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Perseverative Cognitions: Assessment and Associations with Stress, Sleep and BP

持久认知：评估以及与压力、睡眠和血压的关联

基本信息

批准号：
8708951
负责人：
TANYA M Spruill
金额：
$ 20.76万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2016-07-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Psychological stress has been linked to the development of hypertension (HTN) but the process by which this occurs is poorly understood. Prolonged blood pressure (BP) responses to stress have been shown to increase risk for HTN, and there is growing evidence indicating that thinking about stressful experiences, in addition to experiencing them directly, can affect BP. Thus, it has been hypothesized that engaging in perseverative cognitions about past or future stressors may contribute to prolonged physiological activation and, over time, the development of HTN. Evidence that perseverative cognitions are associated with delayed BP recovery and impaired sleep quality, which both increase HTN risk, provides preliminary support for the hypothesis. However, progress in this emerging field has been limited by several important conceptual and methodological issues. Little is known about the nature of perseverative cognition in the real world: how much do people ruminate about stressful events, what factors influence the likelihood of engaging in such thoughts, and what are their effects on sleep and BP? Also, to be considered as a possible risk factor, it must be demonstrated that individual differences in perseverative cognition exist and are stable over time. These questions can best be addressed using ecological momentary assessment (EMA). The goal of the proposed R21 is to resolve these issues in preparation for a future application in which we will conduct a larger, more intensive study to formally test the hypothesized model. We will conduct an EMA study in which a diverse sample of 163 normotensive and untreated hypertensive subjects will undergo electronic diary-based assessment of daily stress exposure and perseverative cognitions, actigraphy and ambulatory BP monitoring over a 2-week period. The aims are: (1) To determine the feasibility of using an extended EMA protocol to simultaneously assess stress exposure, perseverative cognitions, sleep quality and BP in the natural environment; (2) To quantify subjects' exposure to daily stress and their experience of perseverative cognitions and explore whether these differ according to situational and/or person-level factors; (3) To assess the stability of stress exposure and perseverative cognitions over a 2-week period, and to estimate the duration of monitoring required to reliably assess each; and (4) To conduct exploratory analyses of associations of daily stress and perseverative cognitions with sleep quality and BP, which will provide effect size estimates to inform future studies. Public Health Significance: More than 28% of the U.S. population has HTN, which continues to be a major cause of morbidity and mortality. Psychological stress increases HTN risk, and understanding the mechanisms involved may lead to improved interventions. This study will address important gaps in the literature and provide critical information for the design of a larger study to determine the role of perseverative cognition in the relationships between stress, impaired sleep and elevated BP. The findings will also be broadly applicable to the design of investigations of other health effects of stress and stress-related thoughts.

描述（由申请人提供）：心理压力与高血压（HTN）的发生有关，但人们对这种情况发生的过程知之甚少。长期对压力的血压 (BP) 反应已被证明会增加患高血压的风险，并且越来越多的证据表明，除了直接经历压力经历之外，思考压力经历也会影响血压。因此，有人假设，对过去或未来压力源进行持久的认知可能有助于延长生理激活，并随着时间的推移，导致高血压的发展。有证据表明，持续认知与血压恢复延迟和睡眠质量受损有关，这两者都会增加高血压风险，为这一假设提供了初步支持。然而，这个新兴领域的进展受到几个重要的概念和方法问题的限制。人们对现实世界中持续认知的本质知之甚少：人们对压力事件的思考程度如何，哪些因素影响进行此类思考的可能性，以及它们对睡眠和血压有何影响？此外，要被视为可能的风险因素，必须证明持久认知存在个体差异，并且随着时间的推移保持稳定。这些问题最好通过生态瞬时评估（EMA）来解决。拟议 R21 的目标是解决这些问题，为未来的应用做好准备，在未来的应用中，我们将进行更大规模、更深入的研究，以正式测试假设的模型。我们将开展一项 EMA 研究，其中 163 名血压正常和未经治疗的高血压受试者的不同样本将在两周内接受基于电子日记的日常压力暴露和持续认知、体动记录和动态血压监测评估。目的是：（1）确定使用扩展的 EMA 协议同时评估自然环境中的压力暴露、持续认知、睡眠质量和血压的可行性； (2) 量化受试者日常压力暴露及其持久认知体验，并探讨这些是否因情境和/或个人因素而有所不同； (3) 评估两周内压力暴露和持续认知的稳定性，并估计可靠评估每一项所需的监测持续时间； (4) 对日常压力和持久认知与睡眠质量和血压的关联进行探索性分析，这将为未来的研究提供效应大小估计。公共卫生意义：超过 28% 的美国人口患有高血压，这仍然是发病和死亡的主要原因。心理压力会增加高血压风险，了解其中的机制可能会改善干预措施。这项研究将弥补文献中的重要空白，并为设计更大的研究提供关键信息，以确定持久认知在压力、睡眠受损和血压升高之间关系中的作用。研究结果还将广泛适用于压力和与压力相关的想法对其他健康影响的调查设计。