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

项目总结 患有慢性疼痛或疾病的人过早发病和死亡的风险增加。所有慢性病的病程都受到疾病相关和生活压力的影响。压力通常会导致焦虑和抑郁，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，已经为患有慢性疼痛和疾病的人开发了行为干预措施。初级研究表明，行为干预可以减少焦虑和抑郁，但这种研究往往没有必要的统计能力来确定替代结果(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记物)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，现在的文献已经足够大，可以进行整合的荟萃分析调查，这将具有相当大的统计学力量。因此，这项拟议的研究将使用荟萃分析方法来评估压力管理干预措施改善假想生物标记物、治疗依从性、健康行为、疾病进展以及心理结果的有效性。我们将包括对患有(A)慢性疼痛或(B)三种慢性病的人进行的研究，特别是心血管疾病、糖尿病和艾滋病毒。拟议的元分析研究将进一步加深我们对行为压力管理干预在慢性疼痛和疾病背景下的有效性的理解，并有助于指导未来的研究转向重要的未回答问题。拟议的荟萃分析研究还将产生有助于指导医疗保健提供者、保险公司和政策制定者的结果，这些人需要准确的信息，以做出关于干预的最佳内容和持续时间、谁最有可能受益以及结果可能因慢性疼痛和疾病情况而异的经验性决策。这个资历丰富且经验丰富的团队提出的研究的创新方面包括：(A)使用最新的科学荟萃分析方法整合大量复杂的文献，(B)精确衡量行为应激管理干预所产生的心理、神经内分泌和免疫益处，(C)确定干预效果的中介和调节因子，以及(D)跨慢性疼痛和疾病的益处的比较。这项研究意义重大，因为慢性疼痛和疾病的患病率、影响和成本，压力的无处不在，以及对多种慢性病进行有效的压力管理干预的必要性。这项研究的长期目标是指导为患有一种或多种慢性病的人开发更强大、更有效和更具成本效益的压力管理干预措施。

PROJECT SUMMARY People living with chronic pain or illness are at increased risk of premature morbidity and mortality. The course of all chronic illnesses 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 chronic pain and illness. Primary-level research indicates that behavioral interventions can reduce anxiety and depression but such research often has not had the statistical power needed to determine 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 will have considerably 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 include research conducted with people living with (a) chronic pain or (b) three chronic diseases, specifically cardiovascular disease, diabetes, and HIV. The proposed meta-analytic research will further our understanding of the efficacy of behavioral stress management interventions in the context of chronic pain and illness, and help to guide future research toward important unanswered questions. The proposed meta-analytic research will also yield results that can help to guide 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 pain and disease conditions. 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 chronic pain and diseases. The research is highly significant because of the prevalence, impact, and cost of chronic pain and illness, 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 one or more chronic conditions.