International Journal of Behavioral Medicine最新文献

Introduction: Family caregivers frequently experience sleep challenges that impact their own health and ability to provide care for a care recipient (i.e., the person a caregiver supports). Cognitive-behavioral therapy for insomnia (CBT-I) effectively treats insomnia, but there is limited evidence regarding caregivers' perceived impacts of this intervention. The current study evaluated caregivers' experiences using Sleep Healthy Using The Internet (SHUTi), an Internet-delivered CBT-I intervention.

Method: The sample comprised caregivers with insomnia who supported care recipients requiring medium- or high-intensity care for any condition, including Alzheimer's disease/dementia (21%), cancer (11%), or a mobility problem (11%). Participating caregivers who used SHUTi (n = 82; age M = 53.20, 85% female, 59% lived with the care recipient) provided open-ended feedback about their experience. Responses were analyzed using a rapid content analysis approach.

Results: Responses revealed that caregivers perceived benefits of SHUTi to their functioning and their understanding of sleep. Caregivers described how the intervention improved their overall daytime abilities, mood, and caregiving capacity. They also shared how the intervention helped them prioritize sleep and self-care, gave them insight into their sleep, and increased their knowledge of healthy sleep.

Discussion: Caregivers reported wide-ranging benefits from CBT-I beyond improved sleep. Despite the untailored nature of this intervention, several caregivers described positive impacts on their caregiving capabilities and outlook, resulting from the program helping them to improve their sleep and self-care more broadly. These results suggest that framing caregiver-focused health interventions as important to both caregivers and care recipients may increase caregivers' uptake of such resources.

Background: Weight discrimination is associated with negative psychological and physical health. However, in those with diabetes, a high risk-group for weight discrimination, this association is not well-understood. This study examined the extent to which weight discrimination is longitudinally associated with cardiometabolic risk factors in adults with diabetes.

Methods: Participants were 833 people (aged ≥ 50 years) with diabetes at wave 5 (2010/2011) of the English Longitudinal Study of Ageing (ELSA). Perceived weight discrimination was measured at wave 5. Participants provided outcome data at waves 6 (2012/2013) and 8/9 (2016/17, 2018/2019) including psychological (depressive symptoms), anthropometric (body mass index [BMI]), and cardiometabolic biomarkers (glycated haemoglobin [HbA1c], triglycerides, total cholesterol/high density lipoprotein [HDL] ratio, fibrinogen). Linear regressions controlled for baseline age, sex, wealth, BMI, and baseline measures of the outcome of interest.

Results: Perceived weight discrimination was associated with greater depressive symptoms (B = 1.40, p < 0.001), higher triglycerides (B = 0.50, p = 0.014), poorer total cholesterol/HDL ratio (B = 0.59, p = 0.005), and greater fibrinogen (B = 0.25, p = 0.025) at wave 6. Effects were attenuated in fully adjusted models and at wave 8/9. Findings were not replicated using a general discrimination measure suggesting results are specific to weight discrimination.

Conclusion: Findings suggest that weight discrimination has deleterious effects on a range of cardiometabolic risk factors in those living with diabetes, at least in the short-term. Interventions targeted to help individuals with diabetes cope with weight stigma are warranted to help reduce the risk of future diabetes-related complications.

Background: The relationship between sleep duration and depression represents a critical public health concern. This study examined how weekday and weekend sleep durations are associated with depression prevalence among US adults. The primary research question was: What is the nature of this association across weekdays and weekends?

Method: Data were drawn from the most recent pre-pandemic cycle of the National Health and Nutrition Examination Survey (NHANES; 2017-March 2020), including 4089 adults aged 20 years and older. Correlational and non-linear regression analyses were conducted to explore the associations between sleep duration and depression indicators. Analyses were also stratified by gender to investigate potential gender differences.

Results: Spearman correlation and restricted cubic spline analysis indicated that weekend sleep duration was correlated with depression prevalence, but not with the total depression score or the annoyance of depression. Restricted cubic spline further analysis revealed a U-shaped association of sleep duration with the prevalence, total score, and annoyance of depression. The inflection points for depression prevalence were approximately 7.7 h for weekdays and 8.3 h for weekends. Better sleep durations were identified as 7.5-7.8 h on weekdays and 8.0-8.7 h on weekends, based on the expected odds ratios (ORs) with median sleep durations as the reference. Meanwhile, some gender differences were also observed.

Conclusion: This study supports and extends previous findings, confirming that both insufficient and excessive sleep are associated with higher depression prevalence. Sleep duration in the identified beneficial ranges (using median sleep duration as a reference) may help reduce the risk of depression, with slight variations by gender. Our findings further underscore the complex relationship between sleep and mental health and suggest the need to attend to intra-week variations in sleep behavior. These insights may inform the development of more refined and personalized mental health promotion strategies in the future.

Background: Patients with intermediate risk thyroid cancer face the decision of whether or not to undergo radioactive iodine (RAI) treatment after total thyroidectomy. This process is challenging due to the unclear risks and benefits of RAI treatment for intermediate risk disease. The study identified the decisional needs of patients offered RAI treatment for thyroid cancer to inform the development of a web-based patient decision aid (PtDA).

Method: We used purposive sampling to recruit 23 adult patients with thyroid cancer (M_age = 39.1; 83% female) from three metropolitan hospitals who were offered RAI treatment. Participants completed an online survey before taking part in one of four 2-h focus groups moderated by a clinical psychologist. Semi-structured interviews explored patients' experiences, decisional needs, and recommended elements for a PtDA. Two raters independently coded transcripts and used content analysis to analyze qualitative data.  RESULTS: Content analysis revealed three broad domains: (1) the range of patient involvement in the RAI treatment decision-making process, (2) personal values-based decisional outcomes, and (3) decision aid content recommendations on the basis of patients' knowledge gaps about RAI treatment. Patients' recommendations included the need for information on the RAI dose and common side effects, risk stratification, safety precautions for radioactivity, low-iodine diet guidance, and financial costs.

Conclusion: The study provides patient insights for a targeted web-based PtDA that integrates personal values, risk information, and logistical considerations to support informed decision-making about RAI treatment. Future research to examine the benefits of PtDAs for treatment of intermediate-risk thyroid cancer is needed.

Background: Irrational beliefs, considered central cognitive vulnerabilities, are strongly associated with increased distress levels, impacting a broad range of psychological and physiological responses. While the association between irrational beliefs and mental disorders is well-established, fewer studies have explored their relationship with inflammation, which represents an immune-mediated process associated with a wide range of chronic conditions. Moreover, in rheumatologic diseases, inflammatory processes represent the primary mechanism underlying the development of characteristic symptoms. This study aims to examine the correlations between distinct types of irrational beliefs and specific biomarkers of inflammatory responses associated with rheumatic diseases.

Method: The study included 49 participants diagnosed with various rheumatic diseases. Biomarkers assessed were erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The Attitudes and Beliefs Scale-Second Edition (ABS-II) was used for measuring the levels of irrational beliefs.

Results: ESR showed positive correlations with awfulizing and irrational beliefs related to comfort. No significant correlations were found with CRP.

Conclusion: Highlighting significant associations between ESR and irrational beliefs, this research underscores the relationship between psychological factors and physical health in chronic medical conditions, such as rheumatic diseases. These findings offer a basis for future studies investigating the mechanisms linking irrational beliefs and inflammatory processes, further emphasizing the clinical relevance of addressing irrational beliefs in patient care.

Background: The purpose of the current study was to examine habitual sleep duration trajectories across the first 2 years of college and determine whether the trajectories were related to weight gain risk behaviors and increases in body mass index (BMI) and percent body fat.

Method: A sample of 115 students with a BMI between 18.5 and 29.9 was enrolled prior to beginning their first year of college. Data were collected in the laboratory and remotely at three time points across the first 2 years of college. Participants completed a total of eight in-person sessions and three 8-day, at-home recording periods. There were objective measures of body fat composition (i.e., dual-energy X-ray absorptiometry), BMI, sleep (i.e., Phillips Respironics Actiwatch 2 Device), and physical activity (i.e., Actigraph wGT3x-BT accelerometer). Self-report measures of sleep quality (i.e., Pittsburgh Sleep Quality Index) and food and beverage intake (i.e., Automated Self-Administered 24-h Dietary Assessment Tool) were also collected.

Results: The findings suggest that there were no habitual sleep duration trajectories observed; therefore, none of the outcome variables was examined in relation to trajectories. Follow-up mixed effects models suggest that as subjective poor sleep quality worsened, BMI increased both within participants and across the sample. No other significant relationships were found between sleep duration and quality and the other outcome variables.

Conclusion: The findings highlight subjective sleep quality as a potential key component in relation to obesity-related changes. Sample characteristics may have also played a role in the limited findings between the sleep variables and the other obesity-risk outcome variables.

Background: The Appalachian region in the USA has some of the highest rates of cancer and cancer mortality in the country, due in part to suboptimal screening. Routine screening for cervical and colorectal cancer can decrease cancer morbidity and mortality. The current study sought to assess the feasibility and preliminary impact of an intervention guided by the Common-sense Model of Self-regulation to improve cervical and colorectal cancer attitudes and screening intentions.

Method: Participants were approached in safety net clinics in Appalachian communities. Individuals completed surveys before and after an intervention that was designed to address lay understandings about the risks and causes of cervical and colorectal cancer and screening. Interventions were conducted with up to three family members, but at least one person in the family was not within screening guidelines. Paired t-tests assessed the impact of the intervention.

Results: Participants (n = 121) were predominantly women (76.0%) and White (69.4%) and had incomes of $20,000 or less (69.4%). Overall, screening barriers were moderate and did not change after the intervention. In response to the intervention, perceived risk and cervical cancer causes (risk factors) became more accurate, individuals increased in knowledge of colorectal cancer screening, the perceived deadliness of cervical and colorectal cancers decreased, intentions to screen increased, and the appraisal of the effectiveness of screening increased (all p's < 0.05, Holm adjusted).

Conclusion: The intervention had a positive impact on lay understanding of cervical and colorectal cancer and increased intentions to have cancer screening. A larger, randomized control trial is merited to investigate the impact of the intervention on screening rates.

Background: Adaptations of behavioral interventions can optimize the health impact for minoritized groups, including racial and ethnic minorities. While cultural adaptation frameworks exist, there is no singular approach to identifying the contexts that likely matter during early-phase intervention development, outside of those exclusive to a cultural frame. We developed the "Listen In" approach to address this gap; "Listen In" involves a series of steps, resulting in two levels of analysis, that increase an understanding of the target population and inform intervention adaptation.

Methods: We applied "Listen In" to explore how context interfaced with core intervention targets of Goal-focused Emotion-regulation Therapy (developed for young adult testicular cancer survivors) among Latino participants.

Results: Thirty-six hours of audio-recorded intervention sessions from a pilot trial across nine participants (all Latino, aged 20-33) were analyzed. Latino cultural values were found to be an important context for goal navigation processes directly and indirectly. For example, participants described family as being an important value and identified family as having an impact on goal achievement. Recommendations for intervention adaptation, then, included offering the opportunity to invite family into conversations around goal navigation.

Conclusions: An integration of the cultural context, facilitated by using the "Listen In" approach, enhanced our understanding of how GET can be adapted for young Latino survivors in the present study. "Listen In" may be a valuable approach to highlighting nuanced contexts in which intervention mechanisms are enacted. Future researchers may apply this method to help inform early-phase evidence-based intervention adaptations.

Background: This study investigates whether sedentary behavior patterns-such as inter-day variability and intraday accumulation patterns-are associated with dynamic glycemic outcomes, an association not previously examined in women with overweight and obesity.

Method: Fifteen participants (age: 20.6 ± 1.0 years; BMI: 28.1 ± 2.2 kg/m²) underwent simultaneous accelerometer and continuous glucose monitoring. Associations between sedentary behavior patterns (including breaks in sitting, time spent in ≥ 30-min sedentary bouts, and median sedentary bout duration), and their inter-day variability computed as the coefficient of variation (CV), and overall glycemic outcomes were examined using linear regression. Intraday associations between daytime sedentary behavior patterns and time-matched daytime and subsequent nighttime glycemic outcomes were examined using linear mixed models.

Results: Data from 144 person-days were analyzed. After adjustment for total sitting time and relevant covariates, a higher inter-day variability in time spent in ≥ 30-min sedentary bouts was associated with a higher percentage of time spent within the target glucose range (β = 1.281% 95% CI [0.107, 2.454], P = 0.037). A longer intraday median sedentary bout duration was associated with an increased nighttime CV of glucose (β = 0.13% 95% CI [0.012, 0.248], P = 0.031).

Conclusion: Women with overweight and obesity who alternated between days with more prolonged (≥ 30 min) sitting and days with less, and who had a shorter median sedentary bout duration, showed more favorable glycemic outcomes.