Stress and Type 2 Diabetes among Indigenous Adults

描述（由申请人提供）：此修订后的RO1申请是对NIDDK疾病计划公告（PA-09-262）的健康差异的回应。它关注的是美国印第安人（AI），他们的2型糖尿病（T2D）发病率是世界上最高的。这些人口还面临着不成比例的压力，包括经济劣势、失业、社区暴力、歧视以及历史文化创伤和损失的长期影响。然而，矛盾的是，人工智能人往往在一些自我报告的压力测量中得分较低，并且与压力相关的精神障碍（如重度抑郁发作和焦虑症）的患病率较低。拟议研究的目标是通过比较压力生物标志物和自我报告测量来推进人工智能人群压力过程的测量；并使用包括应激生物标志物在内的多种应激指标来研究AI成人中应激过程T2D疾病进展与治疗依从性之间的相互作用。这个以社区为基础的参与性研究是基于与明尼苏达州和威斯康星州的五个Ojibwe保留地的合作伙伴关系，他们邀请研究小组与他们的诊所合作。第一个具体目标是将我们现有的关于社区突出压力源的初步数据与现有措施的新的定性反馈相结合，以适应并随后通过试点调查检查该人群压力措施的心理测量特性。第二个具体目的是研究压力生物标志物与自我报告的心理社会压力源、痛苦症状以及焦虑、抑郁和创伤的诊断措施之间的关系，以确定200名最近被诊断为T2D的AI成人队列中自我报告措施对实际生理压力水平的指示程度。第三个具体目标是对200名最近诊断为T2D AI的成年人进行为期两年的随访，以研究一种创新的概念模型（图1），该模型包含压力过程、治疗依从性、心理健康和疾病并发症风险因素的多种测量方法

DESCRIPTION (provided by applicant): This revised RO1 application is in response to the Health Disparities in NIDDK Diseases Program Announcement (PA-09-262). It focuses on American Indians (AI) whose rates of type 2 diabetes (T2D) are the highest in the world. This population also copes with disproportionate stressors including economic disadvantage, unemployment, community violence, discrimination, and the long- term effects of historical cultural traumas and losses. Yet, paradoxically, AI people tend to score lower on some self-report measures of stress and have lower prevalence rates of stress-related mental disorders such as major depressive episode and anxiety disorders. The goals of the proposed research are to advance measurement of stress processes among AI people through comparisons of stress biomarkers and self-report measures; and to use multiple indicators of stress including stress biomarkers to investigate the interactions between stress processes T2D disease progression and treatment compliance among AI adults. This community based participatory research is based on partnerships with five Ojibwe reservations in Minnesota and Wisconsin who invited the research team to work with their clinics. The first specific aim is to couple our existing preliminary data on community salient stressors with new qualitative feedback on existing measures to adapt and subsequently examine via pilot surveys the psychometric properties of stress measures for this population. The second specific aim is to investigate the relationship between stress biomarkers and self-reported psychosocial stressors, symptoms of distress, and diagnostic measures of anxiety, depression, and trauma to ascertain the degree to which self report measures are indicative of actual physiological stress levels among a cohort of 200 AI adults who have been recently diagnosed with T2D. The third specific aim is to follow a cohort of 200 recently diagnosed T2D AI adults for two years to investigate an innovative conceptual model (Figure 1) of multiple measures of stress processes, treatment compliance, mental health, and risk factors for disease complications