Psychosocial, Immunological and Biobehavioral Benefits of Stress Management Interventions for Chronic Diseases: Comprehensive Systematic Review and Meta-Analyses

 描述（由申请人提供）：慢性疾病，如冠心病 [CHD]、癌症 [CA]、糖尿病 [DM] 和 HIV，是美国过早发病和死亡的主要原因。所有慢性疾病的病程均受到疾病相关和生活压力的影响。压力常常导致焦虑和抑郁，扰乱神经内分泌和免疫功能，引发不健康的行为，并破坏对医疗建议的遵守。为了减轻压力的有害影响，针对慢性病患者制定了行为干预措施。初级研究表明，行为干预可以减少焦虑和抑郁，但此类研究通常不具备所需的统计能力来告知我们替代结果（例如治疗依从性、健康行为改变）、中介机制（例如神经内分泌和免疫标志物）以及干预效果的调节因素（例如患者或疾病特征）。随着最近发表的关于补充和行为医学方法的研究激增，文献现在足够多，可以进行综合荟萃分析研究，该研究可以具有更多的统计能力。因此，拟议的研究将使用荟萃分析方法来衡量压力管理干预措施的功效，以改善假设的生物标志物、治疗依从性、健康行为和疾病进展以及心理结果。我们将对患有四种普遍且昂贵的疾病（CHD、CA、DM 和 HIV）的人群进行抽样研究。拟议的荟萃分析研究将进一步加深我们对慢性病背景下行为压力管理干预措施有效性的理解，并有助于指导未来的研究解决重要的未解答问题。拟议的荟萃分析研究还将产生对医疗保健提供者、保险公司和政策制定者有用的结果，他们需要精确的信息来根据经验做出有关干预的最佳内容和持续时间的决策，谁最有可能受益，以及结果如何因慢性疾病而异。这个合格且经验丰富的团队提出的研究的创新方面包括（a）使用最先进的元分析方法来整合大量复杂的文献，（b）精确测量行为压力管理干预措施所产生的心理、神经内分泌和免疫学益处，（c）识别干预效果的调节因素和调节因素，以及（d）比较四种流行慢性疾病的益处。由于四种慢性病的患病率、影响和成本、压力的普遍存在以及对多种慢性病采取有效压力管理干预措施的需要，这项研究具有非常重要的意义。这项研究的长期目标是指导为慢性病患者开发更强大、更高效、更具成本效益的压力管理干预措施。

 DESCRIPTION (provided by applicant): Chronic diseases, such as coronary heart disease [CHD], cancer [CA], diabetes [DM], and HIV, are the leading cause of premature morbidity and mortality in the U. S. The course of all chronic diseases is affected by disease-related and life stress. Stress often leads to anxiety and depression, disturbs neuroendocrine and immune function, triggers unhealthy behaviors, and undermines adherence to medical recommendations. To alleviate the harmful effects of stress, behavioral interventions have been developed for people living with a chronic disease. Primary-level research indicates that behavioral interventions can reduce anxiety and depression but such research often has not had the statistical power needed to inform us about alternative outcomes (e.g., treatment adherence, health behavior change), mediating mechanisms (e.g., neuroendocrine and immunological markers), and moderators of intervention efficacy (e.g., patient or disease characteristics). With the recent surge in published research on complementary and behavioral medicine approaches, the literature is now large enough to permit an integrated meta-analytic investigation, which can have more statistical power. Therefore, the proposed research will use meta-analytic methods to gauge the efficacy of stress management interventions to improve hypothesized biomarkers, treatment adherence, health behaviors, and disease progression - as well as psychological outcomes. We will sample research conducted with people living with four prevalent and costly conditions (CHD, CA, DM, and HIV). The proposed meta-analytic research will further our understanding of the efficacy of behavioral stress management interventions in the context of chronic disease, and help to guide future research toward important unanswered questions. The proposed meta-analytic research will also yield results that will be useful to health care providers, insurers, and policy makers who need precise information to make empirically-derived decisions about the optimal content and duration of an intervention, who is most likely to benefit, and how results may vary across chronic illnesses. Innovative aspects of the proposed research from this well- qualified and highly experienced team include (a) use of state-of-the science meta-analytic methods to integrate a large and complex literature, (b) precise measurement of the psychological, neuroendocrine, and immunological benefits accruing from behavioral stress management interventions, (c) identification of mediators and moderators of intervention efficacy, and (d) comparison of benefit across four prevalent chronic diseases. The research is highly significant because of the prevalence, impact, and cost of the four chronic illnesses, the ubiquity of stress, and the need for effective stress management interventions for multiple chronic conditions. The long-term goal of this research is to guide the development of more powerful, efficient, and cost-effective stress management interventions for people living with a chronic disease.