Association of Biological and Self-Reported Stress Measures with Cardiovascular Disease and Risk Factors among Adults with Type II Diabetes

Purpose and Background/Significance: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are prevalent comorbid health conditions in adults, affecting roughly 65 % of U.S. adult population, and are among the leading causes of premature disability and mortality. An underlying inflammatory mechanism is hypothesized in the development and progression of CVD. Poor T2DM control, depression, and stress are inflammatory processes that are associated with an increased risk of CVD events, including hypertension, myocardial infarction, stroke, and kidney disease. The purpose of this thesis was to test a model of the relationships between T2DM control, depression, and stress measures as predictors of CVD risk factors and events in a sample of adults (N=45) with T2DM and depressive symptoms. It was hypothesized that, after controlling for socio-demographic characteristics and clinical characteristics, there would be: (a) a positive association between biological and self-report stress measures with self-reported cardiovascular events and risk factors, and; (b) A1c and smoking status would be positively related to biological and self-report distress measures and to self-reported CVD risk factors/events. Methods: A secondary analysis was done using baseline (pre-intervention) data from a randomized trial of a 12-week patient-centered decision support intervention (n=45) to improve patient decision-making about managing depressive symptoms in context of T2DM. Standardized measures included glycemic control (A1c), depressio