Positive affect and clinical outcomes in type 2 diabetes

描述（由申请人提供）：最近对各种慢性疾病和健康样本的研究得出的惊人发现表明，积极影响与显著降低死亡风险相关。在糖尿病患者中，抑郁情绪很常见，与血糖控制较差、症状和并发症增加、对运动和饮食建议的依从性较差、医疗支出增加甚至死亡率有关。尽管我们的研究小组的分析表明，积极的影响与较低的死亡风险有独特的联系，但对糖尿病的积极影响的研究要少得多。从广义上讲，这些适应效应与Fredrickson的“拓宽与构建模型”和Cacioppo的“评价空间理论”是一致的。然而，关于积极影响与改善健康和心理结果之间的具体认知、行为和生理途径，我们知之甚少。我们的首要目标是建立积极影响在2型糖尿病管理中的益处，并基于对这种现象的时间过程、预测因素和作用机制的理解，开发有针对性的社会心理干预。在这个提案中，我们描述了一项前瞻性观察性研究，记录了50名参与者在诊断为2型糖尿病后9个月内积极影响的发生和临床后果。该研究的具体目的是：(1)通过检查其与血糖控制、血压和血脂的独特并发和前瞻性关联，记录2型糖尿病诊断后积极情绪的适应性生理功能；(2)探讨积极情绪的潜在行为和心理影响，包括糖尿病自我管理（如饮食、运动、药物治疗、自我血糖监测和参加推荐的医疗保健预约）、压力相关应对资源和应对反应。研究结果将为2型糖尿病患者积极影响干预的发展提供证据和方向。

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.