Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial.

BACKGROUND: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. METHOD: Twenty-three pregnant women with HIV (WWH), ages 18-45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. RESULTS: Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, ß = - 11.1, t(24) = - 3.1, p < 0.005, 95% CI [- 18.41, - 3.83], and 3 months, ß = - 13.8, t(24) = - 3.3, p < 0.005, 95% CI [- 22.50, - 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. CONCLUSION: A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417.

Adapting, testing, and refining a resilience intervention for older women with HIV: An open pilot study.

Half of persons with HIV in the United States (US), many of whom are women, are over age 50. Aging women with HIV (WWH) face unique biopsychosocial challenges, including stigma, the physiological effects of aging, and illness-associated stressors. Resilience interventions can build awareness of such stressors and aid in facilitating the relaxation response; however, no existing interventions specifically cater to the needs of older WWH. The content of the Relaxation Response Resiliency Program, which teaches positive psychology strategies, relaxation techniques, and cognitive behavioral skills, was adapted for older WWH. Thirteen WWH over 50 participated in an open pilot of the adapted intervention to iteratively refine the program and its procedures. Participants attended either 8 or 10 weekly group sessions; three groups were conducted in total. Pre- and post-intervention assessments and qualitative exit interviews were conducted. Among completers, an increase in resilience was observed. Though significance testing was not conducted, social support also increased, and depression, anxiety, and HIV stigma decreased from pre- to post-intervention. Over half of eligible women enrolled; completers reported high satisfaction with the program. However, retention was difficult; six participants withdrew or were lost to follow-up. Mean number of sessions attended was 3.5 in the 8-session group and 5 in the 10-session groups. In this small sample, the adapted intervention led to a clinically meaningful increase in resilience, though recruitment and retention were challenging. Further refinements to the intervention are needed to minimize attrition and increase acceptability before additional testing is initiated.

Preventing cardiovascular disease in midlife women with HIV: An examination of facilitators and barriers to heart health behaviors.

Midlife women with HIV (WWH) are disproportionately impacted by cardiovascular disease (CVD), yet little is known about perceptions of CVD risk and the factors that influence engagement in heart health behaviors in this population. Few (if any) studies have used a qualitative approach to examine these perceptions, which has important implications for minimizing the negative impact of HIV-related noncommunicable diseases, the risk for which increases after midlife. Eighteen midlife WWH (aged 40-59) in Boston, MA, completed semistructured interviews to explore perceptions of CVD, HIV, and barriers and facilitators to healthy lifestyle behaviors. Interviews were analyzed via thematic analysis. Participants viewed heart health as important but were unaware of HIV-associated CVD risk. Facilitators included family and generational influences, social support, and access to resources. Physical symptoms, menopause, mental health challenges, and limited financial resources were barriers. Midlife WWH may benefit from tailored CVD prevention interventions that target their unique motivations and barriers to healthy behaviors.

Pilot Test of an Acceptance-Based Behavioral Intervention to Promote Physical Activity During Weight Loss Maintenance.

Behavioral interventions for obesity reliably facilitate short-term weight loss, but weight regain is normative. A high level of aerobic exercise may promote weight loss maintenance. However, adopting and maintaining a high level of exercise is challenging, and experiential acceptance may be important. The aim of this study was to pilot test the feasibility and efficacy of an acceptance-based behavioral treatment to promote moderate-to-vigorous physical activity (MVPA) among individuals who had recently lost weight. Adults (n = 16) who had recently lost ≥ 5% of weight were provided with a 12-week, group-based treatment. At 12 weeks, complete analyses indicated that participants had increased activity 69% (completing an average of 198.27 minutes/week of bouted MVPA, i.e., episodes of at least 10 minutes in duration). Medium-to-large effect sizes were observed for changes in process measures, including experiential acceptance. Future research to test this approach using an experimental design, a larger sample, and a longer period of observation is warranted.

The use of novel technology-based weight loss interventions for obese women with endometrial hyperplasia and cancer.

OBJECTIVE: Obesity significantly increases the risk of the development of both endometrial hyperplasia and cancer. Our objective was to assess the feasibility of two technology-based weight loss interventions in this patient population. METHODS: Women with obesity (BMI≥30kg/m(2)) and endometrial hyperplasia or Type I endometrial cancer were randomized 1:1 to a technology-based 6month lifestyle intervention via either telemedicine or text messaging. The telemedicine arm received weekly phone calls, with weights tracked online using Withings© Wi-Fi scales. The text arm received 3-5 personalized messages daily via Text4Diet™. Participants maintained a 1200-1800calorie/day diet, self-monitored food intake and received exercise goals. Biomarkers (IGFBP-1, adiponectin, VEGF, IL1-beta, IL2, IL6, and IL7) were assessed pre- and post-treatment. RESULTS: Twenty women were randomized (Telemedicine: n=10, Text4Diet: n=10), and 90% lost weight. Many were early stage (70%) and grade (43.8%) disease with a median age of 60.5years. We observed a statistically greater weight loss in the Telemedicine arm [median loss: 9.7kg (range: 1.6-22.9kg)] versus 3.9kg (range: 0.3-11.4kg) in the Text4Diet arm (p=0.0231). Similarly, percent weight loss was greater in the Telemedicine (7.6%) as compared to the Text4Diet arm (4.1%, p=0.014). Mean serum levels of IL-2 were significantly (27.15pg/mL vs. 5.18pg/mL, p=0.0495) lower at intervention end as compared to baseline. CONCLUSIONS: A technology-based weight loss intervention is feasible in women with Type I endometrial cancer/hyperplasia. Both interventions produced weight loss, although more person-to-person contact produced more significant outcomes. Reductions in expression of IL-2 were related to weight loss.

Predicting Change in Physical Activity: a Longitudinal Investigation Among Weight-Concerned College Women.

BACKGROUND: Engaging in regular physical activity (PA) is critical for health, and adopting a consistent PA routine early in life is associated with greater PA over the lifespan. College women with weight concerns are at risk for weight gain, which may be prevented with regular PA. However, little is known about changes in PA engagement in this at-risk group. PURPOSE: Using an outcome expectancy framework, this study used a prospective longitudinal design to examine changes in PA during the first 2 years of college. We tested for concurrent and prospective within-person relations between body satisfaction/perceived eating behavior and PA to determine when weight-concerned college women may increase or decrease PA. METHODS: Women who reported weight concerns at the start of college (n = 294) completed five assessments over 2 years, including measured weight, body/eating experiences, and 4 days of pedometer steps (per assessment). Multilevel models addressed the resulting nested data structure (days within assessments within participants). RESULTS: Over 2 years, within-person change accounted for 65 % of PA variability (ICC = 0.35). PA was greatest at (and subsequent to) times when body satisfaction was lower, and when disinhibited eating and hedonic hunger were higher, than an individual's average (ps < 0.05). These changes were associated with 1-3 % of the recommended daily step totals. CONCLUSIONS: Weight-conscious college women show greater PA after negative eating and weight experiences. As these experiences change over time, health promotion efforts should help college women identify alternative, positive motivators for PA, which could facilitate consistent PA engagement.

Do hunger and exposure to food affect scores on a measure of hedonic hunger? An experimental study.

Research suggests that visceral bodily states, such as hunger, can affect participants' responses on self-report measures of eating behavior. The present study evaluated the influence of hunger and exposure to palatable food on self-reported hedonic appetite, measured using the Power of Food Scale (PFS). A secondary aim was to evaluate the effects of these manipulations on self-reported external eating and disinhibition. Participants (N=67) ate a standardized meal followed by a 4-h fast. Participants were randomized to one of four groups (Fasted/Food Absence, Fasted/Food Exposure, Fed/Food Absence, or Fed/Food Exposure). In Phase I of the experiment (Hunger Manipulation), participants randomized to the "Fed" group drank a protein shake, while those in the "Fasted" group did not receive a shake. In Phase II (Palatable Food Exposure), participants in the "Food Exposure" group were visually exposed to palatable food items, while "Food Absence" participants were not. All participants completed the PFS, Dutch Eating Behavior Questionnaire External Eating subscale, and the Disinhibition subscale from the Eating Inventory during Phase II. Results showed no significant main or interactive effects of Hunger condition or Food Exposure condition on PFS, External Eating, or Disinhibition scores (all p's<.33). All effect sizes were small (partial etas squared ⩽.015). Manipulation checks confirmed that the intended hunger and exposure interventions were successful. Results suggest that relatively short fasting periods (e.g., 4h) analogous to typical breaks between meals are not associated with changes in scores on the PFS, External Eating, or Disinhibition scales. Hedonic hunger, at least as measured by the PFS, may represent a relatively stable construct that is not substantially affected by daily variations in hunger. In addition, individual differences in exposure to food in the immediate environment are unlikely to confound research using these measures.

GAP-REACH: a checklist to assess comprehensive reporting of race, ethnicity, and culture in psychiatric publications.

Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-item GAP-REACH checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article.

Developing a pilot lifestyle intervention to prevent cardiovascular disease in midlife women with HIV.

BACKGROUND: Background: Women with HIV (WWH) are at elevated risk for cardiovascular disease (CVD) compared to men with HIV. Lifestyle interventions, like the Diabetes Prevention Program (DPP), may reduce CVD risk, but most fail to address barriers to healthy behaviors facing WWH. OBJECTIVE: Objective: To inform the adaptation of the DPP for midlife WWH, pilot the modified intervention, and assess feasibility, acceptability, and implementation barriers. METHODS: Methods: Interviews were conducted with cisgender, English-speaking WWH ages 40-59 to assess intervention preferences. The adapted DPP was piloted and evaluated. CVD knowledge, CVD risk perception, quality of life, and physical activity were assessed pre- and post-intervention. RESULTS: Results: Eighteen WWH completed interviews. Adaptations included reducing the number of sessions and adding HIV, CVD, stress, aging, menopause, and smoking content. Of 14 women contacted for the pilot, seven completed a baseline, five attended group sessions, and five completed a post-treatment assessment. Attendance barriers included transportation access and costs. Satisfaction was moderate; informal exit interviews indicated that women would recommend the program. CVD knowledge, perceived risk, and physical activity increased, and fatigue and mental health improved. Content on nutrition, aging, HIV, and stress was seen as most useful; suggested changes included group exercises and additional content on recipes, HIV management, and aging. CONCLUSIONS: Conclusions: Midlife WWH reported benefits from our adapted intervention. Increases in CVD knowledge and perceived CVD risk suggest improved awareness of the impact of lifestyle behaviors. Retention was adequate; socioeconomic barriers were common. Intervention feasibility and acceptability may be improved via remote access and further content customization.

Association of trauma-related disorders and dissociation with four idioms of distress among Latino psychiatric outpatients.

Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong 'nexus' of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses.

Psychosocial Correlates of Body Image and Lipodystrophy in Women Aging With HIV.

Body image disturbance is increasingly relevant as women living with HIV (WLWH) live longer. We explored body image disturbance and changes in fat distribution (lipodystrophy) in 63 WLWH (mean age = 51 years) and evaluated associations among lipodystrophy, body image, and psychosocial variables. Eighty-one percent of participants reported one or more body parts (of six assessed) demonstrating lipodystrophy, and more than one third reported three or more affected body parts. Increased belt/waist (58%) and increased chest/breast (39%) sizes were most common. More diffuse lipodystrophy was significantly associated with poorer body image (F[2,54] = 11.86, p < .001, partial η = .313) and anxiety (F[2,52] = 3.82, p = .029, partial η = .133) after controlling for age and duration of infection. Lipodystrophy was prevalent in our sample; more diffuse lipodystrophy was associated with anxiety and poor body image. Providers should assess lipodystrophy in older WLWH and provide referrals for mental health services.

Body image satisfaction among male military veterans with cancer.

Impaired body satisfaction is commonly reported among cancer patients. This study prospectively evaluated body image disturbance among male military veterans with head and neck or colorectal cancer. Patients ( N = 109) completed measures at three points post-diagnosis. Results showed about one-third of participants reporting body-related concerns. Endorsement did not change significantly during the study period. Predictors of worse body satisfaction included younger age, lower education, less social support, and weight loss. Results indicate a substantial minority of men with cancer endorsing body image disturbance, and highlight psychosocial circumstances and weight change as key considerations.

High Rates of Biomarker-Confirmed Alcohol Use Among Pregnant Women Living With HIV in South Africa and Uganda.

BACKGROUND: Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions. METHODS: Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive). RESULTS: Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23-29], median gestational age was 20 weeks [interquartile range: 16-26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045). CONCLUSIONS: Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.

Association between HIV status and psychological symptoms in perimenopausal women.

OBJECTIVE: HIV-infected women are burdened by depression and anxiety, which may impact adherence to antiretroviral therapy and overall quality of life. Yet, little is known about the scope of psychological symptoms in the growing number of HIV-infected women reaching menopause, when affective symptoms are more prevalent in the general population. We conducted a longitudinal study to compare affective symptoms between perimenopausal HIV-infected and non-HIV-infected women. METHODS: The Center for Epidemiologic Studies Depression Scale (CES-D), and the Generalized Anxiety Disorder scale (GAD-7) were completed at baseline and 12 months among 33 HIV-infected and 33 non-HIV-infected perimenopausal women matched by race, age, menstrual patterns, and BMI. Linear regression models estimated the relationship of baseline GAD-7 and CES-D scores with clinical factors. RESULTS: All women were perimenopausal at baseline, and the vast majority remained perimenopausal throughout follow-up. HIV status was associated with higher baseline CES-D scores (median [interquartile range] 21 [12, 29] vs 10 [5, 14]; P = 0.03) and GAD-7 scores (7 [5, 15] vs 2 [1, 7]; P = 0.01), controlling for smoking, substance use, and antidepressant use. Depressive symptoms and anxiety remained significantly higher in the HIV-infected women at 12 months (P ≤ 0.01). Significant relationships of depressive symptoms (P = 0.048) and anxiety (P = 0.02) with hot flash severity were also observed. CONCLUSIONS: Perimenopausal HIV-infected women experienced a disproportionately high level of affective symptom burden over a 12-month observation period. Given the potential for these factors to influence adherence to HIV clinical care and quality of life, careful assessment and referral for treatment of these symptoms is essential.

Common haplotypes at the adiponectin receptor 1 (ADIPOR1) locus are associated with increased risk of coronary artery disease in type 2 diabetes.

Adiponectin, an adipokine facilitating insulin action, has antiatherogenic effects. This study investigated whether common polymorphisms in the adiponectin receptor 1 (ADIPOR1) gene mediating these effects influence the risk of coronary artery disease (CAD) in type 2 diabetes. Linkage disequilibrium analysis of 28 single nucleotide polymorphisms (SNPs) spanning the entire ADIPOR1 locus revealed two haplotype blocks that could be tagged by six SNPs. These six markers were typed in two populations of CAD-positive and -negative subjects with type 2 diabetes, one from Boston (n = 411) and the other from Italy (n = 533). In the Boston population, the three tags of the more 3' block were all significantly associated with CAD (P = 0.001-0.01). A similar trend, although not significant, was found in Italian subjects. Haplotype analysis of the combined populations revealed different haplotype distributions in case and control subjects (P = 0.0002), with one common haplotype being associated in homozygotes with a greater than threefold increase in cardiovascular risk (odds ratio 3.6 [95% CI 1.8-7.2]). Some of the genotypes associated with increased cardiovascular risk were associated with 30-40% lower ADIPOR1 mRNA levels in blood mononuclear cells (n = 60) and adipose tissue biopsies (n = 28) (P = 0.001-0.014). Our findings point to genetic variability at the ADIPOR1 locus as a strong determinant of CAD susceptibility in type 2 diabetes.

Contrasting Gender and Combat Versus Military Sexual Traumas: Psychiatric Symptom Severity and Morbidities in Treatment-Seeking Veterans.

BACKGROUND: Military sexual trauma (MST) and military combat trauma (MCT) are significant risk factors for posttraumatic stress disorder (PTSD). However, no studies have directly contrasted the clinical profiles of Veterans between military-related traumas. Moreover, a notable gender difference in the likelihood of trauma exposure limits our ability to disentangle gender and trauma type. MATERIALS AND METHODS: To address these gaps, we aimed at (1) contrasting psychiatric complaints in Veterans with MST versus MCT exposure and (2) investigating gender differences in Veterans with MST histories. Treatment-seeking Veterans (N = 563) completed semi-structured diagnostic interviews and self-report assessments of PTSD, depressive, and dissociative symptoms. RESULTS: Psychiatric complaints and morbidity were notable after all military-associated traumas, although those seeking care for MST-related events demonstrated more severe PTSD, depressive, and dissociative symptoms and were more likely to meet criteria for non-PTSD anxiety and psychotic disorders. In contrast, few gender-related differences were noted between male and female Veterans with histories of MST. CONCLUSIONS: The experience of MST may reduce typically observed gender-related buffering effects for certain conditions.

Mother-child interactions at six months postpartum are not predicted by maternal histories of abuse and neglect or maltreatment type.

OBJECTIVE: A history of childhood maltreatment (CM) is associated with increased rates of maternal psychiatric symptoms and other adverse outcomes in adulthood among postpartum women. However, to date only a few studies have examined associations between CM and mother-child interactions among a nonclinical sample of postpartum women, and the specific potential influence of the type of abuse or neglect is poorly understood. This study was an aim to examine the relationships between CM types and observed parenting in a nonclinical group of recently postpartum mothers with maltreatment histories. METHOD: Participants were 173 postpartum, nonclinically referred mothers oversampled in the community for CM histories (n = 123, 72%) and their infants who underwent high- and low-stress interactive tasks during their 6-month postpartum visits, which were videotaped for later independent coding on hostile, controlling, and positive parenting. Mothers also provided information on demographics and type of CM they had experienced (i.e., emotional, sexual, physical abuse, and neglect). Differences of maternal parenting by history of CM and specific type were analyzed via 2-way univariate general linear models. RESULTS: Inconsistent with a priori hypotheses, no significant differences emerged between overall CM severity or exposure to any particular CM type and hostile, controlling, or positive parenting in the high- or low-stress tasks. CONCLUSION: Findings suggest that nonclinical postpartum women with CM histories show resilience regarding postpartum parenting quality and do not differentiate from non-CM maltreated postpartum mothers. We discuss the potential influence of resilience, moderating factors, clinical implications, and recommendations based on our findings. (PsycINFO Database Record

Posttraumatic stress disorder and somatic complaints: Contrasting Vietnam and OIF/OEF Veterans' experiences.

OBJECTIVE: To replicate and expand upon the relationship of somatic symptoms and posttraumatic stress disorder (PTSD) by comparing symptoms among service eras in US Veterans. METHOD: Data were collected from 226 Vietnam and 132 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who were referred to a Veterans Affairs (VA) hospital PTSD outpatient clinic between 2005 and 2013. Veterans were administered self-report inventories and a clinical interview to measure somatic symptoms and PTSD severity. A subset of Veterans (n=185) screening positive for PTSD were administered the Clinician Administered PTSD Scale (CAPS) to measure PTSD severity. Multiple moderated linear regressions were used to examine the influence of service era on the relationship between somatic and PTSD symptoms. RESULTS: There were no significant differences between service eras in pain severity, pain interference, and total somatic symptoms reported. Vietnam Veterans were more likely to report limb/join pain (p<.05), fainting (p<.01), and shortness of breath (p<.001), whereas OIF/OEF Veterans were more likely to complain of headaches (p<.001). A significant interaction effect occurred between service era and dizziness (p<.05) and chest pain (p<.01), with OIF/OEF Veterans reporting higher levels of these symptoms significantly more likely than Vietnam Veterans to also experience more severe PTSD. CONCLUSION: Findings are consistent with previous research demonstrating the relationship of somatic symptoms and PTSD across service eras but provide additional data concerning similarities and differences of somatic symptoms between eras. Potential explanations for observed service era differences in somatic symptoms are discussed.

Enhancing physical activity promotion in midlife women with technology-based self-monitoring and social connectivity: A pilot study.

This pilot study tested a novel program to promote adoption and maintenance of aerobic activity in midlife women. Lifestyle modification group sessions were held weekly for 3 months, followed by two booster sessions during the 3-month maintenance phase. During all 6 months of the program, participants used a physical activity sensor to automate self-monitoring and a web platform to facilitate social connectivity. Aerobic exercise increased from 63 to 132 minute/week from baseline to 3 months (p < .01), and activity was maintained at 6 months (135 minute/week). Technology enhancements have strong potential to promote maintenance of behavior change.

The social context of the relationship between glycemic control and depressive symptoms in type 2 diabetes.

OBJECTIVE: Individuals with type 2 diabetes and depressive symptoms have poorer diabetes outcomes than those with diabetes alone, and there is need for improved understanding of the relationship between illness markers and depressive symptoms. The role of social support is well established; less is known about social comparisons (i.e. comparisons to others in the social environment), which are common and influential in chronic illness. The present study examined the mediating effects of social comparison and social support on the relationship between glycemic control and depressive symptoms. METHOD AND OUTCOME MEASURES: Participants with physician-diagnosed type 2 diabetes (N = 185) completed an electronic survey about recent depressive symptoms, glycemic control (HbA1c), perceived social support, and social comparison. RESULTS: Controlling for relevant covariates, social comparison and social support showed independent statistical mediation of the relationship between glycemic control and depressive symptoms (ps < 0.05). Path analysis also showed that including indirect pathways through social comparison and social support reduced the relationship between glycemic control and depressive symptoms to nonsignificance (ß = 0.10, p = 0.14). CONCLUSION: These findings demonstrate that social comparison plays a role in the relationship between diabetes regulation and depression, independent of social support. Greater attention to this aspect of the social environment may render better diabetes outcomes.