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Vaccarino V, Bremner JD. Stress and cardiovascular disease: an update. Nat Rev Cardiol 2024; 21:603-616. [PMID: 38698183 DOI: 10.1038/s41569-024-01024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Diagnostic Imaging, Emory University School of Medicine, Atlanta, GA, USA
- Veterans Administration Medical Center, Decatur, GA, USA
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2
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Tung I, Balaji U, Hipwell AE, Low CA, Smyth JM. Feasibility and acceptability of measuring prenatal stress in daily life using smartphone-based ecological momentary assessment and wearable physiological monitors. J Behav Med 2024; 47:635-646. [PMID: 38581594 DOI: 10.1007/s10865-024-00484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
High levels of stress during pregnancy can have lasting effects on maternal and offspring health, which disproportionately impacts families facing financial strain, systemic racism, and other forms of social oppression. Developing ways to monitor daily life stress during pregnancy is important for reducing stress-related health disparities. We evaluated the feasibility and acceptability of using mobile health (mHealth) technology (i.e., wearable biosensors, smartphone-based ecological momentary assessment) to measure prenatal stress in daily life. Fifty pregnant women (67% receiving public assistance; 70% Black, 6% Multiracial, 24% White) completed 10 days of ambulatory assessment, in which they answered smartphone-based surveys six times a day and wore a chest-band device (movisens EcgMove4) to monitor their heart rate, heart rate variability, and activity level. Feasibility and acceptability were evaluated using behavioral meta-data and participant feedback. Findings supported the feasibility and acceptability of mHealth methods: Participants answered approximately 75% of the surveys per day and wore the device for approximately 10 hours per day. Perceived burden was low. Notably, participants with higher reported stressors and financial strain reported lower burden associated with the protocol than participants with fewer life stressors, highlighting the feasibility of mHealth technology for monitoring prenatal stress among pregnant populations living with higher levels of contextual stressors. Findings support the use of mHealth technology to measure prenatal stress in real-world, daily life settings, which shows promise for informing scalable, technology-assisted interventions that may help to reduce health disparities by enabling more accessible and comprehensive care during pregnancy.
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Affiliation(s)
- Irene Tung
- Department of Psychology, California State University, Dominguez Hills, 1000 E. Victoria Street, Carson, CA, 90747, USA.
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Uma Balaji
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carissa A Low
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joshua M Smyth
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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3
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Benson L, Fleming AR, Hakun JG. Sometimes you just can't: within-person variation in working memory capacity moderates negative affect reactivity to stressor exposure. Cogn Emot 2023; 37:1-11. [PMID: 37720986 PMCID: PMC10951940 DOI: 10.1080/02699931.2023.2258579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/02/2023] [Indexed: 09/19/2023]
Abstract
The executive hypothesis of self-regulation places cognitive information processing at the center of self-regulatory success/failure. While the hypothesis is well supported by cross-sectional studies, no study has tested its primary prediction, that temporary lapses in executive control underlie moments of self-regulatory failure. Here, we conducted a naturalistic experiment investigating whether short-term variation in executive control is associated with momentary self-regulatory outcomes, indicated by negative affect reactivity to everyday stressors. We assessed working memory capacity (WMC) through ultra-brief, ambulatory assessments on smart phones five times per day in a 7-day ecological momentary assessment (EMA) study involving college-aged adults. We found that participants exhibited more negative affect reactivity to stressor exposures during moments when they exhibited lower than usual WMC. Contrary to previous findings, we found no between-person association between WMC and average stress reactivity. We interpret these findings as reflecting the role of executive control in determining one's effective capacity to self-regulate.
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Affiliation(s)
- Lizbeth Benson
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA
| | - Allison R. Fleming
- Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan G. Hakun
- Department of Neurology, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA 16802, USA
- Translational Brain Research Center, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA
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4
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Messman BA, Slavish DC, Briggs M, Ruggero CJ, Luft BJ, Kotov R. Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders. Ann Behav Med 2023; 57:582-592. [PMID: 37078921 DOI: 10.1093/abm/kaad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders. PURPOSE We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders. METHODS Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment. RESULTS Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one. CONCLUSION People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Madasen Briggs
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Benjamin J Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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5
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Ruissen GR, Beauchamp MR, Puterman E, Zumbo BD, Rhodes RE, Hives BA, Sharpe BM, Vega J, Low CA, Wright AGC. Continuous-Time Modeling of the Bidirectional Relationship Between Incidental Affect and Physical Activity. Ann Behav Med 2022; 56:1284-1299. [PMID: 35802004 PMCID: PMC9672348 DOI: 10.1093/abm/kaac024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous research suggests that there is a bidirectional relationship between incidental affect (i.e., how people feel in day-to-day life) and physical activity behavior. However, many inconsistencies exist in the body of work due to the lag interval between affect and physical activity measurements. PURPOSE Using a novel continuous-time analysis paradigm, we examined the temporal specificity underlying the dynamic relationship between positive and negative incidental affective states and moderate-to-vigorous physical activity (MVPA). METHODS A community sample of adults (n = 126, Mage = 27.71, 51.6% Male) completed a 14-day ambulatory assessment protocol measuring momentary positive and negative incidental affect six times a day while wearing a physical activity monitor (Fitbit). Hierarchical Bayesian continuous-time structural equation modeling was used to elucidate the underlying dynamics of the relationship between incidental affective states and MVPA. RESULTS Based on the continuous-time cross-effects, positive and negative incidental affect predicted subsequent MVPA. Furthermore, engaging in MVPA predicted subsequent positive and negative incidental affect. Incidental affective states had a greater relative influence on predicting subsequent MVPA compared to the reciprocal relationship. Analysis of the discrete-time coefficients suggests that cross-lagged effects increase as the time interval between measurements increase, peaking at about 8 h between measurement occasions before beginning to dissipate. CONCLUSIONS The results provide support for a recursive relationship between incidental affective states and MVPA, which is particularly strong at 7-9 hr time intervals. Future research designs should consider these medium-term dynamics, for both theory development and intervention.
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Affiliation(s)
- Geralyn R Ruissen
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Mark R Beauchamp
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Eli Puterman
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Bruno D Zumbo
- Measurement, Evaluation, and Research Methodology Program, University of British Columbia, Vancouver, BC, Canada
- Institute of Applied Mathematics, University of British Columbia, Vancouver, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Benjamin A Hives
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Brinkley M Sharpe
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Julio Vega
- Mobile Sensing + Health Institute (MoSHI), University of Pittsburgh, Pittsburgh, PA, USA
| | - Carissa A Low
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Mobile Sensing + Health Institute (MoSHI), University of Pittsburgh, Pittsburgh, PA, USA
- Department of Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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6
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Feneberg AC, Nater UM. An ecological momentary music intervention for the reduction of acute stress in daily life: A mixed methods feasibility study. Front Psychol 2022; 13:927705. [PMID: 36248548 PMCID: PMC9558284 DOI: 10.3389/fpsyg.2022.927705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Despite the growing potential of mobile-based technologies, innovative interventions targeting the reduction of acute stress in daily life remain under-researched. Music listening is an easy-to-administer activity that is associated with lower levels of biological and self-reported stress. However, the application of music as an intervention in moments of acute stress in daily life remains to be examined. We developed a just-in-time intervention delivering music in moments of stressful experiences in daily life and tested its feasibility using a mixed methods approach. Methods: In this uncontrolled pilot study, the ecological momentary music intervention (EMMI) was tested by 10 chronically stressed women aged 23.5 ± 3.3 years. Over 18 consecutive days, whenever participants reported stressful experiences, they were encouraged to listen to a self-compiled playlist. Subjective stress levels and saliva samples were assessed at three time points per stress report (T0, upon reporting a stressful situation; T1, directly after music listening/15 min after T0 in case of no music listening; T2, 15 min after T1). We analyzed app-based log data, in-the-moment responses, questionnaire data, and semi-structured interview data. Results: On average, participants' compliance with the study protocol lay at 70%. Overall, 65 stressful experiences were reported, 51 of which were followed by music listening, for an average duration of 12:53 min. Complete data (i.e., self-reports and saliva samples at all three time points) were provided for 46 stressful experiences. Participants reported immediate relaxation and distraction through music listening. The interviews revealed that the intervention was easy to use and that music listening in moments of perceived stress was viewed as a new and pleasant activity. Several aspects of the protocol (e.g., number of items and prompts) were identified, which should be improved in future studies. Conclusion: Since repeated stressful experiences in daily life can pose a threat to physical and mental integrity, interventions that are easily applicable and deliver support when needed most are necessary. Following minor adaptations, the EMMI can be considered as a feasible approach to target psychobiological stress responses in daily life, which is worthy of investigation in future larger-scale trials.
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Affiliation(s)
- Anja C. Feneberg
- Department for Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
| | - Urs M. Nater
- Department for Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
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7
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Marcusson-Clavertz D, Sliwinski MJ, Buxton OM, Kim J, Almeida DM, Smyth JM. Relationships between daily stress responses in everyday life and nightly sleep. J Behav Med 2022; 45:518-532. [PMID: 35032255 PMCID: PMC10710174 DOI: 10.1007/s10865-021-00281-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Abstract
Stress and sleep are related, but the nature and time course of this relation is not well understood. We explored the within-person associations of three components of emotional responses to everyday stressors, indexed by negative affect, reactivity (initial response to a stressor), recovery (persistence of the post-stressor response), and pile-up (accumulation of stress episodes), with sleep indicators. We conducted coordinated analyses of data in several studies employing ecological momentary assessments, which captured naturally occurring, self-reported stress and sleep. We defined proximal reactivity as the emotional response to the stressor moment in question compared to an immediate pre-stressor state, and distal reactivity as the emotional response to the stressor moment in question compared to a typical stressor-free state for that person. Results in two of three studies showed that people reported significantly lower sleep quality following days on which they experienced higher levels of distal reactivity to stressors. Days with greater distal reactivity also predicted significantly more difficulty falling asleep in one of two studies. There was no clear association between proximal reactivity and subsequent sleep. Associations of recovery or pile-up with subsequent sleep emerged only in single studies. Poorer sleep quality was significantly related to higher next day levels of negative affect in all three studies, but there were no consistent relations between sleep and next day stress reactivity, recovery, or pile-up. These exploratory analyses suggest that distal reactivity is associated with a heightened risk of experiencing poor sleep quality the following night, and as such the former may serve as a candidate for potential targets for the remediation of the negative effects of stress on sleep.
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Affiliation(s)
- David Marcusson-Clavertz
- The Pennsylvania State University, University Park, PA, USA.
- Department of Psychology, Linnaeus University, Växjö, Sweden.
| | | | - Orfeu M Buxton
- The Pennsylvania State University, University Park, PA, USA
| | - Jinhyuk Kim
- The Pennsylvania State University, University Park, PA, USA
- Department of Informatics, Shizuoka University, Hamamatsu, Shizuoka, Japan
| | | | - Joshua M Smyth
- The Pennsylvania State University, University Park, PA, USA.
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8
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Feneberg AC, Forbes PAG, Piperno G, Pronizius E, Stijovic A, Skoluda N, Lamm C, Nater UM, Silani G. Diurnal dynamics of stress and mood during COVID-19 lockdown: a large multinational ecological momentary assessment study. Proc Biol Sci 2022; 289:20212480. [PMID: 35611528 PMCID: PMC9130787 DOI: 10.1098/rspb.2021.2480] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The COVID-19 pandemic resulted in severe disruption to people's lives as governments imposed national 'lockdowns'. Several large surveys have underlined the detrimental short- and long-term mental health consequences resulting from this disruption, but survey findings are only informative of individuals' retrospectively reported psychological states. Furthermore, knowledge on psychobiological responses to lockdown restrictions is scarce. We used smartphone-based real-time assessments in 731 participants for 7 days and investigated how individuals' self-reported stress and mood fluctuated diurnally during lockdown in spring 2020. We found that age, gender, financial security, depressive symptoms and trait loneliness modulated the diurnal dynamics of participants' momentary stress and mood. For example, younger and less financially secure individuals showed an attenuated decline in stress as the day progressed, and similarly, more lonely individuals showed a diminished increase in calmness throughout the day. Hair collected from a subsample (n = 140) indicated a decrease in cortisol concentrations following lockdown, but these changes were not related to any of the assessed person-related characteristics. Our findings provide novel insights into the psychobiological impact of lockdown and have implications for how, when and which individuals might benefit most from interventions during psychologically demanding periods.
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Affiliation(s)
- Anja C. Feneberg
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Paul A. G. Forbes
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Giulio Piperno
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Ekaterina Pronizius
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Ana Stijovic
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria,Research Platform The Stress of Life (SOLE)—Processes and Mechanisms underlying Everyday Life Stress, University of Vienna, Vienna, Austria
| | - Claus Lamm
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria,Research Platform The Stress of Life (SOLE)—Processes and Mechanisms underlying Everyday Life Stress, University of Vienna, Vienna, Austria
| | - Urs M. Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria,Research Platform The Stress of Life (SOLE)—Processes and Mechanisms underlying Everyday Life Stress, University of Vienna, Vienna, Austria
| | - Giorgia Silani
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria,Research Platform The Stress of Life (SOLE)—Processes and Mechanisms underlying Everyday Life Stress, University of Vienna, Vienna, Austria
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9
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Wang Y, Lugo A, Amerio A, d'Oro LC, Iacoviello L, Odone A, Zucchi A, Gallus S, Stuckler D. The Impact of COVID-19 Lockdown Announcements on Mental Health: Quasi-Natural Experiment in Lombardy, Italy. Eur J Public Health 2022; 32:488-493. [PMID: 35412581 PMCID: PMC9159307 DOI: 10.1093/eurpub/ckac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Evidence showed that mental health problems have risen markedly during COVID-19. It is unclear if part of the mental sufferings relates to the climate of uncertainty and confusion originated from rough communication by health officials and politicians. Here, we test the impact of unanticipated policy announcements of lockdown policies on mental health of the older population. Methods We used a representative telephone-based survey of 4400 people aged 65 years or older in Italy’s Lombardy region to compare information on self-reported symptoms of anxiety, depression and poor-quality sleep of subjects interviewed on the days of the policy announcement with that of subjects interviewed on other days. We used regression models adjusting for potential socio-demographic confounders as well study design with inverse probability weighting. Results On days when policymakers announced to extend the lockdown, mental health deteriorated on average by 5.5 percentage points [95% confidence interval (CI): 1.1–9.8] for self-reported anxiety symptoms and 5.1 percentage points (95% CI: 2.7–7.4) for self-reported depressive symptoms. The effect of the announcement to shorten the lockdown is more moderate but statistically significant. These associations were short term in duration; after just 1 day, self-reported mental health and sleep quality return to levels better than pre-announcement until a new policy change. Conclusions Our research shows that lockdown policy announcements are associated with short-term worsening in mental distress, highlighting the importance of appropriate communication strategies and political determinations in crisis times.
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Affiliation(s)
- Yuxi Wang
- Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Italy, Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Cavalieri d'Oro
- Epidemiology Unit, Agenzia per la Tutela della Salute -ATS- della Brianza (Local Public Health Authority), Monza, Italy
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.,Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Agenzia per la Tutela della Salute-ATS-di Bergamo (Local Public Health Authority), Italy, Bergamo
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Science, Bocconi University, Milan, Italy
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10
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Zawadzki MJ, Hussain M, Kho C. Comparing multidimensional facets of stress with social, emotional, and physical well-being using ecological momentary assessment among a Hispanic sample. Stress Health 2022; 38:375-387. [PMID: 34494721 DOI: 10.1002/smi.3098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/17/2021] [Accepted: 08/09/2021] [Indexed: 11/11/2022]
Abstract
Stress is multidimensional, including exposure, subjective appraisals, perceived coping, rumination, and worry. Although research has shown each dimension can predict poor social, emotional, and subjective well-being, rarely have these dimensions of stress been compared as one is experiencing stress. This paper used ecological momentary assessment (EMA) to repeatedly measure stress dimensions and self-reported health to test whether each stress dimension has a unique relationship with well-being over time at the between-person and within-person levels. Participants (n = 165, 79.6% female) were Hispanic undergraduates, who completed EMAs twice a day for 14 consecutive days, resulting in 3,436 EMAs and 1,987 morning sleep observations. At each EMA, participants reported on the dimensions of stress, feelings of loneliness and belongingness (social well-being), levels of sadness, happiness, and anxiety (emotional well-being), and how healthy they felt (subjective well-being). Sleep quality and duration (subjective well-being) were assessed each morning. Multilevel models revealed few relationships at the between-person level. At the within-person level, appraisals, coping, rumination, and worry consistently predicted social, emotional, and subjective well-being. Lagged analyses suggested some relationships for appraisal, coping, and worry. Results suggest the importance of measuring stress in a multidimensional capacity and examining associations with well-being across multiple health facets.
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Affiliation(s)
- Matthew J Zawadzki
- Department of Psychological Sciences, University of California, Merced, California, USA
| | - Maryam Hussain
- Department of Psychological Sciences, University of California, Merced, California, USA
| | - Carmen Kho
- R. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
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11
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Rodman AM, Vidal Bustamante CM, Dennison MJ, Flournoy JC, Coppersmith DDL, Nook EC, Worthington S, Mair P, McLaughlin KA. A year in the social life of a teenager: Within-person fluctuations in stress, phone communication, and anxiety and depression. Clin Psychol Sci 2021; 9:791-809. [PMID: 34707917 PMCID: PMC8547215 DOI: 10.1177/2167702621991804] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stressful life events (SLEs) are strongly associated with the emergence of adolescent anxiety and depression, but the underlying mechanisms remain poorly understood, especially at the within-person level. We investigated how adolescent social communication (i.e., frequency of calls and texts) following SLEs relates to changes in internalizing symptoms in a multi-timescale intensive year-long study (N=30; n=355 monthly observations; n=~5,000 experience-sampling observations). Within-person increases in SLEs were associated with receiving more calls than usual at both monthly- and momentary-levels, and making more calls at the monthly-level. Increased calls were prospectively associated with worsening internalizing symptoms at the monthly-level only, suggesting that SLEs rapidly influences phone communication patterns, but these communication changes may have a more protracted, cumulative influence on internalizing symptoms. Finally, increased incoming calls prospectively mediated the association between SLEs and anxiety at the monthly-level. We identify adolescent social communication fluctuations as a potential mechanism conferring risk for stress-related internalizing psychopathology.
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12
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Macintyre RI, Heron KE, Dawson CA, Filipkowski KB, Arigo D. Does Assessment Alter Responses? An Examination of Measurement Reactivity in an Ecological Momentary Assessment of Body Comparisons. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.4.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Body comparisons have been implicated in body dissatisfaction and eating disorder development. Ecological momentary assessment (EMA) has been used to capture body comparisons in everyday life; however, the potential for measurement reactivity this approach has on EMA responses has yet to be examined. The present study systematically evaluated measurement reactivity in EMA of body comparisons. Methods: Undergraduate women (N = 75) completed four surveys daily for 11 days; Days 1–4 did not include comparison assessments and Days 5–11 did. Changes were examined in related EMA measures between these time periods and individual difference measures pre- and post-EMA. Results: A within-person MANOVA showed no significant change in the individual difference measures. Multilevel analyses revealed that participants reported fewer comparisons as day of study increased. When they completed EMA with versus without comparison items, they reported fewer occasions of loss of control while eating and less pleasant social company at time of assessment. Discussion: Findings suggest limited concern for reactivity in this approach, though researchers examining body comparisons, loss of control eating, and perceptions of social company should be cautious when interpreting their findings and consider examining reactivity directly. Future research on body comparisons should also consider using run-in periods to improve data quality.
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Affiliation(s)
- Rachel I. Macintyre
- The Virginia Consortium Program in Clinical Psychology Old Dominion University
| | - Kristin E. Heron
- The Virginia Consortium Program in Clinical Psychology Old Dominion University
| | - Charlotte A. Dawson
- The Virginia Consortium Program in Clinical Psychology Old Dominion University
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13
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Mood during pregnancy: Trends, structure, and invariance by gestational day. J Psychiatr Res 2021; 140:260-266. [PMID: 34119911 DOI: 10.1016/j.jpsychires.2021.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/12/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
Mood dynamics during pregnancy are important in understanding a critical period of human development, and also as a model for biopsychosocial stress processes. Here, in four large samples of smartphone app respondents (differentiated by time period and number of responses), we modeled mood for each gestational day during the pregnancy period. We aimed to delineate patterns of changes in mood across pregnancy, as well as potential changes in measurement properties across the period. Results indicated that three prominent mood factors - positivity, distress, and irritability - could account for responses in this period, and that changes in measurement properties of mood items across pregnancy were small in magnitude. Mean irritability increased, and positivity decreased, in the first trimester before reversing in direction; there was also some evidence for previously reported U-shaped trends in mood, where negative mood is greatest early in pregnancy, decreases, and then increases again. Results help characterize mood processes at a detailed level during a critical period, and point to directions for future research to explicate causes and effects of mood changes during this time.
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Heron KE, Braitman AL, Dawson CA, MacIntyre RI, Howard LM, Lewis RJ. Evaluating study procedure training methods for a remote daily diary study of sexual minority women. Mhealth 2021; 7:46. [PMID: 34345623 PMCID: PMC8326946 DOI: 10.21037/mhealth-20-116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) methods can be used to remotely assess physical and mental health in daily life for hard-to-reach, marginalized, and geographically dispersed populations in the U.S., such as sexual minority women (e.g., lesbian, bisexual). However, EMA studies are often complex, and engaging participants from afar can be a challenge. This study experimentally examined whether adding videos to written recruitment materials would improve consent rates, reduce dropout rates, and improve survey completion rates for an online daily diary study. METHODS As part of a 2-week study of same-sex female couples' health, 376 women ages 18-35 were recruited from across the U.S. using a market research firm. Couples were randomized to an introductory information condition (written + video materials or written-only materials) prior to informed consent. RESULTS Overall, 97.1% of eligible women reviewed introductory materials and of these 96.7% consented; consent rates did not differ by condition (written + video: 97.1%, written-only: 97.1%). Dropout rates were low (5.4%) and survey completion rates were high (90.4% of surveys completed); there were no group differences for study dropout (written + video: 3.6%, written-only: 7.0%) or survey completion (written + video: 92.5%, written-only: 88.4%). Data from women randomized to receive videos indicated more than half (53.3%) did not watch any of the five videos in full. However, among those who viewed the videos, time spent watching videos, watching more videos in full, and watching at least one video in full were each positive associated with survey completion rates. CONCLUSIONS In summary, we had high consent rates, low dropout rates, and high survey completion rates regardless of video instructions. Although sexual minority women can be hard to reach, our potential participants appeared highly motivated to take part in research, and thus video recruitment materials were not necessary to improve participation. Future experimental research to maximize EMA study design and implementation could be important for populations less inclined to participate in EMA studies, or who are less familiar with research.
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Affiliation(s)
- Kristin E. Heron
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Abby L. Braitman
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | | | | | - Lindsay M. Howard
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Robin J. Lewis
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
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15
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Yung ST, Chen Y, Zawadzki MJ. Loneliness and psychological distress in everyday life among Latinx college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021:1-10. [PMID: 34242538 DOI: 10.1080/07448481.2021.1927051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Changes in surroundings and social relationships may heighten feelings of loneliness, suggesting the need to measure as a state. This study tested whether loneliness fluctuates within and across days and the resultant associations with psychological distress. Further it tested familism as a moderator as endorsing this cultural value may buffer the negative effects of state loneliness. PARTICIPANTS Participants (n = 220) were Latinx undergraduate students. METHODS Students reported their loneliness levels and psychological distress twice a day for two weeks using an ecological momentary assessment approach. RESULTS Results showed that experiencing a higher than usual level of loneliness predicted greater sadness, stress, and anxiety at both the moment-to-moment and day-to-day level. Familism, measured at baseline, only moderated the relationship between loneliness and sadness. CONCLUSIONS The findings suggest being in a lonely moment may lead to the initiation or amplification of psychological distress immediately and the effects may linger over the day.Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.1927051.
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Affiliation(s)
- Shun Ting Yung
- Department of Psychological Sciences, University of California, Merced, California, USA
| | - Yaoyu Chen
- Department of Psychological Sciences, University of California, Merced, California, USA
| | - Matthew J Zawadzki
- Department of Psychological Sciences, University of California, Merced, California, USA
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16
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Marin-Farrona M, Leon-Jimenez M, Garcia-Unanue J, Gallardo L, Crespo-Ruiz C, Crespo-Ruiz B. Transtheoretical Model Is Better Predictor of Physiological Stress than Perceived Stress Scale and Work Ability Index among Office Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4410. [PMID: 32575454 PMCID: PMC7345331 DOI: 10.3390/ijerph17124410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
Physical activity impacts positively on stress and anxiety. Working conditions affect the quality of life by increasing stress levels, which can affect job performance and work absence. The Perceived Stress Scale (PSS), Work Ability Index (WAI), Transtheoretical Model (TTM), as well as heart rate variability (HRV) have been applied to monitor the state of workers in their job. The aim of this study was to analyze PSS, WAI, and TTM classifications, and to find out how are they linked to physiological stress (HRV). One hundred and thirteen office workers responded to the three questionnaires and their HRV was monitored for at least two full days. Groups were set up according to TTM (Stage 1, Stage 2, Stage 3-4, Stage 5), WAI (weak WAI, medium WAI, good WAI), and PSS (low PSS, medium PSS, high PSS). Results obtained from the test were related to stress values measured by HRV with a Bodyguard2 device. The Stage 5 group from TTM had better HVR and stress levels than the other groups for both women and men (p < 0.05). Participants in the good WAI group and low PSS group had better results than weak WAI and high PSS, but the differences with respect to medium WAI and medium PSS were less clear. Finally, TTM seemed to be the best tool to discriminate physiological stress in office workers with regard to other questionnaires.
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Affiliation(s)
- Maria Marin-Farrona
- IGOID Research Group, Department of Physical Activity and Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Manuel Leon-Jimenez
- IGOID Research Group, Department of Physical Activity and Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Jorge Garcia-Unanue
- IGOID Research Group, Department of Physical Activity and Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Leonor Gallardo
- IGOID Research Group, Department of Physical Activity and Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain
| | | | - Beatriz Crespo-Ruiz
- IGOID Research Group, Department of Physical Activity and Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain
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Association between Reallocation Behaviors and Subjective Health and Stress in South Korean Adults: An Isotemporal Substitution Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072488. [PMID: 32260548 PMCID: PMC7178139 DOI: 10.3390/ijerph17072488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022]
Abstract
This study used an isotemporal substitution (IS) model to determine the potential reallocation effects of sedentary behavior (SB) and physical activity (PA) on subjective health and stress in South Koreans with data from the Sixth Korean National Health and Nutrition Examination Survey 2015. The analysis included 791 participants whose accelerometer-measured PA was available, divided into three age groups (young adults = 151; mid-age adults = 334; older adults = 306). We adopted SB, light PA (LPA), and moderate-to-vigorous PA (MVPA) to determine how time was allocated to each activity level, then examined the effects of reallocation on subjective health and stress across age groups. The analyses were performed in three steps: single-activity, partition, and IS model. An additional ANCOVA was conducted on statistically significant outcomes (i.e., subjective health of young and older adults). We found that among young adults, reallocating 30 min/week of SB to LPA and to MVPA was linked to high levels of subjective health. In older adults, reallocating 30 min/week of SB and LPA to MVPA was associated with high subjective health. However, this relationship was not observed in mid-age adults. None of the age groups showed a relationship between any activity reallocation and stress. Our findings provide the first insight on the development of interventions aimed at promoting active, healthier lifestyles on the basis of behavior reallocation in South Koreans.
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Scott SB, Mogle JA, Sliwinski MJ, Jim HSL, Small BJ. Memory lapses in daily life among breast cancer survivors and women without cancer history. Psychooncology 2020; 29:861-868. [PMID: 32040229 PMCID: PMC10141683 DOI: 10.1002/pon.5357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cancer-associated cognitive decline is a concern among cancer survivors. Survivors' memory lapses (eg, location of keys, names, and reason entered room) may negatively impact quality of life. This study used smartphone-based surveys to compare cancer survivors to those without cancer history on frequency of, severity of, and affective response to daily memory lapses. METHODS For 14 evenings, breast cancer survivors (N = 47, M age = 52.9) and women without a cancer history (N = 105, M age = 51.8) completed smartphone-based surveys on memory lapse occurrence and severity and negative and positive affect. RESULTS Survivors were nearly three times more likely to report a daily memory lapse but did not differ from comparison group on memory lapse severity. Negative affect was significantly higher on days with memory lapses associated with doing something in the future (eg, appointments) but this did not differ across groups. Positive affect was not significantly related to survivorship status or the occurrence of daily memory lapses. CONCLUSION Survivors may be at-risk for more frequent memory lapses. Both survivors and women without a history of cancer reported greater negative affect on days when memory lapses occurred, suggesting that daily cognitive functioning may have important implications for quality of life.
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Affiliation(s)
- Stacey B Scott
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Jacqueline A Mogle
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | - Martin J Sliwinski
- Department of Human Developmental & Family Studies, Center for Healthy Aging, Pennsylvania State University, University Park, Pennsylvania
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Brent J Small
- School of Aging Studies, University of South Florida and H. Lee Moffitt Cancer, Tampa, Florida
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Bell KA, Kobayashi I, Akeeb A, Lavela J, Mellman TA. Emotional response to perceived racism and nocturnal heart rate variability in young adult African Americans. J Psychosom Res 2019; 121:88-92. [PMID: 30955911 PMCID: PMC6703551 DOI: 10.1016/j.jpsychores.2019.03.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 03/15/2019] [Accepted: 03/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heightened autonomic nervous system (ANS) arousal is a well-established contributor to the effect of stress on adverse cardiovascular health outcomes which disproportionately affect African Americans. ANS arousal is normally attenuated during sleep and compromise of this shift is associated with multiple adverse cardiovascular outcomes. Parasympathetic nervous system (PNS) dominance during sleep can be altered by stress. Racism has been recognized to have many negative health consequences in African Americans. Perceived racism has been linked to ANS activity, however, we are not aware of prior research on racism and nocturnal ANS balance. OBJECTIVE To examine relationships between perceived racism and nocturnal ANS activity indexed by heart rate variability (HRV) in healthy African American men and women age 18-35. METHODS Fifty-four participants completed the Perceived Racism Scale and had 24-hour ambulatory electrocardiogram recordings in their homes. Power spectral analysis was used to derive normalized high frequency (nHF) to index PNS activity which was computed by 5-minute epochs during wake and sleep. RESULTS Endorsement of racism and negative emotional reactions during the past year were inversely related to nHF during time in bed. Multiple regression analysis indicated that negative emotional reactions were a significant predictor of nHF during the sleep period F(2,54) = 4.213, p = .020, R2 = 0.135 (adjusted R2 = 0.103). Relationships during wake were not statistically significant. CONCLUSION Findings suggest that perseverative thoughts triggered by negative emotional reactions to racism influencing nocturnal ANS activity may be a pathway by which perceived racism affects health. Support: 3UL1TR001409-02S1 and R01HL087995 to Dr. Mellman.
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Affiliation(s)
| | - Ihori Kobayashi
- Howard University, College of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - Ameenat Akeeb
- Howard University College of Medicine Department of Psychiatry and Behavioral Sciences
| | - Joseph Lavela
- Howard University, College of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - Thomas A. Mellman
- Howard University College of Medicine Department of Psychiatry and Behavioral Sciences
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Neubauer AB, Scott SB, Sliwinski MJ, Smyth JM. How was your day? Convergence of aggregated momentary and retrospective end-of-day affect ratings across the adult life span. J Pers Soc Psychol 2019; 119:185-203. [PMID: 31070397 DOI: 10.1037/pspp0000248] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Daily diary studies and experience sampling studies examine day-to-day variations in affect using different rating types: The former typically collect retrospective affect reports at the end of the day, whereas the latter collects multiple momentary assessments across the day. The present study examined the convergence of (aggregated) momentary assessments collected repeatedly within a day and retrospective assessments collected at the end of the day. Building on prior research on the memory-experience gap and the peak-and-end rule we predicted that participants would report more intense retrospective affect than aggregated momentary affect, and that retrospective affect would be biased toward the peak and the most recent affect of the day. Based on socioemotional selectivity theory and the strength and vulnerability integration model, age differences in these convergence indicators were expected. Findings from 2 age-heterogeneous ecological momentary assessment/daily diary hybrid studies (N = 242, 25-65 years; and N = 175, 20-79 years) revealed (a) a memory-experience gap for negative affect (more intense retrospective ratings than aggregated momentary ratings) that is attenuated with advancing age; (b) only a small memory-experience gap for positive affect for very old adults (66-79 years), but not younger adults; (c) relatively high convergence of aggregated momentary ratings and retrospective ratings despite (d) small biases of retrospective negative affect ratings toward peak and most recent negative affect. Findings suggest that both rating types can discriminate "good days" from "bad days" and provide overlapping but not necessarily exchangeable information. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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