RESUMO
BACKGROUND AND OBJECTIVES: Accumulating evidence suggests a substantial prevalence of mental health disorders worldwide and the association between psychological distress and mental disorders. However, the mechanisms underlying this association are underexplored. Using longitudinal data, this study examined coping strategies as a potential mechanism. METHODS: Participants (N = 2,333) from the Midlife in the United States (MIDUS) completed psychosocial and mental health surveys over 19 years. A parallel mediation model was used to test the direct association between psychological distress (baseline) and self-reported mental disorders (17-19 years follow-up) and the indirect associations via coping strategies (8-11 years follow-up), controlling for demographics and baseline self-reported mental disorders. RESULTS: Psychological distress predicted an increased likelihood of mental disorders later in life. Emotion-focused coping was a significant mediator of this association, but problem-focused coping was not. Psychological distress was positively associated with emotion-focused coping, and emotion-focused coping was positively associated with mental disorders. Psychological distress was negatively associated with problem-focused coping; however, no association was found between problem-focused coping and mental disorders. CONCLUSIONS: Findings provide further support for the longitudinal association between psychological distress and mental health disorders and extend prior research by showing the partial mediating role of emotion-focused coping in this association.
Assuntos
Transtornos Mentais , Angústia Psicológica , Humanos , Capacidades de Enfrentamento , Adaptação Psicológica , Autorrelato , Estresse Psicológico/psicologia , Transtornos Mentais/complicações , Inquéritos e QuestionáriosRESUMO
Subjective wellbeing may predict future health conditions, and lower self-rated physical health (SRH) is associated with the presence of chronic conditions, such as cardiovascular disease (CVD). This study examines whether subjective wellbeing and SRH predict long-term CVD conditions for women using the Midlife in the United States study. The study cohort includes 1716 women participants who completed waves 1 (1995-1996), 2 (2004-2006), and 3 (2013-2014). Data on demographics, chronic conditions of diabetes and CVD, subjective wellbeing (life satisfaction, positive affect, and negative affect), and SRH were collected repeatedly at each wave. Multiple logistic regressions were conducted to test whether subjective wellbeing was associated with a lifetime CVD risk. Greater life satisfaction was significantly associated with a lower risk of CVD at 10 years (odds ratio (OR): 0.83; 95% confidence interval (CI): 0.74-0.95) and 19 years (OR: 0.83; 95% CI: 0.74-0.93), while positive and negative affects were not significantly associated. Additionally, better physical SRH significantly lowered odds of having cardiovascular conditions at both 10 years (OR: 0.79; 95% CI 0.68-0.92) and 19 years (OR 0.74; 95% CI: 0.64-0.86). Measures of life satisfaction and SRH can be used as additional CVD screening tools.
Assuntos
Doenças Cardiovasculares , Humanos , Feminino , Estados Unidos/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doença Crônica , Nível de SaúdeRESUMO
PURPOSE: The purpose of the study was to determine the feasibility of implementing A1C self-testing at home using the A1CNow® Self Check and to compare the accuracy of the A1CNow to a reference standard in African Americans with type 2 diabetes (T2D). METHODS: African American adults with T2D were recruited from 13 different churches (N = 123). Phase 1, conducted during the early phase of the COVID-19 pandemic, examined the feasibility of A1C assessment using the A1CNow performed at home by untrained participants. Phase 2, conducted when in-person research resumed, compared A1C values concurrently measured using the A1CNow and the DCA Vantage™ Analyzer (reference standard) collected by research staff at church testing sites. RESULTS: In Phase 1, 98.8% of participants successfully completed at least 1 at-home A1C test; the overall failure rate was 24.7%. In Phase 2, the failure rate of staff-performed A1CNow testing was 4.4%. The Bland-Altman plot reveals that A1CNow values were 0.68% lower than DCA values, and the mean differences (A1CNow minus DCA) ranged from -2.6% to 1.2% with a limit of agreement between -1.9% to 0.5%. CONCLUSIONS: A1C self-testing is feasible for use in community settings involving African American adults with T2D. The A1CNow Self-Check underestimated A1C values when compared with the reference standard. Ongoing improvements in point-of-care devices have the potential to expand research and clinical care, especially in underserved communities.
Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Adulto , Negro ou Afro-Americano , COVID-19/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Estudos de Viabilidade , Hemoglobinas Glicadas/análise , Humanos , Pandemias , Reprodutibilidade dos Testes , AutotesteRESUMO
Objective: Investigate the association of positivity with generalized anxiety and the mediating roles of resilience and sense of belonging in underrepresented college students. Participants: College students (N = 425; 18.4% White, 17.9% Black, 40.2% Hispanic, 20.2% Asian; 38.1% first-generation; Mage = 19.06; 63.1% female) completed an online survey assessing positivity, anxiety, resilience, and belonging. Methods: Path analysis tested the proposed mediation model, controlling for age, sex, race/ethnicity, first-generation status, living status, and diagnosed disability. Results: Positivity was negatively associated with anxiety directly (Æ = -.468, p < .001) and indirectly through resilience (Æ = -.083, p < .001), but not through belonging (Æ = -.026, p > .05). Positivity was associated with belonging (Æ = .611, p < .001); belonging was not associated with anxiety (Æ = -.042, p > .05). Conclusions: Findings highlight the benefit of positivity on anxiety and the mediating role of resilience among underrepresented college students.
Assuntos
Ansiedade , Estudantes , Feminino , Humanos , Adulto Jovem , Adulto , Masculino , Universidades , Transtornos de Ansiedade , Inquéritos e QuestionáriosRESUMO
PURPOSE: The purpose of this substudy was to determine the most acceptable way to restart the Texas Strength Through Resilience in Diabetes Education (TX STRIDE) study safely using remote technologies. Following the emergence of COVID-19, all in-person TX STRIDE intervention and data collection sessions were paused. METHODS: Qualitative descriptive methods using telephone interviews were conducted during the research pause. A structured interview guide was developed to facilitate data collection and coding. Forty-seven of 59 Cohort 1 participants were interviewed (mean age = 60.7 years; 79% female; mean time diagnosed with type 2 diabetes = 11 years). RESULTS: Data categories and subcategories were generated from the interview responses and included: personal experiences with COVID-19, effects of COVID-19 on diabetes self-management, psychosocial and financial effects of COVID-19, and recommendations for program restart. Although some participants lacked technological knowledge, they expressed eagerness to learn how to use remote meeting platforms to resume intervention and at-home data-collection sessions. Six months after the in-person intervention was paused, TX STRIDE restarted remotely with data collection and class sessions held via Zoom. A majority of participants (72.9%) transitioned to the virtual platform restart. CONCLUSIONS: Qualitative findings guided the appropriate implementation of technology for the study, which facilitated a successful restart. High retention of participants through the study transition provides evidence that participants are invested in learning how to manage their diabetes despite the challenges and distractions imposed by COVID-19.
Assuntos
Negro ou Afro-Americano , COVID-19 , Assistência à Saúde Culturalmente Competente , Diabetes Mellitus Tipo 2 , Autogestão , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , COVID-19/etnologia , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autogestão/educação , Autogestão/psicologia , Texas/epidemiologiaRESUMO
BACKGROUND: Given the psychological stress associated with managing type 2 diabetes (T2D), resilience-promoting interventions may particularly benefit populations experiencing high levels of stress (e.g., racial/ethnic minority and lower-income individuals). Federally qualified Community Health Centers (CHCs) primarily serve these patients and are therefore ideal settings for resilience-promoting T2D programs. This proof-of-concept study tested the Resilience-Based Diabetes Self-Management Education (RB-DSME) intervention within a CHC. METHOD: Thirty-five patients with T2D (M age = 51 years, 71% female, 60% Hispanic, 69% annual household income < $20,000) at two clinics within the CHC completed the RB-DSME, consisting of eight bi-weekly classes and two monthly support groups. In this treatment-only design, resilience resources, self-management behaviors, and physical and mental health outcomes were measured at baseline and 6 months. RESULTS: Attendance (M = 7.66/10) and program satisfaction (M = 6.79/7) were high. Participants improved adaption to stress (d = .67), adaptive coping (d = .60), diabetes empowerment (d = .57), and finding positive meaning (d = .85). Large increases in self-management behaviors (d = 1.38) and number of steps (d = 1.11) were also observed. Participants lowered A1C from baseline (M = 8.79%) to 6 months (M = 8.11%; d = .50), along with diabetes distress (d = 1.31), depressive symptoms (d = .80), and general perceived stress (d = .55). CONCLUSION: This study demonstrated the ability of the RB-DSME to improve resilience resources, self-management behaviors, and health outcomes among racial/ethnic minority and lower-income patients with T2D at clinics within a CHC. A larger, randomized trial should more rigorously test the RB-DSME in this clinical setting.
Assuntos
Diabetes Mellitus Tipo 2 , Autogestão , Adulto , Centros Comunitários de Saúde , Diabetes Mellitus Tipo 2/terapia , Etnicidade , Feminino , Humanos , Masculino , Grupos Minoritários , AutocuidadoRESUMO
Objective: To investigate the association of psychological resources with the prevalence of chronic conditions up to 10 years later, and the mediating roles of health behaviours and allostatic load. Design: Participants from the Midlife in the United States study (N = 850) completed surveys and biomarker assessments over the course of 10 years. Main Outcome Measures: Primary outcome was the prevalence of chronic conditions later in life, controlling for baseline chronic conditions. Secondary outcomes were health behaviours and allostatic load. Direct and indirect associations between psychological resources and chronic conditions were examined. Results: Psychological resources were negatively associated with chronic conditions directly (Æ = -.177, p < .05) and indirectly through health behaviours (Æ = -.026, p < .05), but not through allostatic load (Æ = -.000, p > .05). Psychological resources were positively associated with health behaviours (Æ = .130, p < .01), but no association was found between psychological resources and allostatic load (Æ = -.002, p > .05). Health behaviours were negatively associated with chronic conditions (Æ = -.201, p < .01), and allostatic load was positively associated with chronic conditions (Æ = .197, p < .05). Conclusion: Findings highlight the beneficial influence of psychological resources on chronic conditions, and the mediating role of health behaviours.
Assuntos
Alostase , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Comportamentos Relacionados com a Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: The current study examined whether the link between stress and health-related quality of life was buffered by protective factors, namely mindfulness, in a sample of middle-aged and older adults. METHODS: In this cross-sectional study, 134 healthy, community-dwelling adults (ages 50-85 years) were recruited from Dallas, TX. The participants were screened for depressive symptoms and severity (using the Patient Health Questionnaire [PHQ-9]). All participants completed measures of self-reported health status (i.e. SF36v2: mental and physical health composites), life stress (using the Elders Life Stress Inventory [ELSI]), and trait mindfulness (i.e. Mindful Attention Awareness Scale). RESULTS: Hierarchical regressions (covarying for age, gender, and education) showed that life stress was inversely related to physical and mental health. Mindfulness was positively related to mental health. The negative effect of life stress on mental health was weakened for those individuals with higher levels of trait mindfulness. CONCLUSIONS: The results suggest that mindfulness is a powerful, adaptive strategy that may protect middle-aged and older adults from the well-known harmful effects of stress on mental health.