This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Our group has been investigating associations between history of depression and mental stress on the one hand, and endothelial function on the other hand, in postmenopausal women. To date we have found that relative to their never depressed counterparts, women with a history of depression show impaired resting endothelial function. The association between history of depression and resting endothelial dysfunction is especially strong in women with type 2 diabetes. Preliminary data from our group also suggest that women with a history of depression may show more endothelial dysfunction in response to an acute stressor than their never depressed counterparts. Our group is now interested in testing interventions to improve resting endothelial function, and endothelial stress reactivity, in women at risk for endothelial dysfunction. Expressive writing interventions have shown benefits for a variety of health and mental health outcomes in healthy, medical, and psychiatric samples. This pilot and feasibility study will explore the effects of an expressive writing intervention on endothelial function in women with diabetes. Twenty women will participate, who will be recruited as part of GCRC study #453. History of depression and current depressive symptoms will be assessed at baseline. Resting endothelial function and endothelial stress reactivity will be assessed at baseline using brachial artery flow-mediated dilation (FMD). Participants will then be randomized to either an expressive writing condition, or a control writing condition. Women in the expressive writing condition will write about the facts and emotions related to a personal trauma or upsetting event. Women in the control writing condition will write about assigned topics devoid of emotional content (e.g., fashion, daily tasks, shopping lists). All participants will complete twice-weekly writing sessions for 4 weeks. Participants writing exercises will be mailed to the investigator so that the postmark can verify compliance with the writing schedule. One month after the last writing exercise, participants will return for follow-up resting FMD and FMD stress reactivity assessments. We hypothesize that relative to the women in the control writing condition, women in the expressive writing condition will show improvement in resting FMD and FMD stress reactivity. We further hypothesize that depression history will modify the effect of the intervention such that women with a history of depression will benefit more from the intervention than their never depressed counterparts. We recognize that we will be underpowered to detect significance; the goal of this pilot is to detect trends in the hypothesized directions.
The specific aims are to: 1) estimate an effect size to be used in a power analysis for a subsequent external grant proposal; 2) address the acceptability of the protocol for this population; 3) gather participant feedback to be used to modify the intervention for future proposals.
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