Group stress management delivered by community health workers: Effects on emotional functioning among Latinos with type 2 diabetes

INTRODUCTION: Emotional distress is high among low-income Latinos with type 2 diabetes (T2D) and is associated with poor diabetes outcomes. APPROACH: CALMS-D is an ongoing randomized, controlled community trial comparing diabetes education (DE) vs. DE plus 8-sessions of group stress management (DE+SM) delivered by a community health worker to Latinos with T2D. Participants had T2D>1 year without major complications, HbA1c>7, were Latino, lived in the Hartford, CT area, and had no psychotic, substance abuse, or cognitive disorders. Self-reported measures of emotional functioning, previously validated in Spanish and English, were measured in each participant’s preferred language at baseline and again post-treatment. Depressive symptoms were measured with the 8-item Personal Health Questionnaire (PHQ8), anxiety symptoms with the 8-item NIH PROMIS anxiety scale, diabetes distress with the 5-item Problem Areas in Diabetes (PAID) scale, and mental wellbeing with the 5-item World Health Organization Wellbeing Index (WHO-5). RESULTS: To date, 70 participants have completed post-treatment assessments (38 in intervention; 32 in control group). In repeated measures ANOVAs, tests of time x treatment condition interactions showed that compared to DE only, DE+SM led to significantly decreased depressive symptoms, p=.02, and marginally decreased anxiety symptoms, p=.06. Diabetes distress, p=.06, and wellbeing, p=.06, both marginally improved over time but did not differ by group. Follow-up ANCOVAs controlling for age, gender, and baseline HbA1c showed similar results.  CONCLUSIONS: Preliminary findings suggest that community health workers can effectively deliver DE and SM to improve emotional functioning among Latinos with T2D, and that SM may have particular benefits for symptoms of depression and anxiety.