Positive affect and clinical outcomes in type 2 diabetes

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DESCRIPTION (provided by applicant): Striking findings from recent studies in a variety of chronically ill and healthy samples demonstrate that positive affect is associated with significantly lower risk of mortality. In people with diabetes, depressive mood is common and is associated with poorer glycemic control, increased symptoms and complications, poorer adherence to exercise and diet recommendations, increased health care expenditures, and even mortality. Much less work has been done on positive affect in diabetes, even though analyses from our research team indicate that positive affect is uniquely associated with lower risk of mortality, independently of negative affect. On a broad level, these adaptive effects are consistent with theories such as Fredrickson's Broaden and Build Model and Cacioppo's Evaluative Space theory. However, very little is known about the specific cognitive, behavioral, and physiological pathways that link positive affect with improved health and psychological outcomes. Our overarching aim is to establish the benefits of positive affect in the management of type 2 diabetes, and to develop a targeted psychosocial intervention based on an understanding of the phenomenon's time-course, predictors, and mechanisms of action. In this proposal we describe a prospective observational study to document the occurrence and clinical consequences of positive affect during the 9 months after diagnosis of Type 2 diabetes in a sample of 50 participants. The specific aims of the study are to: (1) Document the adaptive physiologic functions of positive affect following a diagnosis of Type 2 diabetes by examining its unique concurrent and prospective associations with glycemic control, blood pressure, and lipids; and (2) Explore potential behavioral and psychological effects of positive affect including diabetes self management (e.g., diet, exercise, medication, self monitoring of blood glucose, and attendance at recommended health care appointments), stress-related coping resources, and coping responses. Findings will provide evidence and direction for the development of positive-affect based interventions for people with type 2 diabetes. PUBLIC HEALTH RELEVANCE: Positive affect is uniquely associated with lower risk of mortality in people with diabetes. However, the clinical, behavioral, and psychological pathways linking positive affect and poorer health in people with diabetes are unknown. The proposed study will document the clinical consequences of positive affect during the 9 months after diagnosis of Type 2 diabetes in a sample of 50 participants. Findings from the proposed study will provide evidence and direction for the development of psychosocial interventions that include a focus on positive affect for people with type 2 diabetes.