Attachment and telomere length: more evidence for psychobiological connections between close relationships, health, and aging

Where the joy comes from: a qualitative exploration of deep GP-patient relationships

BACKGROUND

Relationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives.

METHODS

Semi-structured interview design. An initial survey assessed patients' perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees' attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP's clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis.

RESULTS

Thirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the 'professional'; human connection; trust; and 'above and beyond'. Patient, GP and practice team all contributed to their cultivation.

CONCLUSIONS

We present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

Attachment insecurity moderates emotion responses to mindfulness and loving-kindness meditation in adults raised in low socioeconomic status households

Research on attachment theory holds that insecure attachment influences people's daily social and emotional experiences. Mindfulness meditation and loving-kindness meditation have been associated with improvements in physical and mental well-being often through their influence on emotion experience and regulation. Yet, little research has examined how emotional well-being may be improved in insecurely attached individuals through meditation practice. We suspected that the emotion profiles of anxious and avoidant attachment may shift with meditation training, both across time and on a particular day. Improving emotional well-being may be especially consequential for those most at risk for negative health outcomes in late life. A diverse community sample of midlife adults raised in low-SES homes (N = 113; 55% white, 87.5% female) completed daily emotion reports for 10 weeks, during which they received 6 weeks of meditation training, randomized to either loving-kindness or mindfulness meditation practice. Results from growth curve analyses revealed that individuals with greater attachment anxiety and randomized to mindfulness meditation reported significant increases over time in positive emotions alongside decreases in negative emotions. Those high in attachment avoidance reported significant decreases in negative emotions in both meditation groups. On the daily level, within-person dose-response analyses revealed that individuals with greater attachment anxiety showed the most consistent dose-response relations between the duration of either meditation practice and same-day increases in positive emotions and decreases in negative emotions. These findings highlight how meditation interventions can shift emotion profiles of insecurely attached midlife adults who are at heightened risk for late life chronic illnesses. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gender Differences in Perceived Stress and Its Relationship to Telomere Length in Costa Rican Adults

Introduction

Stress is associated with disease and reduced leukocyte telomere length (LTL). The objective of this research is to determine if self-perceived stress is associated with telomere length in Costa Rican adults and the gender differences in this association. Findings may help explain how some populations in apparent socioeconomic disadvantage and with limited access to specialized medical services have a remarkably high life expectancy.

Methodology

Data come from the pre-retirement cohort of the Costa Rican Longevity and Healthy Aging Study (CRELES), a population based survey conducted in the households to 2,327 adults aged 53 to 66 years. The DNA to measure LTL was extracted from blood cells in laboratories of the University of Costa Rica whereas the Blackburn laboratory at the University of California performed the telomere length measurement applying the quantitative polymerase chain reaction (Q-PCR). The relationship between telomere length and perceived stress was measured using least-squares multiple regression. Perceived stress was measured by a set of questions about family, job, finances and, health reasons to be stressed. Models included the control variables: (1) age and sex of the participant, (2) whether he or she resides in the Nicoya area, a “blue zone” known for its high longevity, and (3) the aforementioned sociodemographic, health and lifestyles characteristics.

Results

Stress perception and LTL are significantly different by sex. Women perceived higher stress levels than men in almost all aspects studied, except work. Women have significantly longer telomeres. Shorter telomeres are significantly associated with caregiving stress in men and with parental health concerns in women. Counter-intuitive telomere lengthenings were observed among women who feel stressed about caring for family members; and among men who feel stressed due to their family relationships as well as concerns about their own health.

Discussion

Results confirm that people with self-perceived stress due to caregiving or health issues have shorter telomeres. The relationship between stress and telomere length differs between men and women. Gender relations exert a strong modifier effect on the relationship between stress and LTL: gender is related to perceived stress, telomere length, and apparently also to the way stress and LTL are related.

Immune and Epigenetic Pathways Linking Childhood Adversity and Health Across the Lifespan

Childhood adversity is associated with a host of mental and physical health problems across the lifespan. Individuals who have experienced childhood adversity (e.g., child abuse and neglect, family conflict, poor parent/child relationships, low socioeconomic status or extreme poverty) are at a greater risk for morbidity and premature mortality than those not exposed to childhood adversity. Several mechanisms likely contribute to the relationship between childhood adversity and health across the lifespan (e.g., health behaviors, cardiovascular reactivity). In this paper, we review a large body of research within the field of psychoneuroimmunology, demonstrating the relationship between early life stress and alterations of the immune system. We first review the literature demonstrating that childhood adversity is associated with immune dysregulation across different indices, including proinflammatory cytokine production (and its impact on telomere length), illness and infection susceptibility, latent herpesvirus reactivation, and immune response to a tumor. We then summarize the growing literature on how childhood adversity may alter epigenetic processes. Finally, we propose future directions related to this work that have basic and applied implications.

Perceived stress, cytomegalovirus titers, and late-differentiated T and NK cells: Between-, within-person associations in a longitudinal study of older adults

Cytomegalovirus (CMV) and psychological stress are implicated as drivers of immunological aging. It is unknown, however, whether associations among CMV titers, stress, and immune aging are more stable or dynamic over time. The present investigation tested the between-person (stable differences) and within-person (dynamic fluctuations) associations of CMV titers and perceived stress on late-differentiated T and natural killer (NK) peripheral blood cells in a longitudinal study of older adults aged 64-92 years (N = 149). Participants reported stress levels and provided blood biannually for 2.5 years (up to 5 waves per person) to assess CMV IgG titers and composites of late-differentiated CD8 T cells (CD28- and CD57 + subsets) and CD56dim NK cells (CD57+, NKG2C+, and FcεRIγ- subsets). In multilevel models that controlled for demographic variables, higher CMV titers were associated with higher proportions and counts of aged T and NK cells between people and lower counts of aged T cells within people. Perceived stress was associated with higher counts of aged T cells between people, but was not associated with aged NK cells. A significant interaction between stress and CMV titers on T cells between people indicated that older adults with lower stress levels and lower CMV titers had the lowest proportions of late-differentiated T cells, whereas those with higher stress levels had high proportions, regardless of CMV control. Our results provide evidence for longer-term, between-person associations among CMV titers, stress, and immunological aging, rather than dynamic within-person associations. We propose that targeting factors that promote low, stable perceived stress in older adults may retard T cell differentiation and ultimately support healthy aging.