RESUMEN
AIM: To determine the cross-sectional and longitudinal associations between diabetes distress and diabetes management. METHODS: In a non-interventional study, 224 adults with Type 1 diabetes were assessed for diabetes distress, missed insulin boluses, hypoglycaemic episodes, and HbA1c at baseline and 9 months. RESULTS: At baseline, greater distress was associated with higher HbA1c and a greater percentage of missed insulin boluses. Longitudinally, elevated baseline distress was related to increased missed insulin boluses, and decreases in distress were associated with decreases in HbA1c . In supplementary analyses, neither depression symptoms nor a diagnosis of major depressive disorder was associated with missed insulin boluses, HbA1c or hypoglycaemic episodes in cross-sectional or longitudinal analyses. CONCLUSIONS: Significant cross-sectional and longitudinal associations were found between diabetes distress and management; in contrast, no parallel associations were found for major depressive disorder or depression symptoms. Findings suggest that elevated distress may lead to more missed insulin boluses over time, suggesting a potential intervention target. The covarying association between distress and HbA1c points to the complex and likely interactive associations between these constructs. Findings highlight the need to address distress as an integral part of diabetes management in routine care.
Asunto(s)
Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 1/terapia , Estrés Psicológico/etiología , Adolescente , Adulto , Glucemia/metabolismo , Niño , Estudios Transversales , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/etiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Progresión de la Enfermedad , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estrés Psicológico/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
AIMS: To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. METHODS: The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 (DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. RESULTS: The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. CONCLUSIONS: We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.
Asunto(s)
Depresión/diagnóstico , Depresión/epidemiología , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/psicología , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Adulto , Depresión/etiología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Psicometría , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
This study assessed patient awareness and use--as well as obstacles to use--of HMO- and community-based psychosocial support services designed for cancer patients. Participants were a randomly selected group of patients from a large Northwest HMO, with breast (N=145), prostate (N=151), or colon cancer (N=72), and their oncology and urology providers (N=29). Patient awareness was highest for HMO-based services (68-90%) and lower for community- (33%) or Internet-based (10-14%) services, and use rates were low across all services (range 2-8%). Providers reported referring 70% of their patients to HMO cancer support services, but their estimates of actual patient use of these services (40%) were inflated. Providers reported few barriers to referring patients to support services. The most commonly reported patient barriers to using such services were already having adequate support, lack of awareness of the service, and lack of provider referral. Results of regression analyses suggest that education, physician referral, social support, and spirituality may be important influences on use of cancer support services. This study takes a first step toward understanding patient use of existing cancer support services and suggests ways to increase participation in these services.
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Concienciación , Neoplasias de la Mama/psicología , Neoplasias de la Mama/terapia , Neoplasias del Colon/psicología , Neoplasias del Colon/terapia , Sistemas Prepagos de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud , Neoplasias de la Próstata/psicología , Neoplasias de la Próstata/terapia , Apoyo Social , Adulto , Anciano , Anciano de 80 o más Años , Consejo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noroeste de Estados Unidos , Derivación y Consulta/estadística & datos numéricosRESUMEN
This study examined the dynamic relations between adolescent problem behaviors (alcohol, marijuana, deviance, academic failure) over time and predictors of these behaviors. Data from the National Youth Survey (1) included 1,044 adolescents (53.5% male; mean age at year 1 = 13.20). Dependent measures were adolescent alcohol use, marijuana use, deviance, and academic failure, assessed annually over 4 years. Independent measures included age, gender, marital status, income, family time, family support, time with friends, friend deviance, knowledge of friends, activities, and neighborhood problems. An associative latent growth modeling (LGM) analysis showed significant increases and relations between the four behaviors in both initial status and development. Second-order multivariate LGM analyses indicated that the four behaviors could be modeled by a higher-order problem behavior construct. Significant effects on the common problem behavior intercept or slope included time with friends, deviant friends, age, marital status, family time, and support. Additional effects were found to be specific to the initial status and slopes of individual problem behaviors. Overall, results indicate the importance of assessing the relations between adolescent problem behaviors as they change over time and identifying the risk and protective factors that have both common and individual influences on these behaviors.
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Conducta del Adolescente/psicología , Alcoholismo/psicología , Delincuencia Juvenil/psicología , Abuso de Marihuana/psicología , Rendimiento Escolar Bajo , Adolescente , Niño , Análisis Factorial , Familia , Femenino , Humanos , Masculino , Modelos Estadísticos , Análisis Multivariante , Grupo Paritario , Factores de Riesgo , Muestreo , Medio Social , Apoyo Social , Estados UnidosRESUMEN
PURPOSE: To assess the level of physician performance on American Diabetes Association Provider Recognition Program (PRP) measures in two samples of primary care patients, as well as to identify patient, physician, and office characteristics related to performance levels. METHODS: In the two studies, we surveyed 435 Type 2 diabetes patients, cared for by 47 different physicians, on their receipt of PRP preventive care activities. RESULTS: Overall, patients in the two samples reported receiving 74% and 64% of recommended services. In both samples, performance of microvascular/glycemic control activities and cardiovascular lab checks (84% and 74%) was significantly higher than behavioral self-management/patient-focused activities (61% and 48%) (p<0.001). From a set of patient, physician, and practice setting characteristics, only the use of community resources for chronic illness management support was associated with service performance. CONCLUSIONS: We found considerable variability in the levels of performance in providing PRP-recommended activities. Greater attention should be focused on self-management and patient-focused activities, given that these are delivered less frequently than medical/laboratory checks.
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Diabetes Mellitus/terapia , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Adulto , Anciano , Humanos , Persona de Mediana Edad , Estados UnidosRESUMEN
We report on the development and validation of an instrument to assess support and resources for chronic illness management (the Chronic Illness Resources Survey; CIRS). The 64-item full instrument and the 29-item Brief CIRS are based on a social-ecologic model, designed to apply across chronic diseases, and assess support and resources at each of seven levels (e.g., family and friends, physician and health care team, neighborhood/community). A prospective evaluation with 123 patients having heart disease, arthritis, diabetes, and/or COPD revealed that the overall instrument, as well as subscales and the brief instrument, had acceptable internal consistency, moderate to high test-retest reliability, good construct validity, and moderate concurrent and prospective criterion validity. We discuss potential uses of the CIRS for assessment, feedback, tailoring intervention, and evaluation and make recommendations for future research.
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Actitud Frente a la Salud , Enfermedad Crónica , Autocuidado , Medio Social , Apoyo Social , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Deseabilidad Social , Encuestas y CuestionariosRESUMEN
This study investigated the relationship between weight gain concern and outcomes of a large-scale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers.
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Actitud Frente a la Salud , Cese del Hábito de Fumar , Prevención del Hábito de Fumar , Aumento de Peso , Adulto , Índice de Masa Corporal , Femenino , Humanos , Prevalencia , Estudios Prospectivos , Cese del Hábito de Fumar/estadística & datos numéricosRESUMEN
This study examined associations between the development of adolescent alcohol, cigarette, and marijuana use and risky sexual behavior, over time, using latent growth modeling methodology. Gender differences in the development and relationships between use of substances and risky sexual behavior were also examined. Participants were 257 adolescents (mean age = 15.96 years) assessed at three time points over an 18-month period. The intercepts of marijuana with cigarettes and alcohol, and all three substances with risky sexual behavior were significantly related. Development of the three substances showed similar patterns and development of cigarette use covaried with development of risky sexual behavior. There were no significant differences for boys and girls in these relationships. Results are discussed in relation to the need for greater understanding of nonsexual and sex-related problem behaviors and for analyses examining development and change in these behaviors during adolescence.
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Consumo de Bebidas Alcohólicas/epidemiología , Abuso de Marihuana/epidemiología , Modelos Psicológicos , Conducta Sexual , Fumar/epidemiología , Adolescente , Femenino , Humanos , Masculino , Análisis Multivariante , Noroeste de Estados Unidos/epidemiologíaRESUMEN
Coronary heart disease (CHD) is the leading cause of death among women in the United States, yet few studies have specifically targeted women who have CHD, and still fewer have examined how behavior and psychosocial factors affect lifestyle change. This article reviews what is known about lifestyle change, with an emphasis on psychosocial factors related to change, in women with CHD. Studies exploring individual lifestyle improvement areas--exercise, nutrition, smoking, and social support--as well as studies of comprehensive lifestyle changes are reviewed. Strong conclusions were precluded because of the paucity of studies, widely variable and inconsistent findings, flawed methodologies, and inadequate reporting of results. Future research is advised to develop and test intervention programs for women with CHD, addressing barriers to participation, lifestyle change patterns, psychosocial and quality of life outcomes, and physiologic change.
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Enfermedad Coronaria/prevención & control , Estilo de Vida , Salud de la Mujer , Adulto , Enfermedad Coronaria/etiología , Ejercicio Físico , Femenino , Humanos , Persona de Mediana Edad , Estado Nutricional , Factores de Riesgo , Fumar , Apoyo Social , Estados UnidosRESUMEN
Smoking cessation rates, progression in stage of change for smoking cessation, and serious quit attempts were examined over 2 years in a cohort of 242 men and women smokers (mean age 39.7 years, mean body mass index [BMI] 26.3) as a function of expressing concern about gaining weight because of quitting smoking. Participants were employees of 25 companies who were in a worksite health promotion program aimed at reducing risk factors for cardiovascular disease. Multivariate odds ratios (controlled for age, education, job class, sex, and BMI) for quitting smoking, attempting to quit smoking, and progressing in stage of change for smoking cessation as a function of weight concern were not significant. Interactions between sex and weight concern, and BMI and weight concern were also not significant. These findings, in a working, predominantly blue-collar population, and those of other studies, suggest that concern about gaining weight is, at best, a weak predictor of change in smoking behavior among most smokers.
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Actitud Frente a la Salud , Cese del Hábito de Fumar/psicología , Fumar/psicología , Aumento de Peso , Adulto , Índice de Masa Corporal , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/psicología , Femenino , Estudios de Seguimiento , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Fumar/efectos adversos , Lugar de TrabajoRESUMEN
The purpose of this study was to evaluate the effects of a revised worksite health promotion program that featured an employee steering committee/menu approach to intervention. The "Take Heart II" program was evaluated using a quasi-experimental matched-pair design with worksite as the unit of analysis. Experimental and control worksites did not differ on baseline organizational or employee demographic variables or on baseline levels of dependent variables. Outcome and process results revealed consistent, but modest effects favoring intervention worksites on most measures. Cross-sectional analyses generally failed to produce statistically significant intervention effects, but cohort analyses revealed significant beneficial effects of the Take Heart II intervention on eating patterns, behavior change attempts, and perceived social support. Neither analysis detected a beneficial effect of intervention on cholesterol levels.
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Enfermedad Coronaria/prevención & control , Promoción de la Salud , Estilo de Vida , Lugar de Trabajo , Adulto , Anciano , Estudios de Cohortes , Enfermedad Coronaria/psicología , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipercolesterolemia/prevención & control , Hipercolesterolemia/psicología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: The specific aims of the present study were to report on the level of personal beliefs and social and environmental barriers across different regimen areas and patient subgroups and on the relationship of personal models and perceived barriers to the level of self-management. RESEARCH DESIGN AND METHODS: This study focused on several issues related to personal models (representations of illness) and perceived barriers to diabetes self-management among a large heterogeneous survey sample of 2,056 adults throughout the U.S. RESULTS: Respondents felt that diabetes was a serious disease and that their self-management activities will control their diabetes and reduce the likelihood of long-term complications. Most frequently reported barriers were related to dietary adherence, followed by exercise and glucose testing barriers. Both personal models and barriers significantly predicted level of self-management in all three regimen areas studied (diet, exercise, and glucose testing) after controlling for the influence of demographic and medical history factors. Regimen-specific models and barriers proved to be stronger predictors than more global measures. Differences on personal models and barriers were observed among different patient groups (e.g., age, health insurance, and insulin-taking status). Possible reasons for these differences and implications for intervention and future research are discussed. CONCLUSIONS: Both the personal-model and barriers scales had good internal consistency and predicted variance in each of the self-management variables after controlling for demographic and medical history factors. These brief self-report personal-model scales demonstrated good internal reliability and were as predictive of self-management as the lengthier interview-based measures in previous studies. The assessment of the treatment effectiveness component of personal models may be sufficient for most clinical purposes.
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Cultura , Diabetes Mellitus/psicología , Diabetes Mellitus/rehabilitación , Modelos Psicológicos , Autocuidado , Factores Socioeconómicos , Adulto , Negro o Afroamericano , Factores de Edad , Actitud Frente a la Salud , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 1/rehabilitación , Diabetes Mellitus Tipo 2/psicología , Diabetes Mellitus Tipo 2/rehabilitación , Dieta para Diabéticos , Ejercicio Físico , Femenino , Humanos , Seguro de Salud , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Análisis de Regresión , Factores Sexuales , Fumar/epidemiología , Estados Unidos , Población BlancaRESUMEN
OBJECTIVE: To report on the development and validation of a rating scale to code the various components of written tobacco policies. DESIGN: A one-page Tobacco Policy Rating Form (TPRF) was developed to apply to written policies in both worksites and American Indian tribes. Fifteen worksite and 24 tribal tobacco policies from a diverse set of companies and tribes of varying size and economic status were rated on the TPRF by two separate sets of experienced and inexperienced raters. Kendall's coefficient of concordance (W) was computed to measure inter-rater agreement. RESULTS: The scale was found to produce a high level of agreement when used by both experienced and inexperienced raters on both tribal and worksite policies. For experienced raters, W = 0.92, P < 0.0001 for tribal policies and W = 0.97, P < 0.0001 for worksite policies; for inexperienced raters, W = 0.89, P < 0.0001 for tribal policies and W = 0.96, P < 0.0001 for worksite policies. CONCLUSIONS: The TPRF seems worthy of future use as a tool to rate the strength and comprehensiveness of written tobacco policies. It may be extended to other settings such as schools and municipalities, or used by investigators studying behavioural or economic consequences of smoking policies. Those interested in policy change may find the TPRF useful as a way of describing existing policies and as a quantitative measure of change.
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Nicotiana , Política Organizacional , Plantas Tóxicas , Prevención del Hábito de Fumar , Lugar de Trabajo , Terapia Conductista , HumanosRESUMEN
This article describes the conceptual basis, design, and intervention approach for a worksite-based heart disease risk reduction project. Baseline characteristics of the 26 moderate size worksites participating in the Take Heart Project are also described. The trial is designed to produce changes at both the organization and employee level on tobacco use, dietary fat intake, and serum cholesterol. A key feature of the intervention is creation of employee steering committees to enhance ownership and involvement. From a menu of brief, low-intensity health education and environmental change activities, these committees select activities best suited to their worksite. The baseline characteristics of organizations randomized to intervention and control conditions were similar, and indicated a relatively high level of worksite activity related to cholesterol and smoking.