Bidirectional Pathways

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By: Sydney Bernstein-Miller

Depression often affects people in their 20s and 30s, while diabetes often occurs when people are in their 50s and 60s. These two age groups and their experiences may appear pretty dissimilar on paper, but research has revealed that people with a history of depression are twice as likely to develop diabetes later in life.

That’s where Briana Mezuk, Ph.D. comes in.

An associate professor for the VCU Department of Family Medicine and Population Health with a background in psychiatric epidemiology, Mezuk studies the potential underlying mechanisms that explain why someone with depression is more likely to develop diabetes.

"We've assumed for a while that diabetes can cause depression – that's not very surprising," said Mezuk who has been with VCU since 2009. "What is surprising is the idea that diabetes and depression may be bidirectional and that depression, through both behavioral pathways, such as sleep disturbances and not exercising, and biological pathways, like inflammation, can lead to diabetes."

Mezuk was recently awarded an American Diabetes Association (ADA) grant for a study titled, "Stress, self-regulatory behaviors, and diabetes disparities," in which she will examine how stress, 'race' and 'place' intersect to produce diabetes disparities.

The ADA grant was informed from a 2012 pilot study titled, "Stress reactivity and glycemia among African Americans at high risk for type 2 diabetes," which was funded by the C. Kenneth and Dianne Wright Center for Clinical and Translational Research (CCTR) at VCU (grant number: UL1TR000058).

In what Mezuk describes as "instrumental impact" for her research, the CCTR grant allowed her to explore whether the complex protocol was possible and also discover how she would measure stress and collect data.

"This was an important time in our research because the CCTR pilot grant gave us the opportunity to think more deeply about how our findings would relate to social disparities and health," Mezuk said. "It would have been impossible to properly study the problem at hand without considering the roles socioeconomic status, physical environment and race play."

Today Mezuk is using the groundwork developed in her pilot study to propel her ADA grant research. Her main hypothesis is that blunted stress reactivity is associated with faster progression of metabolic risk among adults with pre-diabetes.

In the hopes of uncovering ways of preventing diabetes through substantial lifestyle modifications, Mezuk is studying the coping behaviors and self-regulation techniques people engage in in response to stress. In particular, Mezuk analyzes self-regulatory behaviors that are harmful to diabetes (e.g. smoking, eating high fats, limiting exercise) versus healthy habits (e.g. mediating, yoga, running).

"I'm grateful for the interdisciplinary collaboration that makes this kind of research possible," Mezuk said. "Psychologists, economists, endocrinologists... It's important that all of these teams work together in research, particularly when the science involves identifying and addressing health disparities."

To learn more about Mezuk’s study, visit the Group for Research on the Epidemiology of Mobility, Aging, and Psychiatry (GREMAP) at www.gremap.org.