Positive and negative online social experiences and self-rated health: Associations and examination of potential pathways

OBJECTIVE

Technology is changing the way individuals socially connect. However, not much is known about how online forms of social exchanges might link to outcomes that predict longevity. This preregistered study examined the association between online social support and social negativity with self-rated health (SRH) and potential pathways responsible for such links.

METHOD

In this preregistered analysis, a sample of 1,356 U.S. residents was recruited based on the U.S. Census track. Participants were at least 18-year-old social media users and completed the study online. Well-validated measures of online social support, online social negativity, general offline perceived support, internet addiction, social anxiety, and SRH were obtained.

RESULTS

Main results indicate that both online social support and social negativity were related to better SRH. However, the association between social negativity and better SRH was due to its statistical overlap with online social support. The association between online social support and SRH was primarily mediated by offline social support.

CONCLUSIONS

These results highlight the importance of considering how positive and negative online social interactions are related to health outcomes. It also highlights potential pathways that might be targeted for interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cardiovascular risk, social vigilance, and stress profiles of male law enforcement officers versus civilians

This study examined the cardiovascular disease (CVD) risk profiles of male law enforcement officers (LEOs) and civilians. CVD risk profiles were based on data collected using traditional objective (e.g., resting BP, cholesterol), novel objective (e.g., ambulatory BP) and self-report measures (e.g., EMA social vigilance). A subset of male LEOs (n = 30, M age = 41.47, SD = 8.03) and male civilians (n = 120, M age = 40.73, SD = 13.52) from a larger study were included in analyses. Results indicated LEOs had significantly higher body mass index [BMI], 31.17 kg/m2 versus 28.87 kg/m2, and exhibited significantly higher trait and state social vigilance across multiple measures, whereas perceived stress was higher among civilians. Findings highlight the need for future research examining CVD risk associated with occupational health disparities, including attributes of individuals entering certain professions as well as experiential and environmental demands of the work.

Heart rate variability during social interaction: Effects of valence and emotion regulation

Conceptual models of psychosocial influences on short-term changes (i.e., reactivity) in vagally-mediated heart rate variability (vmHRV) emphasize self-regulatory effort and social threat versus comfort. However, these two general perspectives have been tested separately in nearly all cases, limiting conclusions about the relative importance or possible interactive effects of effortful self-regulation and social stress. The present study compared effects of effort to regulate emotional expression and social stress versus safety on vmHRV reactivity during an interpersonal interaction, in a 2 (self-regulate emotion vs. express emotion freely) × 3 (positive vs. neutral vs. negative interaction valence) × 2 (male vs. female) between-subjects randomized factorial design. A sample of 180 undergraduates (90 women; 69 % White) discussed a current events topic (i.e., human-caused climate change) with a prerecorded partner, presented as a live interaction over a computer. Self-reports of affective responses, self-regulation effort, and appraisals of the partner's behavior, as well as observer ratings of participants' behavior during the interaction, supported the effectiveness of self-regulation and interaction valence manipulations, although the former manipulation may have been somewhat weaker than the latter. Primary analyses of high-frequency heart rate variability (HF-HRV) and root mean square of successive differences (RMSSD) in heart beat intervals recorded at baseline and during the interaction revealed larger decreases in vmHRV during negative than neutral or positive interactions, but no effects of self-regulation instructions. Overall, results indicated more robust effects of social stress on vmHRV reactivity, relative to effects of self-regulatory effort.

Mean affect and affect variability may interact to predict inflammation

INTRODUCTION

Individuals with greater affect variability (i.e., moment-to-moment fluctuations possibly reflecting emotional dysregulation) are at risk for greater systemic inflammation, which is associated with cardiovascular disease. Some evidence suggests that affect variability is linked with poorer health indicators only among those with higher average levels of affect, particularly for positive affect (PA), and that associations may be non-linear. The present study sought to examine whether links between both PA and negative affect (NA) variability and inflammation are moderated by average level of affect.

METHODS

Participants (N = 300, 50 % female, ages 21-70, 60 % non-Hispanic White, 19 % Hispanic, 15 % non-Hispanic Black) completed a lab assessment and provided a blood sample to measure systemic inflammation (i.e., TNF-α, IL-6, CRP). Affect was collected via a two-day ecological momentary assessment protocol where reports were collected about every 45-min during waking hours. Momentary affect ratings were averaged across both days (i.e., iM), separately for PA and NA, for each participant. Affect variability was calculated as the person-specific SD (i.e., iSD) of affect reports, separately for PA and NA. Linear and quadratic interactions were tested. Models included covariates for sex, race, and body mass index.

RESULTS

There were significant interactions between NA iM and NA iSD predicting TNF-α (b = 6.54; p < 0.05) and between PA iM and PA iSD predicting IL-6 (b = 0.45; p < 0.05). Specifically, the association between these affect variability indicators and inflammatory markers were suggestive of a positive association among those with higher average affect but a negative association among those with lower average affect. There was no evidence of non-linear associations between affect and inflammation.

DISCUSSION

Incorporating interactive effects between affect variability and average affect may be an important consideration in understanding affective-inflammatory associations.

Nonsuicidal self-injury, sleep quality, and shame response to a laboratory stress task

OBJECTIVE

Nonsuicidal self-injury (NSSI) frequently functions to regulate shame-based emotions and cognitions in the context of interpersonal stress. The present study sought to examine how sleep quality (SQ) may influence this process in a laboratory setting.

METHODS

Participants included 72 adults (Mage  = 24.28; 36 with a lifetime history of NSSI) who completed a self-report measure of prior month SQ and engaged in a modified Trier social stress task (TSST). State shame ratings were collected immediately before and following the TSST, as well as 5 min post-TSST, to allow for the measurement of shame reactivity and recovery.

RESULTS

No significant results emerged for NSSI history and SQ as statistical predictors of shame reactivity. However, NSSI history was significantly associated with heightened shame intensity during the recovery period of the task, and this was moderated by SQ. Simple slopes analyses revealed a conditional effect whereby poorer SQ (1SD above the mean) was associated with greater intensity of shame during recovery, but only for those with a history of NSSI.

CONCLUSION

Poor SQ may contribute to worrisome emotional responses to daytime stressors in those at risk for NSSI.

Couple-based lifestyle intervention to prevent type 2 diabetes: protocol for a randomised pilot trial

INTRODUCTION

Type 2 diabetes is prevalent among US adults. Lifestyle interventions that modify health behaviours prevent or delay progression to diabetes among individuals at high risk. Despite the well-documented influence of individuals' social context on their health, evidence-based type 2 diabetes prevention interventions do not systematically incorporate participants' romantic partners. Involving partners of individuals at high risk for type 2 diabetes in primary prevention may improve engagement and outcomes of programmes. The randomised pilot trial protocol described in this manuscript will evaluate a couple-based lifestyle intervention to prevent type 2 diabetes. The objective of the trial is to describe the feasibility of the couple-based intervention and the study protocol to guide planning of a definitive randomised clinical trial (RCT).

METHODS AND ANALYSIS

We used community-based participatory research principles to adapt an individual diabetes prevention curriculum for delivery to couples. This parallel two-arm pilot study will include 12 romantic couples in which at least one partner (ie, 'target individual') is at risk for type 2 diabetes. Couples will be randomised to either the 2021 version of the CDC's PreventT2 curriculum designed for delivery to individuals (six couples), or PreventT2 Together, the adapted couple-based curriculum (six couples). Participants and interventionists will be unblinded, but research nurses collecting data will be blinded to treatment allocation. Feasibility of the couple-based intervention and the study protocol will be assessed using both quantitative and qualitative measures.

ETHICS AND DISSEMINATION

This study has been approved by the University of Utah IRB (#143079). Findings will be shared with researchers through publications and presentations. We will collaborate with community partners to determine the optimal strategy for communicating findings to community members. Results will inform a subsequent definitive RCT.

TRIAL REGISTRATION NUMBER

NCT05695170.

Good, bad, and beyond: Perils of partialing positive and negative couple variables within individuals

Partialing correlated predictors to test independent effects is an essential tool in couple research. In actor-partner models, partners' parallel scores are partialed in tests of unique associations with outcomes. Correlated aspects of couple functioning are also often partialed within individuals to examine separate effects. Partialed versions of measures are typically interpreted as assessing the same construct as original unadjusted variables, but in fact their meaning can change. Extending a prior report on changes in construct validity resulting from partialing partners' parallel scores, the present analyses examined effects of partialing measures of positive and negative relationship variables within individuals, specifically perceived support from the partner and relationship conflict. In 300 middle-aged and older couples, we utilized participants' interpersonal circumplex ratings of their partner's typical behavior during marital interactions to compare interpersonal correlates of unadjusted and within-person partialed forms of the Quality of Relationships Inventory Support and Conflict scales. Compared to unadjusted scores, partialed support scores (i.e., adjusted for conflict) were substantially less closely associated with ratings of partner's warmth, and were associated with a less submissive (i.e., less agreeable, cooperative) form of warmth. Compared to unadjusted scores, partialed conflict scores (i.e., adjusted for support) were substantially less closely correlated with ratings of the partner's hostility, and were associated with a more controlling (i.e., critical, coercive) form of hostility. Results were nearly identical for wives and husbands. Partialing correlated scores within individuals can alter the construct validity of relationship measures, suggesting the need for careful reporting and interpretation in couple research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adaptation to social-evaluative threat: Effects of repeated acceptance and status stressors on cardiovascular reactivity

Social-evaluative threat plays a key role in research on stress, health and related psychophysiological mechanisms such as cardiovascular reactivity (CVR). Social-evaluative threats can activate two broad social motives: striving for status, achievement and influence, and/or striving for acceptance, inclusion, and connection. Prior research emphasizes threats related to status (e.g., task performance) or combined threats to status and acceptance, obscuring their independent effects. Further, because prior research has mostly utilized single stressors, it is not clear if effects of social-evaluative threats involving status and acceptance on CVR persist or adapt quickly over repeated exposures. To address these issues, 139 undergraduates (93 females) were randomly assigned to undergo two repetitions of a stressful role-played interaction with a pre-recorded antagonistic partner under one of four conditions in a factorial design: low evaluative threat, high status threat only, high acceptance threat only, or a combined threat. In a single laboratory session, systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were recorded during baseline and two stressor exposures. Task-induced CVR demonstrated significant adaptation across exposures. Both forms of social evaluative threat produced additional CVR, and these differences between high and low social-evaluative threat were generally maintained across exposures. Hence, threats to social status and acceptance have independent and sustained effects on CVR across multiple stressor exposures, even in the context of overall adaptation of cardiovascular responses.

To put asunder: Are there perils of partialing in actor-partner interdependence models?

In research on couples, statistical adjustment (i.e., partialing) for correlations between partners' parallel scores is common and useful, as in the actor-partner interdependence model. Original and partialed scores are typically interpreted as assessing the same construct, but this may not be a valid assumption. Other approaches to nonindependence-such as common fate modeling-may better represent some couple constructs. This study of 300 couples utilized participants' interpersonal circumplex ratings of partners' typical behavior during marital interactions to evaluate the interpersonal meaning of unadjusted and partialed forms of the Marital Adjustment Test (MAT), a measure of overall relationship quality, and the Quality of Relationships Inventory-Support (QRI-S) and Conflict (QRI-C) scales, which measured perceived support from and conflict with the partner. After partialing partners' scores, MAT and QRI-S scores were substantially less closely associated with ratings of partners' warmth, their primary expected interpersonal correlates. Partner-partialed QRI-C scores were substantially less closely correlated with ratings of partners' hostility and were associated with a somewhat more controlling form of hostility. In contrast, partialing partners' trait optimism scores resulted in minimal changes in interpersonal correlates of this personality characteristic. Couple-level MAT, QRI-S, and QRI-C variables representing overlapping variance across partners while partialing unshared variance in spouses' scores (i.e., common fate scores) had highly similar interpersonal correlates when compared to unadjusted versions. Potential alterations in construct validity resulting from partialing partners' scores warrant interpretive caution, and alternative analytic frameworks (e.g., the common fate model) may better maintain the construct validity of some dyadic measures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Within-person associations of optimistic and pessimistic expectations with momentary stress, affect, and ambulatory blood pressure

BACKGROUND AND OBJECTIVES

Although dispositional optimism and pessimism have been prospectively associated with health outcomes, little is known about how these associations manifest in everyday life. This study examined how short-term optimistic and pessimistic expectations were associated with psychological and physiological stress processes.

METHODS

A diverse sample of adults (N = 300) completed a 2-day/1-night ecological momentary assessment and ambulatory blood pressure (ABP) protocol at ∼45-minute intervals.

RESULTS

Moments that were more optimistic than typical for a person were followed by moments with lower likelihood of reporting a stressor, higher positive affect (PA), lower negative affect (NA), and less subjective stress (SS). Moments that were more pessimistic than typical were not associated with any affective stress outcome at the following moment. Neither optimism nor pessimism were associated with ABP, and did not moderate associations between reporting a stressor and outcomes.

DISCUSSION

These findings suggest that intraindividual fluctuations in optimistic and pessimistic expectations are associated with stressor appraisals.

Retrospective Database Analysis: Dose Escalation and Adherence in Patients Initiating Biologics for Ulcerative Colitis

BACKGROUND

Biologic therapies are often used in patients with ulcerative colitis (UC) who are nonresponsive to conventional treatments. However, nonresponse or loss of response to biologics often occurs, leading to dose escalation, combination therapy, and/or treatment switching. We investigated real-world treatment patterns of biologic therapies among patients with UC in the USA.

METHODS

This study analyzed data from the IBM® MarketScan® Commercial and Medicare Supplemental Databases (medical/pharmacy claims for >250 million patients in the USA) to identify patients with UC initiating a biologic therapy (adalimumab, infliximab, golimumab, or vedolizumab) with 12 months of follow-up post-initiation. Key measures were patient baseline characteristics, dose escalation (average maintenance dose >20% higher than label), adherence (proportion of days covered), and ulcerative colitis-related healthcare costs in the 12 months following biologic therapy initiation.

RESULTS

Of 2,331 patients included in the study (adalimumab [N = 1,291], infliximab [N = 810], golimumab [N = 127], and vedolizumab [N = 103]), 28.1% used concomitant immunosuppressant therapy within 12 months post-initiation. Overall, 23.6% (adalimumab), 34.8% (infliximab), 9.9% (golimumab), and 39.2% (vedolizumab) of patients dose escalated within 12 months. Patients who dose escalated incurred USD 20,106 higher total UC-related healthcare costs over 12 months than those who did not. Adherence (covariate-adjusted proportion of days covered) ranged from 0.63 to 0.73, and 39.3% of patients discontinued within 12 months (median treatment duration = 112 days).

CONCLUSION

Dose escalation was common, and incurred higher costs, in patients with UC initiating biologic therapies. Suboptimal adherence and/or discontinuation within 12 months of initiation occurred frequently, highlighting the challenges in managing these patients.

An iPS-derived in vitro model of human atrial conduction

Atrial fibrillation (AF) is the most common arrhythmia in the United States, affecting approximately 1 in 10 adults, and its prevalence is expected to rise as the population ages. Treatment options for AF are limited; moreover, the development of new treatments is hindered by limited (1) knowledge regarding human atrial electrophysiological endpoints (e.g., conduction velocity [CV]) and (2) accurate experimental models. Here, we measured the CV and refractory period, and subsequently calculated the conduction wavelength, in vivo (four subjects with AF and four controls), and ex vivo (atrial slices from human hearts). Then, we created an in vitro model of human atrial conduction using induced pluripotent stem (iPS) cells. This model consisted of iPS-derived human atrial cardiomyocytes plated onto a micropatterned linear 1D spiral design of Matrigel. The CV (34-41 cm/s) of the in vitro model was nearly five times faster than 2D controls (7-9 cm/s) and similar to in vivo (40-64 cm/s) and ex vivo (28-51 cm/s) measurements. Our iPS-derived in vitro model recapitulates key features of in vivo atrial conduction and may be a useful methodology to enhance our understanding of AF and model patient-specific disease.

Partialing Alters Interpersonal Correlates of Negative Affective Symptoms and Traits: A Circumplex Illustration

INTRODUCTION

Negative affective symptoms (e.g., anxiety, depression, and anger) are correlated and have parallel associations with outcomes, as do related personality traits (i.e., facets of neuroticism), often prompting statistical control (i.e., partialing) to determine independent effects. However, such adjustments among predictor variables can alter their construct validity. In three studies, the interpersonal circumplex (IPC) and a related analytic approach (i.e., Structural Summary Method) were used to evaluate changes in interpersonal correlates of negative affective characteristics resulting from partialing.

METHODS

Samples of undergraduates (Sample 1 n = 3283; Sample 2 = 688) and married couples (n = 300 couples) completed self-report (three samples) and partner rating (sample 3) measures of anxiety, depression and anger, and IPC measures of interpersonal style.

RESULTS

Anxiety, depression, and anger had expected interpersonal correlates across samples. Partialing depression eliminated interpersonal correlates of anxiety. When anxiety was controlled, depression measures were more strongly associated with submissiveness and less closely associated with low warmth. Adjustments involving anger magnified differences in dominance versus submissiveness associated with the negative affects.

DISCUSSION

Removal of overlap among negative affective measures via partialing alters their interpersonal correlates, potentially complicating interpretation of adjusted associations.

Impact of Methotrexate Discontinuation, Interruption, or Persistence in US Patients with Rheumatoid Arthritis Initiating Tofacitinib + Oral Methotrexate Combination

PURPOSE

Using data from real-world practice, this analysis compared outcomes in patients with rheumatoid arthritis (RA) initiating treatment with an oral Janus kinase inhibitor, tofacitinib, in combination with persistent, discontinued, or interrupted treatment with oral methotrexate (MTX).

METHODS

This retrospective claims analysis (MarketScan® databases) included data from US patients with RA and at least one prescription claim for tofacitinib, dated between January 1, 2013, and April 30, 2017. Eligible patients were continuously enrolled for ≥12 months before and after treatment initiation, and initiated tofacitinib in combination with oral MTX, with at least two prescription claims for each. Patients were grouped according to treatment pattern (MTX-Persistent, MTX-Discontinued, or MTX-Interrupted). Tofacitinib treatment persistence, adherence, and effectiveness, as well as all-cause and RA-related health care costs, were assessed.

FINDINGS

A total of 671 patients were eligible for inclusion; 504 (75.1%) were MTX-Persistent; 131 (19.5%), MTX-Discontinued; and 36 (5.4%), MTX-Interrupted. Rates of tofacitinib treatment persistence, adherence, and effectiveness at 12 months were similar between the MTX-Persistent and MTX-Discontinued cohorts. The percentage of patients switched from tofacitinib to another advanced disease-modifying antirheumatic drug within 12 months of tofacitinib initiation was greater in the MTX-Persistent cohort compared with that in the MTX-Discontinued cohort. RA-related health care costs at 12 months post-initiation were significantly greater in the MTX-Persistent cohort compared with those in the MTX-Discontinued cohort.

IMPLICATIONS

The findings from this analysis of real-world data indicate that patients who initiate tofacitinib in combination with oral MTX may discontinue MTX and still experience outcomes similar to those in patients who persist with MTX, with lesser RA-related health care costs. These results support those from a previous clinical study on methotrexate withdrawal in patients with RA (NCT02831855).

Clinical outcomes with alpelisib (ALP) plus fulvestrant (FUL) after prior treatment (tx) with FUL in patients (pts) with advanced breast cancer (ABC): A real-world (RW) analysis

1055

Background: ALP (α-selective PI3K inhibitor and degrader) + FUL was FDA approved and reflected in the NCCN guidelines in 2019 for pts with hormone receptor–positive/human epidermal growth factor receptor 2–negative (HR+/HER2−) ABC with PIK3CA mutations following progression on or after endocrine-based therapy (ET). The Phase III SOLAR-1 trial excluded prior FUL, and data on ALP + FUL after FUL are limited. As cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) + ET (including FUL) is the standard in the first line (1L) or second line (2L) for pts with HR+/HER2− ABC, more data on ALP + FUL post-FUL are needed. Here we report patterns and clinical outcomes on RW use of ALP + FUL in pts with HR+/HER2– ABC with prior FUL exposure. Methods: This retrospective study used de-identified electronic health record data from the ConcertAI Patient360 Breast Cancer data product sourced from US oncology centers. Adults with HR+/HER2− ABC treated with ALP + FUL (index tx) who received prior FUL (monotherapy or in combination) in the metastatic setting were included; pts with a PIK3CA negative test on or prior to the index were excluded. Pts were followed until date of death or last activity. RW progression-free survival (rwPFS), defined as first documented progression/death from ALP + FUL start date, was assessed. Results: This analysis included 157 pts (median age, 63 y [57-71 y]) who received ALP + FUL from 2019 to 2021, with 11.5% pts in 1L, 17.8% in 2L, 26.8% in third line (3L), and 43.9% in fourth line and beyond (4L+). Prior FUL tx included CDK4/6i + FUL (74.5%), FUL alone (33.8%), and non-CDK4/6i + FUL (21.0%). In pts who received ALP + FUL in 1L (n = 18), prior FUL exposure was in the same line without documented progression. In the metastatic setting, 28.0% of pts received > 1 FUL-containing regimen and/or 72.0% received prior chemotherapy (CT). At the median duration of follow-up (8.7 mo [4.1-12.5 mo]), the median rwPFS was 5.7 mo (4.0-7.3 mo) in the overall population. The median rwPFS was also analyzed by line of therapy (Table). In pts with CDK4/6i + FUL as immediate prior therapy (n = 39), the median rwPFS was 6.2 mo (3.0-9.1 mo); 79.5% of these pts received ALP in ≤ 3L. At the time of analysis, 107 pts (68.2%) had discontinued ALP + FUL; the median time to discontinuation was 4.7 mo (3.7-6.1 mo). Following discontinuation of ALP + FUL, CT was the most common subsequent therapy (33.8%). Conclusions: This analysis on RW data from early years of ALP access in the US shows clinical benefit of ALP + FUL in pts with HR+/HER2− ABC with PIK3CA mutation even when exposed to prior FUL, confirming the oncogenic dependence of the tumor on the PIK3CA mutation. [Table: see text]

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

Purpose of Review

Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD.

Recent Findings

Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence—and are influenced by—stressful aspects of acute coronary crises and longer-term patient adjustment and management.

Summary

Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.

Economic Burden and Healthcare Resource Use of Alopecia Areata in an Insured Population in the USA

INTRODUCTION

Comparative data on the economic burden of alopecia areata relative to the general population are limited. The objective of this retrospective database analysis was to evaluate healthcare resource utilization and direct medical costs among patients with alopecia areata from the US payer perspective compared with matched controls.

METHODS

Validated billing codes were used to identify patients with alopecia areata from the IQVIA PharMetrics Plus (2016-2018) who had continuous pharmacy and medical enrollment for 365 days both before (baseline period) and after (evaluation period) the index date. Demographic and clinical characteristics were characterized, and baseline comorbidities were assessed with the Quan Charlson Comorbidity Index.

RESULTS

Using the exact matching feature from Instant Health Data, 14,340 patients with alopecia areata were matched with 42,998 control patients aged ≥ 12 years. Patients with alopecia areata had higher healthcare resource utilization and adjusted total all-cause mean medical costs versus matched controls ($8557 versus $6416; p < 0.0001), because of higher inpatient costs, emergency department visits, ambulatory visits, number of prescriptions and prescription costs, and other costs such as durable medical equipment and home healthcare. The number of inpatient visits did not significantly differ between the two groups. Mean ambulatory costs were $3640 for patients with alopecia areata and $2062 for controls, and mean pharmacy costs were $3287 and $1843, respectively (p < 0.0001 for both). Pharmacy costs related to immunologic agents represented 50.0% of the total difference in pharmacy spending between patients with alopecia areata and controls. Surgery on the integumentary system accounted for 9.5% of the total difference in ambulatory costs.

CONCLUSION

Alopecia areata is associated with significant incremental healthcare resource utilization and costs relative to matched controls due to increased spending in areas such as surgical procedures and psychological and pharmacological interventions. Costs are primarily driven by ambulatory and pharmacy spending.

Clinical and Humanistic Burden of Atopic Dermatitis in Europe: Analyses of the National Health and Wellness Survey

Introduction

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease that negatively impacts overall health, quality of life (QoL), and work productivity. Prior studies on AD burden by severity have focused on moderate-to-severe disease. Here, we describe the clinical and humanistic burden of AD in Europe across all severity levels, including milder disease.

Methods

Data were analyzed from the 2017 National Health and Wellness Survey from adult respondents with AD in the EU-5 (France, Germany, Italy, Spain, and the UK). AD disease severity was defined based on self-reported assessments as “mild,” “moderate,” or “severe” and by Dermatology Life Quality Index (DLQI) severity bands. Self-reported outcomes for AD respondents by severity were assessed using propensity score matching. These outcomes included a wide range of selected medical/psychological comorbidities, overall QoL and functional status (EuroQol 5-Dimensions 5-Level and Short Form-36 version 2 questionnaires), and work productivity and activity impairment (Work Productivity and Activity Impairment questionnaire).

Results

In total, 4208 respondents with AD (mild AD, 2862; moderate AD, 1177; severe AD, 169) and 4208 respondents without AD were included in this analysis. Results showed greater burden across severity levels compared with matched non-AD controls. A higher proportion of respondents with mild-to-moderate AD, defined by DLQI severity bands, reported atopic comorbidities (P < 0.05) and a wide range of cardiac, vascular, and metabolic comorbidities, including hypertension, high cholesterol, angina, and peripheral vascular disease (P < 0.005), compared with non-AD controls. Relative to potential impacts of various medical and psychological burdens, respondents with mild-to-moderate AD reported higher activity impairment than controls (P < 0.0001).

Conclusion

Clinical and humanistic burden was observed in European respondents with AD compared with matched non-AD controls across severity levels, with burden evident even in milder disease, highlighting the importance of improving disease management in early stages of AD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13555-022-00700-6.

The Role of Resilience in Psychological Health Among Bariatric Surgery Patients

OBJECTIVE

Many individuals who undergo bariatric surgery have experienced repeated unsuccessful diet attempts and negative messages from healthcare providers, family, and others about their weight. Research pre- and post-operatively has taken a pathological or risk-based approach, investigating psychiatric problems and disordered eating. In contrast, the current study explores resilience in this population.

METHODS

Participants were 148 bariatric surgery patients. Participants completed measures pre-operatively and 1.5-3 years post-operatively, including the Binge Eating Scale, Eating Disorder Examination Questionnaire, Patient Health Questionnaire, Generalized Anxiety Questionnaire, Impact of Weight on Quality of Life, Coping Responses Inventory, and Duke Social Support and Stress Scales. The Connor-Davidson Resilience Scale was measured post-operatively.

RESULTS

Correlations demonstrated a significant association between post-operative resilience and lower symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life. Resilience was also associated with greater social support and less social stress, and greater use of approach coping strategies. Resilience was significantly associated with improvements in symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life from pre- to post-operative assessments. In regression models, associations remained significant after controlling for psychosocial variables at baseline (e.g., binge eating symptoms pre-operatively) and demographic covariates.

CONCLUSIONS

Psychological resilience has been under-studied in the literature on obesity and bariatric surgery, with a primary focus on risk factors for poor outcomes. This study was among the first to investigate associations between resilience and post-operative psychological outcomes. Results suggest the field would benefit from consideration of patient resilience in psychological assessments and interventions.

Living with Ulcerative Colitis in Japan: Biologic Persistence and Health-Care Resource Use

Objective

The aim of the study was to improve understanding of adherence and persistence to biologics, and their association with health-care resource utilization (HCRU), in Japanese patients with moderate to severe ulcerative colitis (UC).

Methods

Data were from Medical Data Vision, a secondary care administrative database. A retrospective, longitudinal cohort analysis was conducted of data from UC patients initiating biologic therapy between August 2013 and July 2016. Data collected for 2 years prior (baseline) and 2 years after (follow-up) the index date were evaluated. Patients completing biologic induction were identified, and adherence/persistence to biologic therapy calculated. HCRU, steroid, and immunosuppressant use during baseline and follow-up were assessed. Biologic switching during the follow-up was evaluated. Descriptive statistics (e.g., means and proportions) were obtained and inferential analyses (from Student's t tests, Fisher's exact tests, χ² tests, the Cox proportional hazard model, and negative binomial regression) were performed.

Results

The analysis included 649 patients (adalimumab: 265; infliximab: 384). Biologic induction was completed by 80% of patients. Adherence to adalimumab was higher than that to infliximab (p < 0.001). Persistence at 6, 12, 18, and 24 months was higher with infliximab than with adalimumab (p < 0.05). Overall, gastroenterology outpatient visits increased, and hospitalization frequency and duration decreased, from baseline to follow-up. UC-related hospitalizations were fewer and shorter, and endoscopies fewer, in persistent than in nonpersistent patients, although persistent patients made more outpatient visits than nonpersistent patients. Hospitalization duration was lower in persistent than nonpersistent patients. Approximately 50% of patients received an immunosuppressant during biologic therapy; 5% received a concomitant steroid during biologic therapy. Overall, 17% and 3% of patients, respectively, received 2nd line and 3rd line biologics.

Conclusions

Poor biologic persistence was associated with increased non-medication-associated HCRU. Effective treatments with high persistence levels and limited associated HCRU are needed in UC.

Partner's Perceived Social Support Influences Their Spouse's Inflammation: An Actor-Partner Analysis

Social support has been linked to lower cardiovascular morbidity and mortality. However, most studies have examined perceived support as an intrapersonal construct. A dyadic approach to social support highlights how interdependence between individuals within relationships, including partner perceptions and interactions, can influence one's health. This study's overall purpose was to test actor-partner models linking perceived social support to inflammation. Ninety-four cisgender married couples completed perceived support measures and had their blood drawn for CRP and IL-6 to produce an overall inflammatory index. The primary results indicate that only a partner's level of perceived support was related to lower inflammation in their spouse. Our sample size, although moderate for inflammatory studies, was probably not large enough to detect actor influences. These data highlight the importance of taking a dyadic perspective on modeling perceived support and its potential mechanism.

Moving Toward, Moving Against, and Moving Away: An Interpersonal Approach to Construct Validation of the Horney-Coolidge Type Inventory

Karen Horney's interpersonal theory of adjustment defined three different neurotic trends involving characteristic social behavior and motives: compliant (moving toward people), aggressive (moving against people), and detached (moving away from people). The Horney-Coolidge Type Inventory (HCTI) was developed to assess these trends, but has not been validated using standard methods in the interpersonal perspective. The studies reported here refined the structure of the HCTI, and utilized the structural summary method (SSM) to identify relationships of the three shortened HCTI trend scales with the interpersonal circumplex (IPC) in single university (n = 514) and multisite university (n = 3,283) samples. Results across both studies confirmed predicted interpersonal characteristics of each trend: Compliance was associated with warm submissiveness, aggression was associated with hostile dominance, and detachment was associated with hostile or cold submissiveness. However, analyses of facets within the three HCTI trend domains revealed significant differences. Results are discussed as a potential guide to further refinement of assessments of the Horney maladaptive trends, and support inclusion of Horney's model in current interpersonal theory.