Reducing CVD Risk in Caregivers: A Brief Behavioral Activation Intervention

降低护理人员的 CVD 风险：简短的行为激活干预

• 批准号: 7465742
• 负责人: BRENT T MAUSBACH
• 金额: $ 28.51万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7465742
• 关键词: Achievement; Adaptive Behaviors; Address; Affect; Affective; Aging; Alzheimer' s Disease; Anxiety; Arousal; Behavior Therapy; Behavioral; Biological; Biological Factors; Biological Markers; California; Cardiovascular Diseases; Cardiovascular system; Caregivers; Caring; Coagulation Process; Cognitive Therapy; Collaborations; Communities; Complement; Condition; Coping Behavior; Data; Dementia; Diagnosis; Effectiveness; Elevation; Emotional; Enrollment; Environment; Epinephrine; Event; Family member; Feeling; Fibrin fragment D; Goals; Health; Health Care Costs; Home environment; Individual; Inflammation; Inflammatory; Injury; Interleukin-6; Interleukins; Intervention; Knowledge; Life; Link; Literature; Love; Mediating; Mediator of activation protein; Mental Depression; Mental Health; Monitor; Morbidity - disease rate; Nature; Norepinephrine; Numbers; Outcome; Outcome Study; Participant; Personal Satisfaction; Physiological; Plasma; Population; Productivity; Psyche structure; Public Health; Publications; Randomized; Research; Risk; Risk Marker; Sampling; Self Efficacy; Services; Societies; Stress; Stroke; Support Groups; Symptoms; Testing; Theoretical model; Thinking; Time; Translating; Treatment Efficacy; Universities; Week; Work; base; cardiovascular disorder risk; cardiovascular risk factor; caregiving; coping; cost; depressive symptoms; follow-up; improved; intervention program; programs; psychologic; psychological distress; psychological outcomes; psychosocial; reinforcer; response; skills; sound; theories; von Willebrand Factor

DESCRIPTION (provided by applicant): Due to an aging society, the number of people diagnosed with dementia is expected to increase dramatically over the next two decades, with a concomitant rise in the number of family members providing informal care for their loved ones. The stresses associated with this care have been well-documented in the scientific literature, and are noted to be associated with increased risk for psychological and physical morbidity, particularly cardiovascular disease. Indeed, caregiving is associated with elevations in negative affect (e.g., depressive and anxiety symptoms), which in turn is associated with biological indicators that are thought to predict CVD risk (e.g., markers of coagulation, endothelial injury, or inflammation). The primary goal of this study is to examine the efficacy of a brief Behavioral Activation Treatment (BAT), called the Pleasant Events Program (PEP), for reducing biological CVD risk indicators in a sample of spousal Alzheimer caregivers. We will also examine whether this intervention is successful for modifying Sympathoadrenal Medullary (SAM) activation, which is one mechanism linking stress and affect to CVD risk biomarkers. We will enroll 100 dementia caregivers and randomly assign them to receive 4-sessions of PEP or 4-sessions of support + information. Our PEP intervention will be conducted in caregivers' homes and will emphasize the importance of monitoring and increasing activities that help individuals make contact with natural reinforcers in their environments, identifying and reducing negative coping responses, and selection and achievement of behavioral goals for healthier living. Caregivers will be assessed for our biological outcomes at baseline, 6-, and 12-weeks to determine intervention efficacy. Given the brief nature of the PEP intervention, the ease with which it can be applied in real-world settings (e.g., community agencies providing services to caregivers), and lack of difficult skills for interventionists and caregivers to acquire, we believe our PEP intervention will be easily transferred to "real-world" settings. If our PEP intervention is efficacious, it may have a considerable impact on both the physical and mental health of caregivers, and will likely have public health implications. Public Health Relevance: Cardiovascular disease and depression are some of the most costly illnesses to society, and caring for a loved-one with Alzheimer's disease has been associated with increased risk for both depression and cardiovascular disease. Indeed, depressive symptoms have been linked with elevated plasma concentrations of D-dimer, Interleukin-6 (IL-6), and von Willebrand Factor (vWF), all of which are associated with increased risk for cardiovascular disease (CVD). The present research tests a brief behavioral intervention for reducing both depressive symptoms and CVD biomarkers in Alzheimer caregivers. If successful, this intervention may help improve overall physical and mental health in this population, can be easily implemented into community-based organizations, and ultimately reduce the impact of these conditions on caregivers and society.

描述（由申请人提供）：由于社会老龄化，预计在未来二十年内，被诊断患有痴呆症的人数将急剧增加，同时为亲人提供非正式护理的家庭成员数量也将随之增加。与这种护理相关的压力已在科学文献中得到充分记载，并指出与心理和身体疾病，特别是心血管疾病的风险增加有关。事实上，抑郁与负面情绪的升高有关（例如，抑郁和焦虑症状），这反过来又与被认为预测CVD风险的生物学指标相关（例如，凝血、内皮损伤或炎症的标志物）。本研究的主要目的是检查一个简短的行为激活治疗（BAT），称为愉快的事件计划（PEP），在配偶阿尔茨海默氏症照顾者的样本中减少生物CVD风险指标的有效性。我们还将研究这种干预是否能成功地改变交感肾上腺髓质（SAM）激活，这是一种将压力和影响与CVD风险生物标志物联系起来的机制。我们将招募100名痴呆症护理人员，并随机分配他们接受4次PEP或4次支持+信息。我们的PEP干预将在护理人员的家中进行，并将强调监测和增加活动的重要性，这些活动有助于个人与环境中的自然生物接触，识别和减少消极的应对反应，以及选择和实现更健康的生活行为目标。护理人员将在基线、6周和12周时评估我们的生物学结局，以确定干预疗效。考虑到PEP干预的简短性质，它可以在现实世界的环境中应用的容易程度（例如，我们相信，我们的PEP干预将很容易地转移到“现实世界”的环境中。如果我们的PEP干预是有效的，它可能会对照顾者的身心健康产生相当大的影响，并可能会对公共卫生产生影响。 公共卫生相关性：心血管疾病和抑郁症是社会上最昂贵的疾病之一，照顾患有阿尔茨海默病的亲人与抑郁症和心血管疾病的风险增加有关。事实上，抑郁症状与D-二聚体、白细胞介素-6（IL-6）和血管性血友病因子（vWF）的血浆浓度升高有关，所有这些都与心血管疾病（CVD）风险增加有关。本研究测试了一种简短的行为干预，以减少阿尔茨海默氏症照顾者的抑郁症状和CVD生物标志物。如果成功，这种干预可能有助于改善这一人群的整体身心健康，可以很容易地实施到社区组织，并最终减少这些条件对照顾者和社会的影响。