Marital Quality Buffers the Association Between Socioeconomic Status and Ambulatory Blood Pressure

BACKGROUND

Socioeconomic status is robustly associated with rates of death and disease. Psychophysiological stress processes are thought to account for a portion of this association.

PURPOSE

Although positive and supportive relationships can buffer psychophysiological stress responses, no studies have examined whether the quality of a primary adult relationship-marriage-may buffer the negative association between socioeconomic status and stress-related disease processes.

METHODS

The current study examines the interaction between income and marital quality (supportive vs. ambivalent) on individuals' daily ambulatory blood pressure, a valid and reliable indicator of cardiovascular risk.

RESULTS

Results revealed that supportive marital relationships buffered the otherwise higher ambulatory diastolic blood pressure associated with low income.

CONCLUSIONS

Results are consistent with the buffering hypothesis of social support and suggest that a supportive spouse may buffer stress-related autonomic processes linking low socioeconomic status to risk for cardiovascular disease.

Hierarchy and health: Physiological effects of interpersonal experiences associated with socioeconomic position

OBJECTIVE

The inverse association between socioeconomic position (SEP) and cardiovascular disease may involve social psychophysiological processes. To test effects of aspects of SEP on physiological reactivity, we experimentally manipulated 3 features of social context related to social hierarchy-social rank or status relative to an interaction partner, the partner's degree of dominant behavior, and the presence of social-evaluative threat.

METHOD

The study design was a 2 × 2 × 2 × 2 (Participant Relative Status [high vs. low] × Partner Dominance [high vs. low] × Evaluative Threat [high vs. low] × Sex [male vs. female]) factorial, and 180 undergraduates participated. Cardiovascular and salivary cortisol responses were measured while participants engaged in a controlled interaction task with a prerecorded confederate partner.

RESULTS

Lower participant relative status resulted in greater increases in systolic (SBP) and diastolic blood pressure (DBP). Interacting with a more dominant partner resulted in greater increases in SBP and heart rate (HR), and larger changes in cardiac sympathetic and parasympathetic activation. Higher levels of social-evaluative threat evoked larger increases in HR and SBP. In some cases, these effects were stronger in men than in women, and aspects of the low status social context had synergistic effects on some physiological outcomes.

CONCLUSION

Interpersonal interactions and experiences may contribute to the association between SEP and cardiovascular health through the mechanism of physiological activation. Recurring patterns of everyday social experiences and their physiological effects may be a pathway linking the broader social context to cardiovascular disease. (PsycINFO Database Record

Dispositional optimism and sleep quality: a test of mediating pathways

Dispositional optimism has been related to beneficial influences on physical health outcomes. However, its links to global sleep quality and the psychological mediators responsible for such associations are less studied. This study thus examined if trait optimism predicted global sleep quality, and if measures of subjective well-being were statistical mediators of such links. A community sample of 175 participants (93 men, 82 women) completed measures of trait optimism, depression, and life satisfaction. Global sleep quality was assessed using the Pittsburgh Sleep Quality Index. Results indicated that trait optimism was a strong predictor of better PSQI global sleep quality. Moreover, this association was mediated by depression and life satisfaction in both single and multiple mediator models. These results highlight the importance of optimism for the restorative process of sleep, as well as the utility of multiple mediator models in testing distinct psychological pathways.

On the validity of self-report assessment of cognitive abilities: Attentional control scale associations with cognitive performance, emotional adjustment, and personality

Individual differences in attentional control involve the ability to voluntarily direct, shift, and sustain attention. In studies of the role of attentional control in emotional adjustment, social relationships, and vulnerability to the effects of stress, self-report questionnaires are commonly used to measure this construct. Yet, convincing evidence of the association between self-report scales and actual cognitive performance has not been demonstrated. Across 2 independent samples, we examined associations between self-reported attentional control (Attentional Control Scale; ACS), self-reported emotional adjustment, Five-Factor Model personality traits (NEO Personality Inventory-Revised) and performance measures of attentional control. Study 1 examined behavioral performance on the Attention Network Test (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002) and the Modified Switching Task (MST; Suchy & Kosson, 2006) in a large sample (n = 315) of healthy young adults. Study 2 (n = 78) examined behavioral performance on standardized neuropsychological tests of attention, including Conner's Continuous Performance Test-II and subtests from the Wechsler Adult Intelligence Scales, Third Edition (WAIS-III; Psychological Corporation, 1997) and Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001). Results indicated that the ACS was largely unrelated to behavioral performance measures of attentional control but was significantly associated with emotional adjustment, neuroticism, and conscientiousness. These findings suggest that although self-reported attentional control may be a useful construct, researchers using the ACS should exercise caution in interpreting it as a proxy for actual cognitive ability or performance. (PsycINFO Database Record

Attribution of Causality and the Overjustification Effect

Using false physiological feedback to influence attribu tions of intrinsic or extrinsic motivation, it was found that the overjustification effect is mediated by one's self-perceived motiva tion. Contingent reward significantly decreased intrinsic interest, which was defined as the number of trials on the target activity during a free choice period. This overjustification effect was significantly decreased when individuals were given an intrinsic interpretation of their behavior, while individuals given an extrin sic interpretation for their behavior showed a non-significant augmentation of the overjustification effect.

Personality as Risk and Resilience in Physical Health

Research on the association between personality characteristics and subsequent physical health has produced several consistent findings and identified other tentative relationships. Chronic anger/hostility and neuroticism/negative affectivity are the best established personality risk factors for poor health. Optimism, social dominance, and other traits also appear to influence risk. Several mechanisms have been identified as possibly underlying these effects, but few have been evaluated definitively. Future research may be well served by incorporation of concepts and methods from current personality research.

It's Complicated: Marital Ambivalence on Ambulatory Blood Pressure and Daily Interpersonal Functioning

BACKGROUND

Marriage decreases cardiovascular morbidity although relationship quality matters. While some marriages contain highly positive aspects (supportive), marriages may also simultaneously contain both positive and negative aspects (ambivalent). Individuals whose spouses or own behavior is ambivalent may not experience the same cardiovascular-protective benefits of marriage.

PURPOSE

The purpose of this study is to elucidate the physiological pathways by which marital quality may influence long-term health and examine ambivalent behavior on interpersonal-functioning and ambulatory blood pressure (ABP).

METHODS

Interpersonal functioning and ABP were examined in 94 couples.

RESULTS

Spousal and own ambivalent behavior was associated with lower intimacy (ps < .01) and higher systolic ABP (ps < .01). Spousal ambivalent behavior was associated with lower ratings of partner responsiveness (p < .01) and less self- and spousal-disclosure (ps < .05). Mediational analyses indicated that own behavior mediated links between spousal ambivalent behavior and ABP.

CONCLUSIONS

Despite the positivity in relationships, individuals whose spouses' or own behavior is ambivalent may not receive cardiovascular protection from this positivity.

Electrophysiologic Scar Substrate in Relation to VT: Noninvasive High-Resolution Mapping and Risk Assessment with ECGI

BACKGROUND

Ischemic cardiomyopathy (ICM) can provide the substrate for ventricular tachycardia (VT).

OBJECTIVE

To map noninvasively with high resolution the electrophysiologic (EP) scar substrate, identify its relationship to reentry circuits during VT, and stratify VT risk in ICM patients.

METHODS

Noninvasive high-resolution epicardial mapping with electrocardiographic imaging (ECGI) was performed in 32 ICM patients (17 with clinical VT, 15 without VT). Abnormal scar EP substrate was determined based on electrogram (EGM) amplitude (as percentage of maximal peak-to-peak voltage over the entire ventricular epicardium; total scar [TS] < 30%; dense scar [DS] < 15%), fractionation, and presence of late potentials (LPs). Scar burden was defined as the ratio of the scar size to the total epicardial surface area. The VT activation pattern was mapped and correlated with the EP substrate to identify components of the reentry circuit.

RESULTS

Patients with VT had higher scar burden (TS: 51.0 ± 9.3% vs 36.5 ± 5.4%, P < 0.05; DS: 29.5 ± 7.3% vs 16.8 ± 6.8%, P < 0.05) with lower normalized unipolar EGM voltage (TS: 0.107 ± 0.027 vs 0.153 ± 0.031, P < 0.05; DS: 0.073 ± 0.023 vs 0.098 ± 0.026, P < 0.05), greater prevalence of fractionated EGMs (TS: 44.1 ± 10.6% vs 26.8 ± 6.3%, P < 0.05; DS: 50.8 ± 10.8% vs 30.9 ± 7.0%, P < 0.05), and LPs (TS: 26.8 ± 10.7% vs 15.8 ± 5.3, P < 0.05). VTs were mapped in eight patients; the reentry circuits were closely related to the EP substrate.

CONCLUSIONS

ECGI noninvasively identified scar EP substrate that underlies abnormal conduction in ICM patients. It identified regions within the scar that aligned with critical elements of the reentry circuit during VT. ECGI can potentially be used for VT risk stratification in ICM patients.

Ethnic/racial differences in the association between social support and levels of C-reactive proteins in the North Texas Heart Study

Perceived social support has been reliably related to lower rates of morbidity and mortality. However, studies modeling C-reactive protein (CRP) as an important biological pathway linking social support to health have produced inconsistent results. Given purported ethnic/racial differences in sensitivity to social resources, the present study tested if ethnicity/race moderated the link between perceived support and CRP in a diverse community sample of 300 participants from the North Texas Heart Study. Consistent with prior research, there was no overall link between social support and CRP levels. However, the association between social support and high sensitivity (hs)-CRP levels was moderated by ethnicity/race as perceived support predicted lower hs-CRP levels primarily in African Americans. These results suggest the importance of considering how ethnicity/race may inform models on the complex biological mechanisms linking social support to health.

Social Relationships and Sleep Quality

BACKGROUND

The quality of social relationships and social support appears to be associated with physical health outcomes and sleep quality. Almost all previous research in this area focuses on positive aspects of relationships.

PURPOSE

The present study thus intended to examine the links between supportive, aversive, ambivalent, and indifferent network ties and sleep quality.

METHODS

Relationship data, Pittsburgh Sleep Quality Index (PSQI)-assessed sleep quality, and depression were examined in 175 middle-aged and older adults.

RESULTS

Consistent with hypotheses, supportive ties were positively related to sleep quality, while aversive ties predicted worse sleep quality, associations that were primarily seen for close relationships. Ambivalent and indifferent ties were not significant predictors of sleep quality. Importantly, depression was found to mediate the link between relationship quality and sleep quality.

CONCLUSIONS

These data suggest the more specific types of social relationships that may be linked to poor sleep quality and that depression appears to underlie these associations.

Assessment of social traits in married couples: Self-reports versus spouse ratings around the interpersonal circumplex

Personality traits predict the quality of intimate relationships, and as a result can be useful additions to assessments of couple functioning. For traits involving social behavior, the affiliation (i.e., warmth, friendliness vs. hostility, quarrelsomeness) and control (i.e., dominance vs. deference, submissiveness) dimensions of the interpersonal circumplex (IPC) are an alternative to the 5-factor model traits of agreeableness and extraversion, given that they may provide a more specific and relevant description of social behavior in the context of couple functioning. The couple context creates an opportunity to supplement commonly used self-reports with informant ratings. Although substantial correlations between self-reports and partner ratings of personality are well-documented, differences between these assessment modalities in levels of affiliation and control have not been examined previously. The present study of 301 middle-aged and older couples addressed this issue by comparing self-reports and spouse ratings, using parallel forms of a measure of the interpersonal circumplex derived from the NEO (Neuroticism-Extraversion-Openness) PI-R (Personality Inventory-Revised). Participants reported lower trait dominance relative to spouses' ratings, and less trait hostility. For dominance, this discrepancy was evident at all levels of marital quality, but for hostility it was particularly apparent among couples reporting low marital quality. The tendency to self-report less dominance relative to ratings by spouses was stronger among women than men. These discrepancies may be important in couple assessment and intervention. (PsycINFO Database Record

Self-reports and spouse ratings of neuroticism: perspectives on emotional adjustment in couples

Evidence of reciprocal associations between individual emotional adjustment and the quality of intimate relationships has led to the growing use of interventions that combine a focus on couple issues with a focus on individual emotional functioning. In these approaches, spouse ratings of emotional functioning can provide an important second method of assessment, beyond the much more commonly used self-reports. Although an extensive literature demonstrates substantial convergent correlations between self-reported and spouse-rated emotional adjustment, levels of adjustment evident across these 2 assessment methods are much less commonly compared, especially among couples reporting higher levels of marital distress. Well-documented limitations of both self-reports and spouse ratings suggest that differences--which would not necessarily be evident in correlations between methods--might be common and substantial, perhaps raising complications in couple assessments and intervention. The present study compared self-reports and spouse ratings of neuroticism and its specific components using the NEO Personality Inventory-Revised in a sample of 301 middle-aged and older couples. For overall neuroticism and the specific facets of anxiety, angry hostility, and vulnerability, self-reported levels of negative emotionality were consistently lower than the parallel ratings by spouses, most notably among couples reporting low levels of marital adjustment. Hence, substantial underestimates of negative emotionality obtained through self-reports as compared to ratings by spouses (or overestimates as obtained through spouse ratings) may be common and could complicate couple assessment and intervention.

The postimplantation electrocardiogram predicts clinical response to cardiac resynchronization therapy

BACKGROUND

Biventricular (BiV) pacing for cardiac resynchronization therapy (CRT) is intended to improve left ventricular function by coordinating systolic activity of the septum and free walls. Optimal resynchronization should be manifested by 12-lead electrocardiogram (ECG) patterns consistent with resynchronized activation, a tall (≥4 mm) R wave in V1, and predominant negative deflection in lead I (RV1SI). We investigated whether the presence or absence of RV1SI predicts heart failure outcomes within 1 year of CRT implant.

METHODS

Two independent physicians reviewed the paced ECG of 213 patients post-CRT device implantation with disputes resolved by a third reviewer. The primary end points of all-cause death, unplanned hospitalization, left ventricular assist device implant, or transplant within a 1-year follow-up were blindly adjudicated according to standard definitions. Groups were compared via Kaplan-Meier estimates and Cox proportional hazards models to determine association with event-free survival.

RESULTS

Among CRT patients postimplantation, 56 (26.3%) exhibited the RV1SI pattern on ECG. Patients with the RV1SI pattern were significantly less likely to achieve the primary end point as compared to patients without the RV1SI pattern (33.9% vs 52.2%; Log Rank P = 0.022). This difference was driven by a significantly lower risk for unplanned hospitalization among patients with the RV1SI pattern (hazard ratio = 0.510; confidence interval [0.298, 0.876]). The predictive value remained after adjustment for potential confounders (P = 0.004).

CONCLUSIONS

The 12-lead ECG postimplantation predicts clinical outcomes of BiV pacing. Such prediction may be useful in predicting the need for alternative or advanced heart failure therapies. Further study into ECG patterns may help to prospectively guide CRT.

Marital quality, depressive symptoms, and the metabolic syndrome: a couples structural model

The indirect association of marital quality with metabolic syndrome (MetS) through depressive symptoms was examined in 301 middle-aged and older couples. MetS components (i.e., waist circumference, blood pressure, blood draws to assess triglycerides, HDL cholesterol, and fasting glucose) were assessed following a 12-h fast, and were treated as a continuous latent variable for analyses. In structural equation modeling of this indirect effect, overall model fit was good, and husbands' and wives' marital quality was associated with MetS only through depressive symptoms. Joint tests of the parameters indicated that gender did not moderate this association. The best fitting, most parsimonious model, after nested model comparisons, was one in which husbands' and wives' indirect paths were equated. Overall, marital quality was related to MetS through its relationship to depressive symptoms for men and women. Associations of marital quality and depression with MetS may overlap, and couple-based approaches to psychosocial risk factors for cardiovascular disease may be useful in future research.

Affiliation and Control in Marital Interaction

The principle of complementarity in interpersonal theory states that an actor’s behavior tends to “pull, elicit, invite, or evoke” responses from interaction partners who are similar in affiliation (i.e., warmth vs. hostility) and opposite in control (i.e., dominance vs. submissiveness). Furthermore, complementary interactions are proposed to evoke less negative affect and promote greater relationship satisfaction. These predictions were examined in two studies of married couples. Results suggest that complementarity in affiliation describes a robust general pattern of marital interaction, but complementarity in control varies across contexts. Consistent with behavioral models of marital interaction, greater levels of affiliation and lower control by partners—not complementarity in affiliation or control—were associated with less anger and anxiety and greater relationship quality. Partners’ levels of affiliation and control combined in ways other than complementarity—mostly additively, but sometimes synergistically—to predict negative affect and relationship satisfaction.

A cross-sectional analysis of the association between perceived network social control and telomere length

OBJECTIVE

Social control in the health domain refers to attempts by social network members to get an individual to modify their health behaviors. According to the dual effects model of social control, having one's health behavior controlled by others should be related to healthier behavioral change, but might arouse psychological distress as one may resent being controlled. Despite potential healthy behavior change, the stress of social control may thus be detrimental as interpersonal stress has been related to negative health outcomes. In the present study, the association between perceived social control and telomere length was tested to examine its association to biological outcomes.

METHOD

In this cross-sectional study, a relatively healthy community sample of 140 middle age and older adults completed measures of perceived social control, perceived stress, and health behaviors. Peripheral blood mononuclear cells were used to determine telomere length.

RESULTS

Main results showed that higher levels of perceived direct social network control were associated with shorter telomere length. These links were not influenced by statistical controls for medication use, self-rated health, trait hostility, and optimism. Perceived social control was also related to greater perceived stress but not health behaviors overall. However, neither perceived stress nor health behaviors mediated the link between social control and telomere length.

CONCLUSIONS

Although the study design precludes strong inferences, these results suggest that perceived social control may be associated with cellular aging. These data also highlight the utility of integrating biological outcomes into social control models. (PsycINFO Database Record

Trait hostility is associated with systemic inflammation in married couples: an actor-partner analysis

Trait anger and hostility predict the development of coronary heart disease, and systemic inflammation may partly mediate this association. In a sample of 94 middle-aged and older married couples, we replicate research showing a within individuals (i.e., actor effect) association of trait hostility with high sensitivity C-reactive protein (hsCRP). As a novel extension of that research, the present study also examined the association of individuals' trait hostility with their partners' hsCRP (i.e., partner effect). Controlling for potential confounds, trait hostility, measured with the Buss-Perry Aggression Questionnaire, was significantly associated with both participants' own hsCRP, b=.0528 (SE=.0196), p=.008 and their partners' levels b=.0473 (SE=.0194), p=.016. Hence, the inflammatory correlates of trait hostility occur not only within individuals but between them, as well. The effects of unhealthy personality traits may extend to intimate partners and possibly other social network members.

Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors

PURPOSE

Hormone receptor-positive (HR+) cancers account for most breast cancer diagnoses and deaths. Among survivors with HR + breast cancers, endocrine therapy (ET) reduces 5-year risk of recurrence by up to 40%. Observational studies in Medicare- and privately-insured survivors suggest underutilization of ET. We sought to characterize ET use in a low-income Medicaid-insured population in North Carolina.

METHODS

Medicaid claims data were matched to state cancer registry records for survivors aging 18-64 diagnosed with stage 0-II HR + breast cancer from 2003 to 2007, eligible for ET, and enrolled in Medicaid for at least 12 of 15 months post-diagnosis. We used multivariable logistic regression to model receipt of any ET medication during 15 months post-diagnosis controlling for age, race, tumor characteristics, receipt of other treatments, comorbidity, residence, reason for Medicaid eligibility, involvement in the Breast and Cervical Cancer Control Program (BCCCP), and diagnosis year.

RESULTS

Of 222 women meeting the inclusion criteria, only 50% filled a prescription for ET. Involvement in the BCCCP and earlier year of diagnoses were associated with significantly higher odds of initiating guideline-recommended ET (adjusted odds ratio [AOR] for the BCCCP 3.76, 95% confidence interval [CI] 1.67-8.48; AOR for 2004 relative to 2007 2.80, 95% CI 1.03-7.62; AOR for 2005 relative to 2007 2.11, 95% CI 0.92-4.85).

CONCLUSIONS

Results suggest substantial underutilization of ET in this population. Interventions are needed to improve timely receipt of ET and to better support survivors taking ET.

IMPLICATIONS FOR CANCER SURVIVORS

Low-income survivors should be counseled on the importance of ET and offered support services to promote initiation and long-term adherence.

Subjective social status: construct validity and associations with psychosocial vulnerability and self-rated health

BACKGROUND

Subjective social status (SSS) predicts health outcomes independently of traditional, objective indicators of socioeconomic status (SES). However, the potential confounding and mediating effects of negative affect and similar psychosocial risk and resilience factors have not been adequately addressed through formal studies of convergent and discriminant validity of SSS measures.

PURPOSE

The current study provides such a test of construct validity and subsequently examines whether psychosocial factors mediate the relationship between SSS and self-rated health.

METHODS

We examined the convergent and discriminant validity of the MacArthur scales of SSS relative to measures of psychosocial risk and resilience (i.e., neuroticism, depressive symptoms, optimism, and marital quality) as well as SES (i.e., income) in 300 middle-aged and older married US couples. We also tested a factor of psychosocial vulnerability as a mediator of the relationship between SSS and self-rated health.

RESULTS

Findings indicated clear convergent and discriminant validity of the MacArthur scales. Further, controlling age and income, both the US and community measures of SSS predicted psychosocial factors for men, however, only the community measure was independently predictive for women. Psychosocial vulnerability significantly mediated the pathway between SSS and self-rated health for men and women after controlling age and income.

CONCLUSIONS

These results provide strong support for the construct validity of the MacArthur scales and provide additional evidence of the role of psychosocial risk and resilience factors as mediators of the effects of SSS on health.