Patient and health care provider views of depressive symptoms and diabetes in American Samoa

High Type 2 diabetes prevalence, associated with recent cultural changes in diet and physical activity, characterizes the U.S. territory of American Samoa. Comorbid diabetes and depression rates are high worldwide and contribute to negative diabetes outcomes; these rates have not been assessed in American Samoa. In this study, 6 focus groups were conducted with 39 American Samoan adults with diabetes; questions on perceptions of diabetes and depressive symptoms were included. Thirteen health care staff interviews were conducted to gain insight into diabetes care in American Samoa. Focus groups and health care staff interviews were translated, transcribed, and entered into NVivo 8 to facilitate analysis. Thematic analysis showed that diabetes patients saw depressive symptoms as directly contributing to high blood sugar. However, these symptoms were rarely mentioned spontaneously, and providers reported they seldom assess them in patients. Many patients and health care staff believed the best ways to respond to feelings of depression involved relaxing, leaving difficult situations, or eating. Staff also discussed cultural stigma associated with depression and the importance of establishing rapport before discussing it. Health care providers in American Samoa need training to increase their awareness of depressive symptoms' negative impact on diabetes management in patients who screen positive for depression. All providers must approach the subject in a supportive context after establishing rapport. This information will be used for cultural translation of a community health worker and primary care-coordinated intervention for adults with diabetes in American Samoa, with the goal of creating an effective and sustainable intervention.     

Integrating stage and continuum models to explain processing of exercise messages and exercise initiation among sedentary college students.

Concepts from the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992), theory of planned behavior (I. Ajzen, 1985), and the elaboration likelihood model (R.E. Petty & J.T. Cacioppo, 1986b) were used to examine how exercise readiness impacted processing of exercise messages and exercise initiation. Sedentary college students (n = 147) were assessed for exercise attitude, intent, behavior, and stage of change. Students also listed their thoughts after reading messages with either strong or weak arguments for exercise. Attitude predicted depth of message processing, but stage of change did not. Stage of change and intent at baseline predicted exercise adoption at 1- to 3-month follow-up (n = 134), with baseline activity moderating the effect of intent. Tailoring messages to recipients' depth of processing and interactive effects of intent and behavior on exercise adoption should be considered in future research.     

Marital Adjustment of Army Spouses One Year After Operation Desert Storm1

One year after Operation Desert Storm, marital adjustment was studied among 773 Army spouses married to soldiers who had been deployed. Interviews with some spouses and soldiers, conducted during site visits to a sample of installations, led to the identification of 19 marital adjustment events. Questions regarding these events were included in a mailed questionnaire that was sent to a sample of Army spouses. A factor analysis of the 19 events produced five factors: (a) Distance, (b) Closeness, (c) Role sharing, (d) Independent Spouse, (e) Dependent Spouse/Withdrawn Soldier. Predictors of factor scores were examined through multiple regression analysis. Predictors of factor scores included stress, prior marital problems, social support, and emotional well-being. Most spouses adjusted well to the deployment. Adjustment patterns are discussed in light of previous literature on war separation and attachment theory.     

Comparison of brain activation during word retrieval done silently and aloud using fMRI

Using functional MRI we compared the patterns of activation in an effortful word retrieval task (stem completion) performed both silently and aloud. The silent and overt conditions showed expected differences in activation magnitude in regions such as primary motor cortex. Some regions, such as frontal operculum and dorsolateral frontal cortex, showed similar activation magnitude across conditions. Thalamus was more active on the left in both conditions and showed a symmetric drop in activity in the silent compared with the overt condition. Putamen was also more active in the overt condition and showed a larger decrease in activity on the right than on the left in the silent compared with the overt condition. Thus it appears that silent and overt performance of this task engage the thalamus and putamen in different ways.