement, and Global Cognition in Non-Hispanic Black and White Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 77:2137-2147. [PMID: 34387343 PMCID: PMC9683487 DOI: 10.1093/geronb/gbab153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Prior research indicates that depressive symptoms disproportionately affect cognition in non-Hispanic Blacks relative to non-Hispanic Whites. Depressive symptoms have been linked to worse global cognition in older adulthood through lower leisure activity engagement, but less is known regarding the distinct types of activities that drive these associations and whether associations involving depressive symptoms, leisure activities, and cognition differ across racial groups. METHODS This cross-sectional study used data from the Michigan Cognitive Aging Project (n = 453, 52.80% Black, Mage = 63.60 years). Principal components analysis identified 6 subtypes of leisure activities (cognitive, creative, community, physical, children, and games). Mediation models examined whether distinct leisure activity subtypes mediated the association between depressive symptoms and performance on a comprehensive neuropsychological battery and whether race moderated these associations. RESULTS There were no racial differences in the level of depressive symptoms after adjusting for sociodemographic, socioeconomic, and health covariates. Only lower cognitive activity engagement mediated the negative association between depressive symptoms and global cognition. Multigroup models revealed that this indirect effect was only evident in Blacks, who showed a stronger negative association between depressive symptoms and cognitive activity engagement than Whites. After accounting for indirect effects, a direct effect of higher depressive symptoms on worse cognition remained and did not differ across racial groups. DISCUSSION Depressive symptoms may disproportionately affect cognition among Blacks through a greater negative impact on engagement in cognitively stimulating activities that have been shown to promote cognitive reserve. Additional research is necessary to identify other mechanisms linking depressive symptoms and cognition.
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Affiliation(s)
- Neika Sharifian
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Ketlyne Sol
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Jordan D Palms
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Alexa G Martino
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Laura B Zahodne
- Address correspondence to: Laura Zahodne, PhD, Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA. E-mail:
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Page-Reeves J, Murray-Krezan C, Regino L, Perez J, Bleecker M, Perez D, Wagner B, Tigert S, Bearer EL, Willging CE. A randomized control trial to test a peer support group approach for reducing social isolation and depression among female Mexican immigrants. BMC Public Health 2021; 21:119. [PMID: 33430845 PMCID: PMC7798010 DOI: 10.1186/s12889-020-09867-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female Mexican Immigrants (FMIs) experience high rates of depression compared with other populations. For this population, depression is often exacerbated by social isolation associated with the experience of immigration. Aim 1. To measure whether a culturally situated peer group intervention will reduce depression and stress associated with the experience of immigration. Aim 2. To test whether an intervention using a "women's funds of knowledge" approach results in improved resilience, knowledge and empowerment. Aim 3. To investigate whether a culturally situated peer group intervention using a women's funds of knowledge approach can give participants a sense and experience of social and physical connection ("emplacement") that is lost in the process of immigration. METHODS This mixed-methods study will implement "Tertulias" ("conversational gatherings" in Spanish), a peer support group intervention designed to improve health outcomes for FMI participants in Albuquerque, New Mexico. We will document results of the intervention on our primary hypotheses of a decrease in depression, and increases in resilience and social support, as well as on our secondary hypotheses of decreased stress (including testing of hair cortisol as a biomarker for chronic stress), and an increase in social connectedness and positive assessment of knowledge and empowerment. DISCUSSION This project will address mental health disparities in an underserved population that experiences high rates of social isolation. Successful completion of this project will demonstrate that health challenges that may appear too complex and too hard to address can be using a multi-level, holistic approach. Our use of hair samples to test for the 3-month average levels of systemic cortisol will contribute to the literature on an emerging biomarker for analyzing chronic stress. TRIAL REGISTRATION This study was registered with ClinicalTrials.gov on 2/3/20, Identifier # NCT04254198 .
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Affiliation(s)
| | | | - Lidia Regino
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Daniel Perez
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Susan Tigert
- University of New Mexico, Albuquerque, New Mexico, USA
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Hoare E, Dash SR, Varsamis P, Jennings GL, Kingwell BA. Fasting Plasma Glucose, Self-Appraised Diet Quality and Depressive Symptoms: A US-Representative Cross-Sectional Study. Nutrients 2017; 9:nu9121330. [PMID: 29215576 PMCID: PMC5748780 DOI: 10.3390/nu9121330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/10/2017] [Accepted: 12/05/2017] [Indexed: 11/25/2022] Open
Abstract
Depression and type 2 diabetes (T2D) contribute significantly to global burden of disease and often co-occur. Underpinning type 2 diabetes is poor glycaemic control and glucose is also an obligatory substrate for brain metabolism, with potential implications for cognition, motivation and mood. This research aimed to examine the relationships between fasting plasma glucose and depressive symptoms in a large, population representative sample of US adults, controlling for other demographic and lifestyle behavioural risk factors. Using the 2013–2014 National Health and Nutrition Examination Survey (NHANES) data, this study first investigated the relationship between fasting plasma glucose and mental disorders at a population-level, accounting for demographic, health behavioural and weight-related factors known to co-occur with both type 2 diabetes and mental disorders. Depressive symptoms were derived from the 9-item Patient Health Questionnaire. Fasting plasma glucose was obtained through medical examination and demographic (age, household income, sex) and health characteristics (perceived diet quality, daily time sedentary) were self-reported. Body mass index was calculated from objectively measured height and weight. In the univariate model, higher fasting plasma glucose was associated with greater depressive symptoms among females (b = 0.24, 95% CI = 0.05, 0.43, p < 0.05), but not males. In the final fully adjusted model, the relationship between fasting plasma glucose and depressive symptoms was non-significant for both males and females. Of all independent variables, self-appraised diet quality was strongly and significantly associated with depressive symptoms and this remained significant when individuals with diabetes were excluded. Although diet quality was self-reported based on individuals’ perceptions, these findings are consistent with a role for poor diet in the relationship between fasting plasma glucose and depressive symptoms.
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Affiliation(s)
- Erin Hoare
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Sarah R Dash
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Pia Varsamis
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Garry L Jennings
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
| | - Bronwyn A Kingwell
- Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne, VIC 3004, Australia.
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Lehrer HM, Dubois SK, Brown SA, Steinhardt MA. Resilience-based Diabetes Self-management Education: Perspectives From African American Participants, Community Leaders, and Healthcare Providers. DIABETES EDUCATOR 2017; 43:367-377. [PMID: 28614997 DOI: 10.1177/0145721717714894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this qualitative, focus group study was to further refine the Resilience-based Diabetes Self-management Education (RB-DSME) recruitment process and intervention, build greater trust in the community, and identify strategies to enhance its sustainability as a community-based intervention in African American church settings. Methods Six 2-hour focus groups (N = 55; 10 men and 45 women) were led by a trained moderator with a written guide to facilitate discussion. Two sessions were conducted with individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in previous RB-DSME pilot interventions and their family members, two sessions with local church leaders, and two sessions with community healthcare providers who care for patients with T2DM. Two independent reviewers performed content analysis to identify major themes using a grounded theory approach. The validity of core themes was enhanced by external review and subsequent discussions with two qualitative methods consultants. Results There was expressed interest and acceptability of the RB-DSME program. Church connection and pastor support were noted as key factors in building trust and enhancing recruitment, retention, and sustainability of the program. Core themes across all groups included the value of incentives, the need for foundational knowledge shared with genuine concern, teaching with visuals, dealing with denial, balancing the reality of adverse consequences with hope, the importance of social support, and addressing healthcare delivery barriers. Conclusion Focus groups documented the feasibility and potential effectiveness of RB-DSME interventions to enhance diabetes care in the African American community. In clinical practice, inclusion of these core themes may enhance T2DM self-care and treatment outcomes.
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Affiliation(s)
- H Matthew Lehrer
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas (Mr Lehrer, Dr Dubois, Prof Steinhardt)
| | - Susan K Dubois
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas (Mr Lehrer, Dr Dubois, Prof Steinhardt)
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Brown)
| | - Mary A Steinhardt
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas (Mr Lehrer, Dr Dubois, Prof Steinhardt)
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Joseph JJ, Wang X, Diez Roux AV, Sanchez BN, Seeman TE, Needham BL, Golden SH. Antecedent longitudinal changes in body mass index are associated with diurnal cortisol curve features: The multi-ethnic study of atherosclerosis. Metabolism 2017; 68:95-107. [PMID: 28183457 PMCID: PMC5312946 DOI: 10.1016/j.metabol.2016.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/15/2016] [Accepted: 12/05/2016] [Indexed: 01/05/2023]
Abstract
CONTEXT Prior studies have shown a cross-sectional association between body mass index (BMI) and salivary diurnal cortisol profile features (cortisol features); however, to our knowledge prior population-based studies have not examined the longitudinal association of body-mass index (BMI) with cortisol features. OBJECTIVE To examine the association of (1) prior annual BMI percent change over 7years with cortisol features, (2) baseline cortisol features with subsequent change in BMI over 6years and (3) the association of change in cortisol features with change in BMI over 6years. DESIGN Longitudinal study. SETTING Multi-Ethnic Study of Atherosclerosis (MESA) Stress I & II Studies (2004-2006 & 2010-2012). PARTICIPANTS 1685 ethnically diverse men and women attended either MESA Stress exam (mean age 65±10years at MESA Stress I; mean age 69±9years at MESA Stress II). OUTCOME MEASURES Log-transformed cortisol features including wake-up cortisol, cortisol awakening response, early decline slope (30min to 2h post-awakening), late decline slope (2h post-awakening to bedtime), bedtime, and total area under the curve (AUC) cortisol. RESULTS Over 7years, following multivariable adjustment, (1) a 1% higher prior annual BMI % increase was associated with a 2.9% (95% CI: -5.0%, -0.8%) and 3.0% (95% CI: -4.7%, -1.4%) lower current wake-up and total AUC cortisol, respectively; (2) there was no significant association between baseline cortisol features and subsequent change in BMI and (3) among participants with BMI≥30kg/m2, flattening of the late decline slope was associated with increases in BMI (every 1-unit increase late decline slope were associated with a 12.9% increase (95%CI: -1%, 26.8%) in BMI, respectively). CONCLUSIONS We found a significant association between prior annual BMI % change and cortisol features, but no significant association between baseline cortisol features and subsequent change in BMI. In participants with obesity increases in BMI were associated with less pronounced declined. Collectively, our results suggest that greater adiposity may lead to a blunted diurnal cortisol profile.
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Affiliation(s)
- Joshua J Joseph
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
| | - Xu Wang
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Ana V Diez Roux
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Brisa N Sanchez
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Teresa E Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Belinda L Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Sherita Hill Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States
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Lehrer HM, Dubois SK, Maslowsky J, Laudenslager ML, Steinhardt MA. Hair cortisol concentration and glycated hemoglobin in African American adults. Psychoneuroendocrinology 2016; 72:212-8. [PMID: 27500952 DOI: 10.1016/j.psyneuen.2016.06.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND African Americans have higher diabetes prevalence compared to Whites. They also have elevated cortisol levels - indicating possible HPA axis dysregulation - which may raise blood glucose as part of the biological response to physiological and psychosocial stress. Little is known about chronic cortisol levels in African Americans, and even less about the role of chronically elevated cortisol in type 2 diabetes development in this racial group. PURPOSE We used analysis of cortisol in hair to examine associations of long-term (∼3months) cortisol levels with glycated hemoglobin (HbA1c) in a group of African American adults. In exploratory analyses, we also studied the relationship of hair dehydroepiandrosterone (DHEA) with HbA1c. METHOD Participants were 61 community-dwelling African American adults (85% female; mean age 54.30 years). The first 3cm of scalp-near hair were analyzed for cortisol and DHEA concentration using enzyme-linked immunoassay analysis. Glycated hemoglobin was assessed, and regression analyses predicting HbA1c from hair cortisol and DHEA were performed in the full sample and in a subsample of participants (n=20) meeting the National Institute of Diabetes and Digestive Kidney Disease (NIDDK) criteria for type 2 diabetes (HbA1c≥6.5%). RESULTS In the full sample, HbA1c increased with hair cortisol level (β=0.22, p=0.04, f(2)=0.10), independent of age, sex, chronic health conditions, diabetes medication use, exercise, and depressive symptoms. In the subsample of participants with an HbA1c≥6.5%, hair cortisol was also positively related to HbA1c (β=0.45, p=0.04, f(2)=0.32), independent of diabetes medication use. Glycated hemoglobin was unrelated to hair DHEA in both the full sample and HbA1c≥6.5% subsample. CONCLUSION Long-term HPA axis dysregulation in the form of elevated hair cortisol is associated with elevated HbA1c in African American adults.
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Affiliation(s)
- H Matthew Lehrer
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Susan K Dubois
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Julie Maslowsky
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Mark L Laudenslager
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Mary A Steinhardt
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA.
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Abstract
Although an association between diabetes mellitus (DM) and cognitive dysfunction has been recognized for a century, it is often not considered as a complication of DM and remains under-recognized. Cognitive dysfunction, usually present as mild cognitive impairment, can occur with either type 1 or type 2 DM. Both forms of DM contribute to accelerated cerebral atrophy and to the presence of heightened white matter abnormalities. These effects are noted most at the two extremes of life, in childhood and in the advanced years. The cognitive spheres most affected include attention and executive function, processing speed, perception, and memory. Although DM is unlikely to lead to frank dementia, its ability to exacerbate existing neurodegenerative processes, such as Alzheimer disease, will impact tremendously upon our society in the upcoming decades as our population ages. This chapter describes the clinical impact of DM upon the brain, along with discussion of the potential therapeutic avenues to be discovered in the coming decades. We need to prepare for better preventative and therapeutic management of this cerebral neurodegenerative condition.
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Affiliation(s)
- Cory Toth
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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Possible Contribution of PTSD to Altered Cortisol Activity in Young Adult Obese African-American Women. J Racial Ethn Health Disparities 2016; 2:231-6. [PMID: 26863340 DOI: 10.1007/s40615-014-0070-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/02/2014] [Accepted: 10/24/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE African-Americans have been found to experience increased rates of post-traumatic stress disorder (PTSD), obesity, and flatter diurnal cortisol slopes compared to other demographic groups. Further exploration, however, is needed to understand how PTSD impacts diurnal cortisol activity in obese African-American women. The purpose of the current study is to examine the relationship between salivary cortisol levels and PTSD in a sample of obese young adult African-American women and to examine how depression and insomnia influence the relationship. METHODS Thirty-four young adult African-American women (mean age = 24.0 years; mean BMI = 37.4 kg/m(2), 6/34 of the sample had a score of 40 or above on the PTSD Checklist (PCL) representing clinically significant PTSD) filled out questionnaires assessing PTSD, lifetime exposure to traumatic events, insomnia severity, and depression. A home-based assessment of salivary cortisol was provided upon awakening at 30 min and 1, 3, 6, and 12 h. RESULTS There was a significant interaction between PTSD status and diurnal cortisol activity (p < 0.04). There were trends for higher cortisol levels at awakening (p < 0.051) and 30 min post-awakening (p < 0.059) with PTSD. The significance of the interaction between PTSD and cortisol was attenuated by co-varying for depression and insomnia (p > 0.05). CONCLUSION PTSD, influenced by depression and insomnia symptoms, has an impact on diurnal cortisol activity in obese young adult African-American women.
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Steinhardt MA, Brown SA, Dubois SK, Harrison L, Lehrer HM, Jaggars SS. A resilience intervention in African-American adults with type 2 diabetes. Am J Health Behav 2015; 39:507-18. [PMID: 26018099 DOI: 10.5993/ajhb.39.4.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To explore the feasibility and outcomes of a resilience-based diabetes self-management education (RB-DSME) program to improve psychological and physiological health in African-American adults with type 2 diabetes. METHODS An experimental group (N = 32) received RB-DSME and a comparison group (N = 33) received standard DSME. Psychological and physiological measures were taken at baseline and 6 months. ANCOVAs assessed whether the experimental group improved its overall outcome relative to the comparison group, while controlling for baseline scores. RESULTS The experimental group's outcomes were significantly improved vis-à-vis the comparison group for diabetes knowledge, positive meaning, HDL cholesterol, and fasting blood glucose. CONCLUSIONS The RB-DSME shows feasibility and promise for enhancing health; a full-scale randomized trial is warranted.
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Affiliation(s)
| | - Sharon A Brown
- The University of Texas School of Nursing Family Wellness Center, Austin, TX, USA
| | | | | | | | - Shanna S Jaggars
- Community College Research Center, Teachers College, Columbia University, New York, NY, USA
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Sims M, Redmond N, Khodneva Y, Durant RW, Halanych J, Safford MM. Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study. Ann Epidemiol 2015; 25:426-32. [PMID: 25891100 PMCID: PMC4632969 DOI: 10.1016/j.annepidem.2015.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To examine the association of depressive symptoms with coronary heart disease (CHD) end points by race and income. METHODS Study participants were blacks and whites (n = 24,443) without CHD at baseline from the national Reasons for Geographical and Racial Differences in Stroke cohort. Outcomes included acute CHD and CHD or revascularization. We estimated race-stratified multivariate Cox proportional hazards models of incident CHD and incident CHD or revascularization with the 4-item Center for Epidemiological Studies Depression Scale, adjusting for risk factors. RESULTS Mean follow-up was 4.2 ± 1.5 years; CHD incidence was 8.3 events per 1000 person-years (n = 366) among blacks and 8.8 events per 1000 person-years (n = 613) among whites. After adjustment for age, sex, marital status, region, and socioeconomic status, depressive symptoms were significantly associated with incident CHD among blacks (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.00-1.91) but not among whites (HR, 1.10; 95% CI, 0.74-1.64). In the fully adjusted model, compared with blacks who reported no depressive symptoms, those reporting depressive symptoms had greater risk for the composite end point of CHD or revascularization (HR, 1.36; 95% CI, 1.01-1.81). Depressive symptoms were not associated with incident CHD end points among whites. CONCLUSIONS High depressive symptoms were associated with higher risk of CHD or revascularization for blacks but not whites.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
| | - Nicole Redmond
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Yulia Khodneva
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Raegan W Durant
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Jewell Halanych
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Monika M Safford
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
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Dietary Adherence, Glycemic Control, and Psychological Factors Associated with Binge Eating Among Indigenous and Non-Indigenous Chileans with Type 2 Diabetes. Int J Behav Med 2015; 22:792-8. [PMID: 25786595 DOI: 10.1007/s12529-015-9478-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite the strong association between obesity and binge eating, limited research has examined the implications of binge eating on dietary adherence and psychological factors in ethnically diverse type 2 diabetes patients. PURPOSE This study investigated the prevalence of binge eating and its association with dietary adherence, glycemic control, and psychological factors among indigenous and non-indigenous type 2 diabetes patients in Chile. METHOD Participants were 387 indigenous (Mapuche) and non-indigenous (non-Mapuche) adults with type 2 diabetes. Self-report measures of binge eating, dietary adherence, diet self-efficacy, body image dissatisfaction, and psychological well-being were administered. Participants' weight, height, and glycemic control (HbA(1c)) were also obtained. RESULTS Approximately 8 % of the type 2 diabetes patients reported binge eating. The prevalence among Mapuche patients was 4.9 %, and among non-Mapuche patients, it was 9.9 %. Compared to non-binge eaters, binge eating diabetes patients had greater body mass index values, consumed more high-fat foods, were less likely to adhere to their eating plan, and reported poorer body image and emotional well-being. CONCLUSION Results of this study extend previous research by examining the co-occurrence of binge eating and type 2 diabetes as well as the associated dietary behaviors, glycemic control, and psychological factors among indigenous and non-indigenous patients in Chile. These findings may increase our understanding of the health challenges faced by indigenous populations from other countries and highlight the need for additional research that may inform interventions addressing binge eating in diverse patients with type 2 diabetes.
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Corey SM, Epel E, Schembri M, Pawlowsky SB, Cole RJ, Araneta MRG, Barrett-Connor E, Kanaya AM. Effect of restorative yoga vs. stretching on diurnal cortisol dynamics and psychosocial outcomes in individuals with the metabolic syndrome: the PRYSMS randomized controlled trial. Psychoneuroendocrinology 2014; 49:260-71. [PMID: 25127084 PMCID: PMC4174464 DOI: 10.1016/j.psyneuen.2014.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Chronic stimulation and dysregulation of the neuroendocrine system by stress may cause metabolic abnormalities. We estimated how much cortisol and psychosocial outcomes improved with a restorative yoga (relaxation) versus a low impact stretching intervention for individuals with the metabolic syndrome. METHODS We conducted a 1-year multi-center randomized controlled trial (6-month intervention and 6-month maintenance phase) of restorative yoga vs. stretching. Participants completed surveys to assess depression, social support, positive affect, and stress at baseline, 6 months and 12 months. For each assessment, we collected saliva at four points daily for three days and collected response to dexamethasone on the fourth day for analysis of diurnal cortisol dynamics. We analyzed our data using multivariate regression models, controlling for study site, medications (antidepressants, hormone therapy), body mass index, and baseline cortisol values. RESULTS Psychosocial outcome measures were available for 171 study participants at baseline, 140 at 6 months, and 132 at 1 year. Complete cortisol data were available for 136 of 171 study participants (72 in restorative yoga and 64 in stretching) and were only available at baseline and 6 months. At 6 months, the stretching group had decreased cortisol at waking and bedtime compared to the restorative yoga group. The pattern of changes in stress mirrored this improvement, with the stretching group showing reductions in chronic stress severity and perseverative thoughts about their stress. Perceived stress decreased by 1.5 points (-0.4; 3.3, p=0.11) at 6 months, and by 2.0 points (0.1; 3.9, p=0.04) at 1 year in the stretching compared to restorative yoga groups. Post hoc analyses suggest that in the stretching group only, perceived increases in social support (particularly feelings of belonging), but not changes in stress were related to improved cortisol dynamics. CONCLUSIONS We found significant decreases in salivary cortisol, chronic stress severity, and stress perception in the stretching group compared to the restorative yoga group. Group support during the interactive stretch classes may have contributed to these changes.
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Affiliation(s)
- Sarah M Corey
- University of California, San Francisco, CA 94115, USA.
| | - Elissa Epel
- University of California, San Francisco, CA 94115, USA
| | | | | | - Roger J Cole
- Synchrony Applied Health Sciences, Del Mar, CA 92014, USA
| | | | | | - Alka M Kanaya
- University of California, San Francisco, CA 94115, USA
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Cukić I, Weiss A. Personality and diabetes mellitus incidence in a national sample. J Psychosom Res 2014; 77:163-8. [PMID: 25149025 DOI: 10.1016/j.jpsychores.2014.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 06/18/2014] [Accepted: 07/06/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To test whether personality traits were prospectively associated with type 2 diabetes incidence. METHODS The sample (n=6798) was derived from the National Health and Nutrition Examination Survey Epidemiological Follow-up Study cohort. We fit four logistic regression models to test whether neuroticism, extraversion, openness to experience, or the Type A behavior pattern predicted type 2 diabetes incidence. Model 1 included sex, age, and race/ethnicity. Model 2 added personality traits, Model 3 added depressive symptoms, and Model 4 added body mass index (BMI), hypertension, and cigarette smoking status as predictors. RESULTS In Model 1 age was associated with increased risk of diabetes (2% per year); being black as opposed to white was associated with a three-fold increase in risk. In Model 2 age and being black were still significant and extraversion was associated with decreased risk (17% per standard deviation [SD]). In Model 3 age, being black, and extraversion were still significant. In addition, neuroticism was associated with decreased risk (26% per SD) and depressive symptoms were associated with increased risk (28% per SD). In Model 4 age, being black, neuroticism, and depressive symptoms were still significant. BMI was associated with increased risk (14% per SD) and extraversion was no longer significant. CONCLUSIONS Higher neuroticism was associated with reduced type 2 diabetes risk even after controlling for race/ethnicity, age, depressive symptoms, and BMI. Extraversion and Type A behavior were not significant after including covariates.
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Affiliation(s)
- Iva Cukić
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, UK.
| | - Alexander Weiss
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, UK
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Brummett BH, Babyak MA, Jiang R, Shah SH, Becker RC, Haynes C, Chryst-Ladd M, Craig DM, Hauser ER, Siegler IC, Kuhn CM, Singh A, Williams RB. A functional polymorphism in the 5HTR2C gene associated with stress responses also predicts incident cardiovascular events. PLoS One 2013; 8:e82781. [PMID: 24386118 PMCID: PMC3867393 DOI: 10.1371/journal.pone.0082781] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/28/2013] [Indexed: 12/01/2022] Open
Abstract
Previously we have shown that a functional nonsynonymous single nucleotide polymorphism (rs6318) of the 5HTR2C gene located on the X-chromosome is associated with hypothalamic-pituitary-adrenal axis response to a stress recall task, and with endophenotypes associated with cardiovascular disease (CVD). These findings suggest that individuals carrying the rs6318 Ser23 C allele will be at higher risk for CVD compared to Cys23 G allele carriers. The present study examined allelic variation in rs6318 as a predictor of coronary artery disease (CAD) severity and a composite endpoint of all-cause mortality or myocardial infarction (MI) among Caucasian participants consecutively recruited through the cardiac catheterization laboratory at Duke University Hospital (Durham, NC) as part of the CATHGEN biorepository. Study population consisted of 6,126 Caucasian participants (4,036 [65.9%] males and 2,090 [34.1%] females). A total of 1,769 events occurred (1,544 deaths and 225 MIs; median follow-up time = 5.3 years, interquartile range = 3.3–8.2). Unadjusted Cox time-to-event regression models showed, compared to Cys23 G carriers, males hemizygous for Ser23 C and females homozygous for Ser23C were at increased risk for the composite endpoint of all-cause death or MI: Hazard Ratio (HR) = 1.47, 95% confidence interval (CI) = 1.17, 1.84, p = .0008. Adjusting for age, rs6318 genotype was not related to body mass index, diabetes, hypertension, dyslipidemia, smoking history, number of diseased coronary arteries, or left ventricular ejection fraction in either males or females. After adjustment for these covariates the estimate for the two Ser23 C groups was modestly attenuated, but remained statistically significant: HR = 1.38, 95% CI = 1.10, 1.73, p = .005. These findings suggest that this functional polymorphism of the 5HTR2C gene is associated with increased risk for CVD mortality and morbidity, but this association is apparently not explained by the association of rs6318 with traditional risk factors or conventional markers of atherosclerotic disease.
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Affiliation(s)
- Beverly H. Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
| | - Michael A. Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Svati H. Shah
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Richard C. Becker
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carol Haynes
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Megan Chryst-Ladd
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Damian M. Craig
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Elizabeth R. Hauser
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Epidemiological Research and Information Center, Durham VA Medical Center, Durham, North Carolina, United States of America
| | - Ilene C. Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Cynthia M. Kuhn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Abanish Singh
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Redford B. Williams
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
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Champaneri S, Xu X, Carnethon MR, Bertoni AG, Seeman T, DeSantis AS, Roux AD, Shrager S, Golden SH. Diurnal salivary cortisol is associated with body mass index and waist circumference: the Multiethnic Study of Atherosclerosis. Obesity (Silver Spring) 2013; 21:E56-63. [PMID: 23404865 PMCID: PMC3602310 DOI: 10.1002/oby.20047] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 07/30/2012] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Neuroendocrine abnormalities, such as activation of the hypothalamic-pituitary-adrenal (HPA) axis, are associated with obesity; however, few large-scale population-based studies have examined HPA axis and markers of obesity. We examined the cross-sectional association of the cortisol awakening response (CAR) and diurnal salivary cortisol curve with obesity. DESIGN AND METHODS The Multiethnic Study of Atherosclerosis Stress Study includes 1,002 White, Hispanic, and Black men and women (mean age 65 ± 9.8 years) who collected up to 18 salivary cortisol samples over 3 days. Cortisol profiles were modeled using regression spline models that incorporated random parameters for subject-specific effects. Cortisol curve measures included awakening cortisol, CAR (awakening to 30-min postawakening), early decline (30 min to 2-h postawakening), late decline (2-h postawakening to bedtime), and the corresponding areas under the curve (AUC). Body mass index (BMI) and waist circumference (WC) were used to estimate adiposity. RESULTS For the entire cohort, both BMI and WC were negatively correlated with awakening cortisol (P < 0.05), AUC during awakening rise, and early decline and positively correlated to the early decline slope (P < 0.05) after adjustments for age, race/ethnicity, gender, diabetes status, socioeconomic status, β-blockers, steroids, hormone replacement therapy, and smoking status. No heterogeneities of effects were observed by gender, age, and race/ethnicity. CONCLUSIONS Higher BMI and WC are associated with neuroendocrine dysregulation, which is present in a large population sample, and only partially explained by other covariates.
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Affiliation(s)
- Shivam Champaneri
- Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xiaoqiang Xu
- Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Amy S. DeSantis
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Ana Diez Roux
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Sandi Shrager
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Sherita Hill Golden
- Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins University School of Medicine and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Corresponding author: Address correspondence and requests for reprints to: Dr. Sherita Hill Golden, Johns Hopkins University School of Medicine, Division of Endocrinology and Metabolism, 2024 E. Monument Street, Suite 2-616, Baltimore, MD 21205, Tel: (410) 502-0993, Fax (410) 955-0476,
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Brummett BH, Kuhn CM, Boyle SH, Babyak MA, Siegler IC, Williams RB. Cortisol responses to emotional stress in men: association with a functional polymorphism in the 5HTR2C gene. Biol Psychol 2011; 89:94-8. [PMID: 21967853 DOI: 10.1016/j.biopsycho.2011.09.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/29/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
Abstract
The serotonin 5HTR2C receptor has been shown to mediate HPA axis activation during stress. We hypothesized that a functional polymorphism (rs6318) of the 5HTR2C gene would be associated with HPA axis response to a laboratory stress protocol. The present sample consisted of 41 men (22 African Americans, 19 Caucasians). We found that at rest men with the more active rs6318 Ser23 C allele had similar cortisol values compared to those with the less active Cys23 G allele. During laboratory stress, however, men with the Ser23 C allele exhibited the predicted significantly higher cortisol levels (p<0.001), as well as larger increases in anger (p=0.08) and depressive mood (p=0.006) ratings, compared to the Cys23 G carriers. The increase in cortisol was significantly related to the increases in ratings of anger and depression assessed before and after the emotion induction, and these correlations became nonsignificant when rs6318 genotype was covaried. We conclude that genetic variation in 5HTR2C may be associated with HPA axis activation and stimulated by emotional stress, and also with both psychological and physiological endophenotypes that increase the risk of cardiovascular disease and type-2 diabetes.
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Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States.
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Zeiders KH, Doane Sampey LD, Adam EK. Reciprocal relations between objectively measured sleep patterns and diurnal cortisol rhythms in late adolescence. J Adolesc Health 2011; 48:566-71. [PMID: 21575815 PMCID: PMC3179910 DOI: 10.1016/j.jadohealth.2010.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/13/2010] [Accepted: 08/21/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine how hours of sleep and wake times relate to between-person differences and day-to-day changes in diurnal cortisol rhythms in late adolescence. METHODS Older adolescents (N = 119) provided six cortisol samples (wakeup, +30 minutes, +2 hours, +8 hours, +12 hours, and bedtime) on each of three consecutive days while wearing an actigraph. We examined how average (across 3 days) and day-to-day changes in hours of sleep and wake times related to diurnal cortisol patterns. RESULTS On average, more hours of sleep related to steeper decline in cortisol across the days. Day-to-day analyses revealed that the hours of sleep of the previous night predicted steeper diurnal slopes the next day, whereas greater waking cortisol levels and steeper slopes predicted more hours of sleep and a later wake time the next day. CONCLUSION Our results suggest a bidirectional relationship between sleep and hypothalamic-pituitary-adrenal axis activity.
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Affiliation(s)
| | | | - Emma K. Adam
- School of Education and Social Policy and Institute for Policy Research, Northwestern University
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19
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Lewis TT, Guo H, Lunos S, Mendes de Leon CF, Skarupski KA, Evans DA, Everson-Rose SA. Depressive symptoms and cardiovascular mortality in older black and white adults: evidence for a differential association by race. Circ Cardiovasc Qual Outcomes 2011; 4:293-9. [PMID: 21505153 PMCID: PMC3097274 DOI: 10.1161/circoutcomes.110.957548] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An emerging body of research suggests that depressive symptoms may confer an "accelerated risk" for cardiovascular disease (CVD) in blacks compared with whites. Research in this area has been limited to cardiovascular risk factors and early markers; less is known about black-white differences in associations with important clinical end points. METHODS AND RESULTS The authors examined the association between depressive symptoms and overall CVD mortality, ischemic heart disease (IHD) mortality, and stroke mortality in a sample of 6158 (62% black; 61% female) community-dwelling older adults. Cox proportional hazards models were used to model time-to-CVD, IHD, and stroke death over a 9- to 12-year follow-up. In race-stratified models adjusted for age and sex, elevated depressive symptoms were associated with CVD mortality in blacks (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.61 to 2.36; P<0.001) but were not significantly associated with CVD mortality in whites (HR, 1.26; 95% CI, 0.95 to 1.68; P=0.11; race by depressive symptoms interaction, P=0.03). Similar findings were observed for IHD mortality (black: HR, 1.99; 95% CI, 1.49 to 2.64; P<0.001; white: HR, 1.28; 95% CI, 0.86 to 1.89; P=0.23) and stroke mortality (black: HR, 2.08; 95% CI, 1.32 to 3.27; P=0.002; white: HR, 1.32; 95% CI, 0.69 to 2.52; P=0.40). Findings for total CVD mortality and IHD mortality were attenuated but remained significant after adjusting for standard risk factors. Findings for stroke were reduced to marginal significance. CONCLUSIONS Elevated depressive symptoms were associated with multiple indicators of CVD mortality in older blacks but not in whites. Findings were not completely explained by standard risk factors. Efforts aimed at reducing depressive symptoms in blacks may ultimately prove beneficial for their cardiovascular health.
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Affiliation(s)
- Tené T Lewis
- Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06520, USA.
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Barat P, Tastet S, Vautier V. Impact neuropsychologique à long terme du diabète de type 1 chez l’enfant. Arch Pediatr 2011; 18:432-40. [DOI: 10.1016/j.arcped.2011.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/28/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Strachan MWJ, Reynolds RM, Marioni RE, Price JF. Cognitive function, dementia and type 2 diabetes mellitus in the elderly. Nat Rev Endocrinol 2011; 7:108-14. [PMID: 21263438 DOI: 10.1038/nrendo.2010.228] [Citation(s) in RCA: 288] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Increasing numbers of people are developing type 2 diabetes mellitus, but interventions to prevent and treat the classic microvascular and macrovascular complications have improved, so that people are living longer with the condition. This trend means that novel complications of type 2 diabetes mellitus, which are not targeted by current management strategies, could start to emerge. Cognitive impairment and dementia could come into this category. Type 2 diabetes mellitus is associated with a 1.5-2.5-fold increased risk of dementia. The etiology of dementia and cognitive impairment in people with type 2 diabetes mellitus is probably multifactorial. Chronic hyperglycemia is implicated, perhaps by promoting the development of cerebral microvascular disease. Data suggest that the brains of older people with type 2 diabetes mellitus might be vulnerable to the effects of recurrent, severe hypoglycemia. Other possible moderators of cognitive function include inflammatory mediators, rheological factors and dysregulation of the hypothalamic-pituitary-adrenal axis. Cognitive function should now be included as a standard end point in randomized trials of therapeutic interventions in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Mark W J Strachan
- Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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Champaneri S, Wand GS, Malhotra SS, Casagrande SS, Golden SH. Biological basis of depression in adults with diabetes. Curr Diab Rep 2010; 10:396-405. [PMID: 20878274 DOI: 10.1007/s11892-010-0148-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diabetes and depression are common comorbid conditions. Although certain health behaviors and risk factors partially explain the association of depression and diabetes, other potential mechanisms have yet to be elucidated. Certain neuroendocrine alterations such as activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) may contribute to the association. Additionally, presence of a proinflammatory state shown in recent literature in both diabetes and depression may contribute to this as well. The objectives of this review are to summarize and review the recent evidence showing alterations of these three biological systems-HPA axis, SNS, and inflammatory cascade--in depression, diabetes, and diabetes-related risk factors.
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Affiliation(s)
- Shivam Champaneri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Deverts DJ, Cohen S, DiLillo VG, Lewis CE, Kiefe C, Whooley M, Matthews KA. Depressive symptoms, race, and circulating C-reactive protein: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Psychosom Med 2010; 72:734-41. [PMID: 20668285 PMCID: PMC3037796 DOI: 10.1097/psy.0b013e3181ec4b98] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the prospective association of depressive symptoms with circulating C-reactive protein (CRP) and to determine the direction of that association. METHODS Using data from 2,544 healthy participants in the Coronary Artery Risk Development in Young Adults study (ages, 33-45 years; 55% female; 42% black), we examined the prospective association of depressive symptoms, as measured by the Centers for Epidemiologic Studies Depression Scale, with circulating CRP 5 years later. RESULTS Depressive symptoms in the Coronary Artery Risk Development in Young Adults study Year 15 predicted CRP at Year 20, independent of demographic characteristics, biological and medical risk factors, health behaviors, and Year 15 CRP. This association, however, was conditional on race such that the increase in CRP with increasing depressive symptoms was present in blacks but not whites. In neither blacks nor whites did Year 15 CRP predict Year 20 depressive symptoms. Among black participants, when examined in separate analyses, higher scores on the depressed affect and somatic symptoms subscales of the Centers for Epidemiologic Studies Depression Scale and lower scores on the positive affect subscale were associated with greater Year 20 CRP. The interpersonal problems subscale was unrelated to CRP. When all four subscale scores were entered simultaneously in the same model, black participants' scores on the positive affect and somatic symptoms subscales emerged as independent predictors of Year 20 CRP, whereas the depressed affect and interpersonal problems subscales did not. CONCLUSIONS Depressive symptoms may be linked more closely to inflammation in blacks than in whites.
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Affiliation(s)
- Denise Janicki Deverts
- Psychology Department, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA.
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Dedert EA, Calhoun PS, Watkins LL, Sherwood A, Beckham JC. Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence. Ann Behav Med 2010; 39:61-78. [PMID: 20174903 DOI: 10.1007/s12160-010-9165-9] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease. PURPOSE The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes. METHODS A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted. RESULTS The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers. CONCLUSIONS Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.
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Affiliation(s)
- Eric A Dedert
- VA Research Service, Department of Psychiatry and Behavioral Sciences, Durham Veterans Affairs and Duke University Medical Centers, Durham, NC, USA.
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Gale CR, Kivimaki M, Lawlor DA, Carroll D, Phillips AC, Batty GD. Fasting glucose, diagnosis of type 2 diabetes, and depression: the Vietnam experience study. Biol Psychiatry 2010; 67:189-92. [PMID: 19892320 DOI: 10.1016/j.biopsych.2009.09.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent findings suggest that both low and very high fasting blood glucose concentrations may be linked with depression, though whether type 2 diabetes is associated with depression may depend on awareness of the diagnosis. We explored the association between fasting glucose and type 2 diabetes (undiagnosed and diagnosed) and depression in middle-aged men. METHODS Participants were 4293 US veterans who underwent an examination during which fasting blood glucose was measured, major depression diagnosed using DSM-III criteria, and depressive symptoms assessed with Minnesota Multiphasic Personality Inventory (MMPI) clinical scale for depression. RESULTS Compared with those with normal fasting glucose, men with undiagnosed type 2 diabetes had nearly double the odds of major depression, odds ratio (95% confidence interval) 1.80 (1.01, 3.22), and men with diagnosed diabetes had triple the odds of major depression, 3.82 (1.68, 8.70), after adjustment for confounding variables. Men with undiagnosed or diagnosed diabetes had higher MMPI depression scores. There was no curvilinear association between fasting glucose and depression (p > .45). CONCLUSIONS These findings do not support a U-shaped association between fasting glucose and depression. They suggest that the positive association between type 2 diabetes and depression extends beyond those who are aware they have the disease.
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Affiliation(s)
- Catharine R Gale
- Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton SO166YD, United Kingdom.
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Uncovering the pathways linking depression and physical health. J Adolesc Health 2009; 45:321-2. [PMID: 19766934 PMCID: PMC2792079 DOI: 10.1016/j.jadohealth.2009.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 07/27/2009] [Indexed: 11/24/2022]
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Kivimaki M, Tabak AG, Batty GD, Singh-Manoux A, Jokela M, Akbaraly TN, Witte DR, Brunner EJ, Marmot MG, Lawlor DA. Hyperglycemia, type 2 diabetes, and depressive symptoms: the British Whitehall II study. Diabetes Care 2009; 32:1867-9. [PMID: 19592627 PMCID: PMC2752923 DOI: 10.2337/dc09-0716] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the recent suggestion that impaired fasting glucose may protect against depression, whereas a diagnosis of diabetes might then result in depression. RESEARCH DESIGN AND METHODS Cross-sectional analysis of 4,228 adults (mean age 60.7 years, 73.0% men) who underwent oral glucose tolerance testing and completed the Center for Epidemiologic Studies Depression scale (CES-D). RESULTS After adjustment for demographic factors, health behaviors, and clinical measurements (BMI, waist circumference, lipid profile, and blood pressure), there was a U-shaped association between fasting glucose and depression (P(curve) = 0.001), with elevated CES-D at low and very high glucose levels. This finding was replicable with 2-h postload glucose (P = 0.11) and A1C (P = 0.007). CONCLUSIONS The U-shaped association between blood glucose and CES-D, with the lowest depression risk seen among those in the normoglycemic range of A1C, did not support the hypothesized protective effect of hyperglycemia.
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Affiliation(s)
- Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK.
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Muhtz C, Zyriax BC, Klähn T, Windler E, Otte C. Depressive symptoms and metabolic risk: effects of cortisol and gender. Psychoneuroendocrinology 2009; 34:1004-11. [PMID: 19278789 DOI: 10.1016/j.psyneuen.2009.01.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 01/23/2009] [Accepted: 01/28/2009] [Indexed: 11/18/2022]
Abstract
We examined gender effects and the role of cortisol in the association between depressive symptoms and metabolic risk in the Stress, Atherosclerosis, and ECG Study (STRATEGY). In 215 healthy adults from the general population (n=107 men, n=108 women, distributed equally across four age groups, 30-70 years), we assessed depressive symptoms by the Patient Health Questionnaire (PHQ score >10) and measured variables of the metabolic syndrome: high-density lipoprotein (HDL), triglycerides, systolic and diastolic blood pressure, fasting blood glucose and waist circumference. Salivary cortisol was assessed at 08:00, 12:00, 16:00 and 22:00 h. Depressive symptoms were not associated with the metabolic syndrome as entity in the total sample or in men and women separately. However, women with depressive symptoms had larger waist circumferences, higher fasting blood glucose, lower HDL-cholesterol, higher diastolic blood pressure, and higher 16:00 and 22:00 h salivary cortisol compared to women without depressive symptoms. These results persisted after adjusting for age, education, smoking, and physical activity. In adjusted regression analyses, inclusion of cortisol attenuated the association between depressive symptoms and waist, fasting glucose, HDL and diastolic blood pressure in women. In men, we did not find an association between depressive symptoms and variables of the metabolic syndrome. In women, depressive symptoms are associated with several variables of the metabolic syndrome. Elevated afternoon and evening cortisol appear to partially mediate this association.
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Affiliation(s)
- Christoph Muhtz
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Steinhardt MA, Mamerow MM, Brown SA, Jolly CA. A resilience intervention in African American adults with type 2 diabetes: a pilot study of efficacy. THE DIABETES EDUCATOR 2009; 35:274-84. [PMID: 19204102 PMCID: PMC3001398 DOI: 10.1177/0145721708329698] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this pilot study was to determine the feasibility of offering the authors' Diabetes Coaching Program (DCP), adapted for African Americans, in a sample of African American adults with type 2 diabetes. METHODS The study used a 1-group, pretest-posttest design to test the acceptance and potential effectiveness of the DCP. Subjects were a convenience sample of 16 African Americans (8 women, 8 men) with type 2 diabetes; 12 subjects (6 women, 6 men) completed the program. The DCP included 4 weekly class sessions devoted to resilience education and diabetes self-management, followed by 8 biweekly support group meetings. Psychosocial process variables (resilience, coping strategies, diabetes empowerment) and proximal (perceived stress, depressive symptoms, diabetes self-management) and distal outcomes (body mass index [BMI], fasting blood glucose, HbA1C, lipidemia, blood pressure) were assessed at baseline and at 6 months after study entry. Qualitative data were collected at 8 months via a focus group conducted to examine the acceptability of the DCP. RESULTS Preliminary paired t tests indicated statistically significant improvements in diabetes empowerment, diabetes self-management, BMI, HbA1c, total cholesterol, low-density lipoprotein cholesterol, and systolic and diastolic blood pressure. Medium to large effect sizes were reported. Resilience, perceived stress, fasting blood glucose, and high-density lipoprotein cholesterol improved, but changes were not statistically significant. Focus group data confirmed that participants held positive opinions regarding the DCP and follow-up support group sessions, although they suggested an increase in program length from 4 to 8 weeks. CONCLUSIONS The pilot study documented the feasibility and potential effectiveness of the DCP to enhance diabetes empowerment, diabetes self-management, and reductions in the progression of obesity, type 2 diabetes, and cardiovascular disease in the African American community. Randomized experimental designs are needed to confirm these findings.
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Affiliation(s)
- Mary A. Steinhardt
- Department of Kinesiology and Health Education, Bellmont Hall 222, University of Texas at Austin, Austin, TX 78712
| | - Madonna M. Mamerow
- Department of Human Ecology, College of Natural Sciences, 1 University Station; A2700, University of Texas at Austin, Austin, TX 78712
| | - Sharon A. Brown
- James R. Dougherty, Jr. Centennial Professor in Nursing, School of Nursing, 1700 Red River Street, University of Texas at Austin, Austin, TX 78701-1499
| | - Christopher A. Jolly
- Department of Human Ecology, College of Natural Sciences, 1 University Station; A2700, University of Texas at Austin, Austin, TX 78712
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Lewis TT, Everson-Rose SA, Colvin A, Matthews K, Bromberger JT, Sutton-Tyrrell K. Interactive effects of race and depressive symptoms on calcification in African American and white women. Psychosom Med 2009; 71:163-70. [PMID: 19188530 PMCID: PMC2896037 DOI: 10.1097/psy.0b013e31819080e5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the cross-sectional associations among race, depressive symptoms, and aortic and coronary calcification in a sample of middle-aged women. Depressive symptoms have been associated with atherosclerotic indicators of coronary heart disease (CHD) in white women. Few studies have examined these associations in samples including African American women, or explored whether any observed associations differ by race. METHODS Participants were 508 (38% African American, 62% white) women. Aortic and coronary calcification were measured by electron beam tomography and depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). Multivariable linear and logistic regression models were conducted to test associations. RESULTS In linear regression models adjusted for race, depressive symptoms were associated with a greater amount of aortic calcification (beta = 0.03, p = .01), and there was a significant race x depressive symptoms interaction (beta = 0.07, p = .006). Findings for depressive symptoms (odds ratio (OR) = 1.03, 95% Confidence Interval (CI) = 1.0-1.06, p = .07), and the race x depressive symptoms interaction (OR = 1.1, 95% CI = 1.01-1.18, p = .01) were similar in race-adjusted multinomial logistic regression models predicting high levels of aortic calcification. Race-specific models revealed a significant association between depressive symptoms and aortic calcification in African American, but not white women. Additional adjustments for education, study site, and CHD risk factors did not alter these results. Depressive symptoms were not associated with coronary calcification for women of either racial group. CONCLUSIONS African American women may be particularly vulnerable to the effects of depressive symptoms on early atherosclerotic disease.
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Neu M, Laudenslager ML, Robinson J. Coregulation in Salivary Cortisol During Maternal Holding of Premature Infants. Biol Res Nurs 2008; 10:226-40. [DOI: 10.1177/1099800408327789] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of this study was to examine coregulation between mothers and preterm infants in hypothalamic-pituitary-adrenocortical (HPA) system activity, as indicated by salivary cortisol levels, while mothers held their infants. The research questions were (a) does mother—infant coregulation in HPA activity occur during holding? and (b) if mother— infant coregulation in HPA activity exists during holding, do type of holding, antenatal steroids, sound level, and maternal touch influence this coregulation? Sample: The sample consisted of 20 mother— infant dyads with infants at a mean postconceptional age of 34.7 weeks (+0.7) and average postnatal age of 15 days (+9) at the time of cortisol sampling. Design: The design was exploratory using convenience sampling. Maternal and infant cortisol levels were obtained at Time 1 (baseline) and Time 2 (end of holding); at each time, the absolute differences in levels between mother and infant were determined. Coregulation was operationalized as less difference between maternal-infant cortisol levels immediately after holding (Time 2) as compared to before holding (Time 1). Results: The two variables with the highest correlation with the Time 1/Time 2 difference score included antenatal steroids and ambient sound level, which were entered into a linear regression equation as predictor variables. A coregulatory relationship in cortisol levels existed between mothers and infants during holding, which was moderated by sound levels. Nurses in the neonatal intensive care unit (NICU) can facilitate the mother—infant relationship, as reflected in coregulatory measures, by promoting a quiet environment, particularly around mothers who are holding their infants.
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Affiliation(s)
- Madalynn Neu
- School of Nursing University of Colorado at Denver and
Health Sciences Center, Denver, Colorado,
| | - Mark L. Laudenslager
- Department of Psychiatry University of Colorado at Denver
and Health Sciences Center, Denver, Colorado
| | - JoAnn Robinson
- Department of Early Childhood Education, University
of Connecticut, Connecticut
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