Association of Social Adversity with Comorbid Diabetes and Depression Symptoms in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study: A Syndemic Framework.

BACKGROUND: U.S. Hispanics/Latinos experience high lifetime risk for Type 2 diabetes and concurrent psychological depression. This comorbidity is associated with poorer self-management, worse disease outcomes, and higher mortality. Syndemic theory is a novel social epidemiological framework that emphasizes the role of economic and social adversity in promoting disease comorbidity and health disparities. PURPOSE: Informed by the syndemic framework, this study explored associations of socioeconomic and psychosocial adversity (low income/education, trauma history, adverse childhood experiences, ethnic discrimination, neighborhood problems [e.g., violence]) with comorbidity of diabetes and depression symptoms in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Sociocultural Ancillary Study. METHODS: Participants were 5,247 Latino adults, aged 18-74, enrolled in four U.S. cities from 2008 to 2011. Participants completed a baseline physical exam and measures of depression symptoms and psychosocial adversity. Multinomial logistic regression analyses were conducted to examine associations of adversity variables with comorbid diabetes and high depression symptoms. RESULTS: Household income below $30,000/year was associated with higher odds of diabetes/depression comorbidity (odds ratio [OR] = 4.61; 95% confidence interval [CI]: 2.89, 7.33) compared to having neither condition, as was each standard deviation increase in adverse childhood experiences (OR = 1.41; 95% CI: 1.16, 1.71), ethnic discrimination (OR = 1.23; 95% CI: 1.01, 1.50), and neighborhood problems (OR = 1.53; 95% CI: 1.30, 1.80). CONCLUSION: Low household income, adverse childhood experiences, ethnic discrimination, and neighborhood problems are related to comorbid diabetes and depression in U.S. Latinos. Future studies should explore these relationships longitudinally.

Extra-familial social factors and obesity in the Hispanic Community Children's Health Study/Study of Latino Youth.

Hispanic/Latino youth are disproportionately affected by obesity. However, how social factors outside of the family relate to Hispanic/Latino youth obesity is not well understood. We examined associations of extra-familial social factors with overweight/obesity prevalence, and their variation by sex and age, in 1444 Study of Latino Youth participants [48.6% female; 43.4% children (8-11 years); 56.6% adolescents (12-16 years)], who were offspring of the Hispanic Community Health Study/Study of Latinos participants. Youth self-reported general social support from friends, dietary-, and physical activity (PA)-specific support from peers, and awareness/internalization of thinness ideals. Overweight/obesity was defined as body mass index ≥ 85th percentile. Logistic regression models assessed effects of social factors and their interactions with age-group and sex, adjusting for potential confounders. Social support from friends interacted with both age and sex in relation to overweight/obesity. Female children who reported lesser (OR 0.60; 95% CI [0.39, 0.91]) and female adolescents who reported greater (OR 1.35; 95% CI [1.06, 1.74]) social support from friends had higher odds of overweight/obesity. Among males, greater awareness/internalization of thinness ideals related to higher odds of overweight/obesity (OR 2.30; 95% CI [1.59, 3.31]). Awareness/internalization of thinness ideals was not associated with overweight/obesity among females. Dietary and PA-specific peer support did not relate to overweight/obesity. Social support from friends and awareness/internalization of thinness ideals were significantly related to odds of overweight/obesity in Hispanic/Latino youth; associations varied by age and sex, and persisted after control for intra-familial factors (overall family support/function; diet and activity specific support).

"One Scar Too Many:" The Associations Between Traumatic Events and Psychological Distress Among Undocumented Mexican Immigrants.

Undocumented immigration often presents with multiple stressors and contextual challenges, which may diminish mental health. This study is the first to provide population-based estimates for the prevalence of traumatic events and its association to clinically significant psychological distress among undocumented Mexican immigrants in the United States. This cross-sectional study used respondent-driven sampling to obtain and analyze data from clinical interviews with 248 undocumented Mexican immigrants residing in high-risk neighborhoods near the California-Mexico border. Overall, 82.7% of participants reported a history of traumatic events, with 47.0% of these meeting the criteria for clinically significant psychological distress. After controlling for relevant covariates, having experienced material deprivation, odds ratio (OR) = 2.26, 95% CI [1.18, 4.31], p = .013, and bodily injury, OR = 2.96, 95% CI [1.50, 5.83], p = .002, and not having a history of deportation, OR = 0.36, 95% CI [0.17, 0.79], p = .011, were associated with clinically significant psychological distress. These results support the need to revisit health and immigration policies and to devise solutions grounded in empirical evidence aimed at preventing the negative effects of trauma and psychological distress in this population.

Fatalism and hypertension prevalence, awareness, treatment and control in US Hispanics/Latinos: results from HCHS/SOL Sociocultural Ancillary Study.

Compared with non-Hispanic whites, US Hispanics/Latinos display similar hypertension prevalence, but lower awareness, treatment, and control. Sociocultural factors may affect these patterns. Fatalism, the belief that health is predetermined by fate, relates to poorer adoption of risk reducing health behaviors. We examined the association of fatalism with hypertension prevalence, awareness, treatment, and control among 5313 Hispanics/Latinos, ages 18-74, who were enrolled from four US communities in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. After accounting for socioeconomic status and acculturation in logistic regression analyses, higher fatalism was associated with increased odds of hypertension (OR 1.14, 95 % CI 1.02, 1.28). This association was non-significant when diabetes and other health-related covariates were statistically adjusted. Fatalism was not associated with hypertension awareness, treatment, or control. Findings suggest that the association of fatalism with hypertension may be due largely to its association with SES, acculturation, or related health conditions.

Adverse childhood experiences and adult disease: Examining mediating pathways in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

OBJECTIVES: Adverse childhood experiences (ACEs) have been linked to adulthood chronic diseases, but there is little research examining the mechanisms underlying this association. We tested pathways from ACEs to adult disease mediated via risk factors of depression, smoking, and body mass index. METHOD: Prospective data from adults 18 to 74 years old from the Hispanic Community Health Study/Study of Latinos and Sociocultural Ancillary Study were used. Retrospectively reported ACEs and hypothesized mediators were measured at Visit 1 (2008-2011). Outcomes of disease prevalence were assessed at Visit 2, approximately 6 years later. The analytic sample includes 5,230 Hispanic/Latino participants with ACE data. Statistical mediation was examined using structural equation modeling on cardiometabolic and pulmonary disease prevalence and reported probit regression coefficients with 95% confidence intervals (CIs). RESULTS: We found a significant association between ACEs and the prevalence of asthma/chronic obstructive pulmonary disorder (standardized ß = .07, 95% CI [0.02, 0.12]). In the mediational model, the direct association was nonsignificant (ß = .02, 95% CI [-0.04, 0.07]) but was mediated by depressive symptoms (ß = .03, 95% CI [0.02, 0.04]). There were no associations between ACEs and the prevalence of diabetes and self-reported coronary heart disease or cerebrovascular disease. However, a small indirect effect was identified via depressive symptoms and coronary heart disease (ß = .02, 95% CI [0.01, 0.03]). CONCLUSION: In this diverse Hispanic/Latino sample, depressive symptoms were found to be a pathway linking ACEs to self-reported cardiopulmonary diseases, although the effects were of small magnitude. Future work should replicate pathways, confirm the magnitude of effects, and examine cultural moderators that may dampen expected associations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of an integrated primary care intervention in improving psychosocial outcomes among Latino adults with diabetes: the LUNA-D study.

OBJECTIVE: To compare the effectiveness of usual care (UC) versus a culturally tailored integrated care model in improving mental health symptoms for Latino patients with Type 2 diabetes mellitus (T2DM). METHODS: We conducted a two-arm randomized controlled trial from 2015 to 2019 at a federally qualified health center. Participants were 456 adults ages 23-80 years who had a previous diagnosis of T2DM and were not currently using insulin. Participants were randomly assigned to Integrated Care Intervention (ICI; including behavioral/mental healthcare, medical visits, health education and care coordination) or UC; standard of care including referrals for health education and behavioral/mental health care where appropriate. Intention-to-treat, multilevel models were used to compare group × time changes in depression and anxiety symptoms (PHQ-8; GAD-7) and perceived stress (PSS-10) across 6 months. RESULTS: Participant mean age was 55.7 years, 36.3% were male, and 63.7% were primarily Spanish speaking. Baseline sociodemographic factors and mental health symptoms across study arms were balanced. Significant group × time interaction effects were observed for anxiety and depression symptoms (p < .05). Within the ICI and UC groups, mean depression symptom changes were -0.93 and -0.39 (p < .01); anxiety symptom changes were -0.97 (p < .01) and -0.11 (p = .35); and perceived stress changes were -1.56 and -1.27 (p < .01), respectively. CONCLUSIONS: Although both ICI and UC showed decreases over time, the ICI group evidenced larger, statistically significant changes in both depression and anxiety. Adapted integrated models of behavioral and chronic disease management appear to be effective and could be considered for usual care practices. CLINICALTRIALS.GOV IDENTIFIER: NCT03983499.

We developed and tested a culturally adapted, enhanced service ("Integrated Care Intervention") for Latino patients with Type 2 diabetes (T2D) to support their physical and mental health. The Integrated Care Intervention included receiving mental healthcare (i.e., "behavioral healthcare") services and health education during a routine appointment. Patients receiving the Integrated Care Intervention were compared to patients receiving standard primary care services (i.e., "Usual Care"), which may include a referral for health education and behavioral health services if their provider feels it is warranted. The study was conducted from 2015 to 2019 at a community health center. Study participants were 456 adults ages 23­80 years who had a previous diagnosis of T2D and were not currently using insulin. Participants were randomly assigned to an Integrated Care Intervention group or Usual Care group. We compared changes in depression and anxiety symptoms and perceived stress over a 6-month period for the two study participant groups. Patients assigned to the Integrated Care Intervention group showed larger improvements in both depression and anxiety symptoms over 6 months than the patients assigned to the Usual Care group. These findings indicate that Latino patients may benefit from receiving both behavioral and chronic disease management services during routine visits with their primary care provider.

Loneliness, Cardiovascular Disease, and Diabetes Prevalence in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

The relationship between loneliness and both cardiovascular disease (CVD) and diabetes mellitus (DM) has been understudied in U.S. Hispanics, a group at high risk for DM. We examined whether loneliness was associated with CVD and DM, and whether age, sex, marital status, and years in U.S moderated these associations. Participants were 5,313 adults (M (SD) age = 42.39 (15.01)) enrolled in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Loneliness was assessed via the 3-item Revised UCLA Loneliness Scale. Level of reported loneliness was low. Loneliness was significantly associated with CVD: OR 1.10 (CI 1.01-1.20) and DM: OR 1.08 (CI 1.00-1.16) after adjusting for depression, demographics, body mass index, and smoking status. Age, sex, marital status, and years in U.S. did not moderate associations. Given that increased loneliness is associated with higher cardiometabolic disease prevalence beyond depressive symptoms, regardless of age, sex, marital status, or years in the U.S., Hispanic adults experiencing high levels of loneliness may be a subgroup at particularly elevated risk for CVD and DM.

Effectiveness of Diabetes Self-Management Education Programs for US Latinos at Improving Emotional Distress: A Systematic Review.

PURPOSE: This systematic review examined whether diabetes self-management education (DSME) interventions for US Latino adults improve general emotional distress (eg, depression symptoms) and/or health-specific emotional distress (eg, diabetes distress). The topic is important given the high prevalence of type 2 diabetes (T2DM), concomitant distress, and worse health outcomes among Latinos and considering the barriers that distress poses for effective diabetes self-management. METHODS: Following PRISMA guidelines, a search of the online databases PsycINFO, CINAHL, PubMed, and CENTRAL was conducted from database inception through April 2018. A comprehensive search strategy identified trials testing DSME interventions for US Latinos with T2DM that reported on changes in general or health-specific emotional distress. Risk of bias was assessed using the EPHPP Quality Assessment Tool. Raw mean differences ( D) and effect sizes ( d) were computed where possible. RESULTS: Fifteen studies were included in the review. Six of 8 studies that examined depression symptoms reported significant symptom reduction. Of 10 studies that examined health-specific emotional distress, 6 reported significant symptom reduction. Effect sizes ranged from -0.20 to -3.85. Null findings were more readily found among studies with very small sample sizes (n < 30) and studies testing interventions without specific psychosocial content, with little cultural tailoring, with less frequent intervention sessions, and with support sessions lacking concurrent diabetes education. Most studies (11) received a weak rating of evidence quality. CONCLUSIONS: There is an absence of strong evidence to support that DSME programs tailored for Latino adults with T2DM are beneficial for improving emotional distress. Methodologically robust studies are needed.

Diabetes Prevention in U.S. Hispanic Adults: A Systematic Review of Culturally Tailored Interventions.

CONTEXT: Type 2 diabetes, prediabetes, and metabolic syndrome are highly prevalent in Hispanic individuals in the U.S. Cultural adaptations of traditional lifestyle interventions have been recommended to better reach this high-risk population. This systematic review examined the effectiveness of diabetes prevention programs for Hispanics in lowering risk for Type 2 diabetes, as evidenced by a reduction in weight or improvement in glucose regulation. EVIDENCE ACQUISITION: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO were searched from database inception to June 2016 for studies that evaluated diabetes prevention trials targeting U.S. Hispanic populations. Twelve publications met criteria for inclusion. EVIDENCE SYNTHESIS: Interventions varied substantially in length, rigor, and tailoring strategies. Five of 12 studies were RCTs. Eight studies included entirely or largely (>70%) female samples. All studies were delivered in Spanish and took place in community settings. Nine studies reported significant reductions in weight, and two in glucose regulation, post-intervention or when compared with controls. Effect sizes were small to moderate, study quality was moderate, and attrition was high in most trials. Interventions with the largest effect sizes included one or more of the following adaptations: literacy modification, Hispanic foods/recipes, cultural diabetes beliefs, family/friend participation, structured community input, and innovative experiential learning. CONCLUSIONS: Culturally tailored lifestyle interventions for diabetes prevention appear to be modestly effective in reducing risk for diabetes in Hispanics in the U.S. More studies are needed that utilize randomized controlled designs, recruit Hispanic men, report intervention content and tailoring strategies systematically, and publish participant evaluation and feedback.

Pilot Test of a Culturally Appropriate Diabetes Prevention Intervention for At-Risk Latina Women.

Purpose The purpose of the study was to test the preliminary effectiveness, feasibility, and acceptability of a peer-led, culturally appropriate, Diabetes Prevention Program (DPP)-based lifestyle intervention for Latina women at high-risk for type 2 diabetes (T2DM). Methods Participants (N = 61) were overweight/obese (body mass index [BMI] ≥25) Latina women with no diabetes, at elevated risk either due to midlife age (45-65 years; n = 37) or history of gestational diabetes mellitus (n = 24). The study used a 1-group pretest-posttest design and offered 12 weeks of peer-led education sessions in a community setting. The intervention targeted physical activity and dietary behaviors to facilitate weight reduction and included culturally appropriate content, age-specific health information, and stress/emotion management strategies. Clinical and self-report assessments were conducted at baseline, month 3, and month 6. Results Mean participant age was 47.8 years (SD = 10.8). Most (91.2%) were born in Mexico, and 43.3% had a ninth-grade education or less. At month 6, participants achieved a mean reduction of 4.1% body weight (7 lb [3.2 kg]). Statistically significant improvements were observed for dietary behaviors, stress, and depression symptoms. Attrition was low, 5% (3 women). Focus groups indicated that intervention content increased knowledge, was applicable, highly valued, culturally relevant, and would be recommended to others. Conclusions This culturally tailored DPP adaptation was feasible and acceptable for 2 groups of Latina women at high-risk for T2DM and showed preliminary effectiveness in reducing weight and modifying self-reported dietary behaviors, stress, and depression symptoms. Further research is needed to identify ways to enhance weight loss and diabetes prevention in this at-risk, underserved population.