Modeling the association between and predictors of two constructs of resilience

Psychological resilience to lifetime trauma and risk for cardiometabolic disease and mortality in older adults: A longitudinal cohort study

OBJECTIVE

Trauma exposure is associated with risk for cardiometabolic disease and mortality, in part through negative psychological sequelae. In contrast, psychological resilience, showing positive psychological health despite experiencing trauma, may offset some of this risk. We examined longitudinal associations of psychological resilience to lifetime trauma and cardiometabolic outcomes and mortality in a large sample of older adults.

METHODS

Using data from 6596 US Health and Retirement Study participants who had experienced lifetime trauma (mean age 64), we defined manifested psychological resilience based on trauma burden and psychological health (composite of low distress and high psychological well-being) through 2012. New onset cardiometabolic disease (heart problems, stroke, diabetes) and mortality were assessed across eight years of follow-up (through 2020). Repeated measures regressions determined associations between psychological resilience and outcomes over follow-up, adjusting for sociodemographic factors and prior disease.

RESULTS

Higher levels of manifested psychological resilience were associated with lower risk for developing any cardiometabolic outcomes (relative risk for one SD higher resilience score, RR = 0.91, 95%CI 0.88-0.94) and for all-cause mortality (RR = 0.73, 95%CI 0.63, 0.86), adjusting for sociodemographic confounders. When examining individual diseases, resilience was significantly associated with lower risk for certain heart problems (i.e., congestive heart failure) and diabetes. Associations generally held when additionally adjusting for adult psychosocial and biobehavioral factors that could be potential pathway variables.

CONCLUSION

Psychological resilience to lifetime trauma may be linked to better cardiometabolic health even later in life. Promoting recovery and psychological resilience to trauma may be a target for more favorable health and longevity.

Depression Pathophysiology: Astrocyte Mitochondrial Melatonergic Pathway as Crucial Hub

Major depressive disorder (MDD) is widely accepted as having a heterogenous pathophysiology involving a complex mixture of systemic and CNS processes. A developmental etiology coupled to genetic and epigenetic risk factors as well as lifestyle and social process influences add further to the complexity. Consequently, antidepressant treatment is generally regarded as open to improvement, undoubtedly as a consequence of inappropriately targeted pathophysiological processes. This article reviews the diverse array of pathophysiological processes linked to MDD, and integrates these within a perspective that emphasizes alterations in mitochondrial function, both centrally and systemically. It is proposed that the long-standing association of MDD with suppressed serotonin availability is reflective of the role of serotonin as a precursor for the mitochondrial melatonergic pathway. Astrocytes, and the astrocyte mitochondrial melatonergic pathway, are highlighted as crucial hubs in the integration of the wide array of biological underpinnings of MDD, including gut dysbiosis and permeability, as well as developmental and social stressors, which can act to suppress the capacity of mitochondria to upregulate the melatonergic pathway, with consequences for oxidant-induced changes in patterned microRNAs and subsequent patterned gene responses. This is placed within a development context, including how social processes, such as discrimination, can physiologically regulate a susceptibility to MDD. Future research directions and treatment implications are derived from this.