A Psychoeducational Intervention for Women with Diabetes

虽然男性糖尿病患者的心脏死亡率下降了（13.1%），但年龄增长了23%

While cardiac mortality for men with diabetes has declined (13.1%), there has been a 23% increase in age- adjusted cardiac mortality for women with diabetes. This poor outcome, occurring in a time of significant advances in the management of heart disease, suggests the need to consider directing treatment at other risk factors. Depression is an independent risk factor for cardiovascular disease About 25% of persons with diabetes have depression, and the rate of depression in women with diabetes is doubled that of men with diabetes. Women with diabetes exhibit worse diabetes self-care, glycemic control, and poorer quality of life than men with diabetes, outcomes that are exacerbated by depression. Anxiety and anger commonly accompany depressive symptoms, appear to impose similar risks for poor medical outcomes, and occur more often in women with diabetes than men with diabetes. Most diabetes education programs may briefly address dysphoric symptoms; however, their primary emphasis is not on the assessment and management of these symptoms. The Study of Women's Emotions and Evaluation of a Psychoeducational (SWEEP) Program will test the effectivenessand feasibility of an eight week psychoeducational intervention on: (1) dysphoric symptoms (depressive symptoms, anxiety, and anger), (2) glycemic control (HbA1c), (3) health- related quality of life (functional status, life satisfaction, and diabetes-related distress), and (4) diabetes self- management (self care behaviors and self-efficacy) at three and 6 months follow-up. Fifty women with type 2 diabetes who are receiving usual medical care (UMC) for diabetes and have significant depressive symptoms, will be randomized to receive a cognitive behavioral psychoeducational intervention delivered in a group format (n=25) or no additional treatment (n=25). A mixed model analysis of variance will be used to test the study hypothesis that the group receiving UMC plus the psychoeducational intervention will have significantly better outcomes than the group that receives UMC alone. The findings should demonstrate the feasibility and health related benefits of psychoeducational treatment in diabetes care for women living with type 2 diabetes. In addition to this research, the application describes a training plan that will enhance the applicant's knowledge and skills in (1) assessment and treatment of depression and other dysphoric mood states (2) cognitive behavioral psychoeducational interventions in womenwith diabetes and (3) clinical trials methodology. Public Information: The SWEEP program, targeted at improving negative emotions such as depression, anxiety and anger, will be tested to see if it improves blood sugar control, self-management of diabetes, and quality of life in women with type 2 diabetes. If proven to be successful,it could become an important adjunct to current diabetes care.