Positive affect and clinical outcomes in type 2 diabetes

描述(由申请人提供)：最近在各种慢性病和健康样本中的惊人研究结果表明，积极的情绪与显著降低的死亡风险有关。在糖尿病患者中，抑郁情绪很常见，并与血糖控制较差、症状和并发症增加、对锻炼和饮食建议的遵从性较差、医疗保健支出增加，甚至死亡率有关。尽管我们研究团队的分析表明，积极情绪与较低的死亡率风险是唯一相关的，但在糖尿病的积极情绪方面所做的工作要少得多，与负面情绪无关。在更广泛的层面上，这些适应效应与弗雷德里克森的拓宽和构建模型和卡乔波的评估空间理论是一致的。然而，人们对积极情感与改善健康和心理结果之间的具体认知、行为和生理途径知之甚少。我们的总体目标是确定积极情绪在2型糖尿病治疗中的益处，并基于对这一现象的时间进程、预测因素和作用机制的理解，开发有针对性的心理社会干预。在这项建议中，我们描述了一项前瞻性观察性研究，以记录在诊断为2型糖尿病后的9个月内积极情绪的发生和临床后果，样本为50名参与者。这项研究的具体目的是：(1)通过研究积极情绪与血糖控制、血压和血脂的独特的同步和前瞻性关联，记录诊断出2型糖尿病后积极情绪的适应性生理功能；以及(2)探索积极情绪的潜在行为和心理影响，包括糖尿病自我管理(例如，饮食、锻炼、药物、血糖自我监测和推荐的医疗预约)、压力相关应对资源和应对反应。研究结果将为开发针对2型糖尿病患者的基于积极情感的干预措施提供证据和方向。 公共卫生相关性：积极的情绪与糖尿病患者较低的死亡风险是唯一相关的。然而，糖尿病患者的积极情绪与较差的健康状况之间的临床、行为和心理联系尚不清楚。这项拟议的研究将在50名参与者的样本中记录在确诊为2型糖尿病后的9个月内积极情绪的临床后果。这项拟议研究的结果将为发展心理社会干预措施提供证据和方向，其中包括关注对2型糖尿病患者的积极影响。

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.