Stress exposure and physical, mental, and behavioral health among american Indian adults with type 2 diabetes

Melissa L. Walls, Kelley J. Sittner, Benjamin D. Aronson, Angie K. Forsberg, Les B. Whitbeck, Mustafa Al’Absi

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish (US)
Article number1074
JournalInternational journal of environmental research and public health
Issue number9
StatePublished - Sep 16 2017

Bibliographical note

Funding Information:
Acknowledgments: We gratefully acknowledge the dedicated Community Research Council and Clinical Project Members of the Gathering for Health team: Sidnee Kellar, Rose Barber, Robert Miller, Tweed Shuman, Lorraine Smith, Sandy Zeznanski, Patty Subera, Tracy Martin, Geraldine Whiteman, Lisa Perry, Trisha Prentice, Alexis Mason, Charity Prentice-Pemberton, Kathy Dudley, Romona Nelson, Eileen Miller, Geraldine Brun, Murphy Thomas, Mary Sikora-Petersen, Tina Handeland, GayeAnn Allen, Frances Whitfield, Phillip Chapman, Sr., Hope Williams, Betty Jo Graveen, Daniel Chapman, Jr., Doris Isham, Stan Day, Jane Villebrun, Beverly Steel, Muriel Deegan, Peggy Connor, Michael Connor, Ray E. Villebrun, Sr., Pam Hughes, Cindy McDougall, Melanie McMichael, Robert Thompson, and Sandra Kier. Research reported in this manuscript is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number DK091250 (M. Walls, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2017 by the authors. Licensee MDPI, Basel, Switzerland.


  • American Indian
  • Diabetes
  • Native American
  • Stress


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