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Psychosocial factors and type 1 diabetes

Fickley, Catherine (2014) Psychosocial factors and type 1 diabetes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Introduction: Psychosocial factors have been associated with outcomes in the general population
and type 2 diabetes, yet rarely in those with type 1 diabetes. We previously demonstrated that
type A behavior is associated with lower mortality risk, while higher depression symptoms are
associated with an increased risk. In addition, stressful life events have been previously
demonstrated to lead to increased depression and poor glycemic control in those with type 1
Methods: We aimed to further understand the type A behavior and mortality relationship through
assessment of potential mediators, moderators, and confounders, and well as by examining the
different Bortner Rating Scale scoring methods using Cox proportional hazards modeling. We
also investigated which psychosocial factors, including trait-anger, interacted with depressive
symptoms to predict mortality, again utilizing Cox proportional hazards modeling. Lastly, we
investigated whether increased life events scores were associated with high depression symptoms
or a change in glycemic control using logistic and linear regression.
Results: We found that type A behavior was no longer significantly predictive of mortality after
the additions of age, inflammatory markers/stress reactants, and waist-to-hip ratio, and that the
item “fast eater, walker, etc.” was the best type A predictor of mortality, but also lost
significance in multivariable modeling. Next, we found that increased depressive symptoms,independent of anxiety and stress, were associated with increased mortality risk only in those with low anger scores. Lastly, we found that increased life events scores were predictive of high
depressive symptomatology, but not with change in glycemic control.
Discussion: Along with the well established, physiological and diabetes care risk factors, psychosocial factors also play an important role in outcome development. These factors in type 1 diabetes were very understudied, thus this work has a large public health impact. In line with
earlier theories of health locus of control, psychosocial factors may impact on mortality risk through a variety of pathways following a diabetes diagnosis. Future research should focus on further exploring these psychosocial factors as individual predictors of mortality, and examining
them in a clinical trial setting to potentially improve outcomes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Fickley, Catherinecef22@pitt.eduCEF22
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairOrchard, Trevortjo@pitt.eduTJO
Committee MemberLloyd,
Committee MemberCostacou,
Committee MemberSonger, Thomastjs@pitt.eduTJS
Committee MemberArena, Vincent C.arena@pitt.eduARENA
Date: 29 September 2014
Date Type: Publication
Defense Date: 16 July 2014
Approval Date: 29 September 2014
Submission Date: 22 July 2014
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 214
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: type 1 diabetes; psychosocial factors; type A behavior; depressive symptomatology; trait-anger; life events; mortality
Date Deposited: 29 Sep 2014 20:53
Last Modified: 15 Nov 2016 14:22


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