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Social Bonding
Social bonding refers to the neurobiology of socialattachment and relies on the neural systemsinvolved in reproduction, social engagementbehaviours, and homeostasis. Centrally activeneuropeptides, such oxytocin and vasopressin, playa role in bond formation (Carter & Porges, 2010).
Researchers agree that social bonding has long-termconsequences for psychological, behavioural andphysiological well-being (Karelina & DeVries, 2010).
The processes through which social interactioninfluences disease pathogenesis and progression stillremain largely unidentified in human research.
Animal research indicates three endogenousmechanisms (Karelina & DeVries, 2010):
Theoretical Background
Stress-Buffering Hypothesis(Cohen & Wills, 1985)
Down-regulation of the hypothalamic-adrenal-pituitary (HPA) axis by social bonding is a convincingmechanism for the benefits of social support(Hostinar, Sullivan, & Gunnar, 2014).
Evidence suggests that oxytocin (OT) attenuatesstress, fear and anxiety via two pathways:
Oxytocin and Type 1 Diabetes
Cortisol increases the transport of energy to musclesvia heightened gluconeogenesis and decreasedglycogenolysis (Khani & Tayek, 2001). Both increasecirculating blood glucose, which will contributetowards hyperglycaemia. AWT1D with chronicallyincreased stress are therefore at greater risk of poormetabolic control and, in the long-run, diabeticcomplications (Giacco & Brownlee, 2010).
If OT is able to down-regulate this response via itsaction on the HPA axis, it may aid metabolic controland provide a biological explanation for the impactof social support in AWT1D:
Oxytocin
Glucocorticoids
Inflammatory signals
Aim
To investigate a potential biological mechanism through which social support is related to diabetes
outcomes
Objective
Assess if the stress-buffering hypothesis
is applicable to AWT1D via the
measurement of oxytocin and cortisol
Hypothesis 1
Greater salivary OT will be associated
with reduced salivary cortisol and improved
glycaemic control (HbA1c)
Hypothesis 2
Gender differences will exist in the
relationship between social support and diabetes outcomes (self-care & HbA1c)
Participants
• n=60
• 29 males, 31 females
• M age = 16.59 (SD=.96)
• 54 MDI, 5 CSII pump
• M HbA1c = 11.3mmol/L
Design
• Cross-sectional
• Two general hospitals in East Midlands
• Paediatric Outpatients
Materials
• Self-Care Inventory –Revised (Weinger et al., 2005)
Bio
Markers
• Salivary OT
• Salivary Cortisol
• Collected via Salivette ®
• HbA1c
Procedure
• During routine clinic visit
• Participants provided 2 saliva samples
• Completed questionnaires
Aims & Objectives
Social Support and Type 1
Diabetes
Diabetes management does not occur in isolation; alarge part of it takes place in a social world (Wysocki &Greco, 2006). Social support can have a significantimpact on diabetes outcomes in adolescents with type 1diabetes (AWT1D) (Helgeson, Siminerio, Escobar, &Becker, 2009).
Qualitative evidence suggests that AWT1D believe peersimpact their disease management (Palladino &Helgeson, 2012). However, the mechanism throughwhich this occurs is uncertain (Lehmkuhl, 2009).
This is likely to be individualised, with demographiccharacteristics playing a role, including gender.Helgeson, Lopez and Kamarck (2009) suggest conflict ismore influential in diabetes outcomes than supportamong female adolescents. Males report lower levels ofpeer support overall (Helgeson et al., 2007), potentiallydue to illness non-disclosure (Greco et al., 2003).
Results
Hypothesis 1• OT related to cortisol (r(54)=-.35, p=.011, 95% CI [-.52, -
.14]) but not HbA1c (r(54)=.13, p=.368, 95% CI [-.09, .32])
Hypothesis 2• OT was not associated with self-care (Females:
r(24)=.18, p=.372, 95% CI[-.22, .53], Males: r(25)=.00,
p=.998, 95% CI [.96, .99]) or HbA1c (Females: r(24)=.23,p=.270, 95% CI[-.18, .56], Males: r(25)=.07, p=.740, 95% CI [-
.31, .42]) for either gender.
• A positive relationship was indicated betweencortisol and self-care in males (r(25)=.44, p=.021, 95%
CI [.18, .68]) but not females (r(24)=.01, p=.981, 95% CI [-.39, .38]).
• This relationship was maintained during regressionanalysis (β=-.437, t(28)=-2.53, p=.018 95% CI [-.008, .004]).
• Cortisol explains a significant proportion of thevariance in self-care in males (r2=.19, F(1,27)=6.38,p=.018).
• OT was not related to HbA1c for either gender(Females: r(24)=-.05, p=.799 95% CI[-.43, .34], Males:
r(25)=.-05, p=.802, 95% CI [-.41, .32]).
Discussion
• OT is not related to diabetes outcomes. Therefore,the mechanism through which social support isassociated with glycaemic control is not via the HPAaxis.
• Paradoxically, a positive impact of cortisol on self-carebehaviours was found. It is suggested that a sufficientamount of stress is required to increase self-carebehaviours.
• It is proposed that optimal stress provides motivationto appropriately self-manage in males.
• Further research is required to assess if this stress isdisease-specific, or if daily hassles and other genericsources are also associated with this improved self-management.
References• Carter, C. S., & Porges, S. W. (2010). Social bonding and attachment. In G. F. Koob, M. Le Moal, & R. F. Thompson (Eds.), Encyclopedia of Behavioral Neuroscience (pp. 257–262). Oxford:
Academic Press.• Cohen, S., & Wills, T. A. (1985). Stress, social support and the buffering hypothesis. Psychological Bulletin, 98(2), 310.• Giacco, F., & Brownlee, M. (2010). Oxidative stress and diabetic complications. Circulation Research, 107(9), 1058–1070.• Greco, P., Harris, M., Milkes, A., Sadler, M., Mertlich, D., & Jones, J. (2003). Revealing the diagnosis of diabetes to friends: The beginnings of social support. Diabetes, 52, A414.• Helgeson, V. S., Lopez, L. C., & Kamarck, T. (2009). Peer Relationships and Diabetes : Retrospective and Ecological Momentary Assessment Approaches. Health Psychology, 28(3), 273–282. • Helgeson, V. S., Siminerio, L., Escobar, O., & Becker, D. (2009). Predictors of metabolic control among adolescents with diabetes: A 4-year longitudinal study. Journal of Pediatric
Psychology, 34(3), 254–270.• Hostinar, C. E., Sullivan, R. M., & Gunnar, M. R. (2014). Psychobiological mechanisms underlying the social buffering of the hypothalamic-pituitary-adrenocortical axis: a review of animal
models and human studies across development. Psychological Bulletin, 140(1), 256–82. doi:10.1037/a0032671• Karelina, K., & DeVries, A. C. (2011). Modeling social influences on human health. Psychosomatic Medicine, 73(1), 67–74. doi:10.1097/PSY.0b013e3182002116• Khani, S., & Tayek, J. a. (2001). Cortisol increases gluconeogenesis in humans: its role in the metabolic syndrome. Clinical Science (London, England : 1979), 101(6), 739–47.• Lehmkuhl, H. D., Merlo, L. J., Devine, K., Gaines, J., Storch, E. a, Silverstein, J. H., & Geffken, G. R. (2009). Perceptions of type 1 diabetes among affected youth and their peers. Journal of
Clinical Psychology in Medical Settings, 16(3), 209–15. doi:10.1007/s10880-009-9164-9• Palladino, D. K., & Helgeson, V. S. (2012). Friends or foes? A review of peer influence on self-care and glycemic control in adolescents with type 1 diabetes. Journal of Pediatric Psychology,
37(5), 591–603.• Weinger, K., Butler, H. a., Welch, G. W., & La Greca, A. M. (2005). Measuring diabetes self-care: A psychometric analysis of the Self-Care Inventory-revised with adults. Diabetes Care,
28(6), 1346–1352. doi:10.2337/diacare.28.6.1346• Wysocki, T., & Greco, P. (2006). Social support and diabetes management in childhood and adolescence: Influence of parents and friends. Current Diabetes Reports, 6(2), 117–22.
Method
Modulation of the HPA
axis (Neumann,
2002)
Facilitation of pro-social behaviours
(Carter, 2007)
Reduced stress