Stress Exposure and Physical, Mental, and Behavioral Health among American Indian Adults with Type 2 Diabetes

Authors

Melissa L. Walls, University of Minnesota Medical SchoolFollow
Kelley J. Sittner Hartshorn, University of Nebraska-LincolnFollow
Benjamin D. Aronson, Ohio Northern UniversityFollow
Angie K. Forsberg, University of Minnesota Medical SchoolFollow
Les B. Whitbeck, University of Nebraska - LincolnFollow
Mustafa al'Absi, University of Minnesota Medical SchoolFollow

ORCID IDs

0000-0001-9739-6221

Date of this Version

2017

Citation

Int. J. Environ. Res. Public Health 2017, 14, 1074

Comments

© 2017 by the authors.

Open access

doi:10.3390/ijerph14091074

Abstract

American Indian (AI) communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical records at tribal clinics. Data are from computer-assisted interviews and medical charts. We found consistent bivariate relationships between chronic to discrete stressors and mental and behavioral health outcomes; several remained even after accounting for participant age, gender, and income. Fewer stressors were linked to physical health. We also document a dose–response relationship between stress accumulation and worse health. Findings underscore the importance of considering a broad range of stressors for comprehensive assessment of stress burden and diabetes. Policies and practices aimed at reducing stress exposure and promoting tools for stress management may be mechanisms for optimal health for AI diabetes patients.