Intraindividual change and variability in daily stress processes: findings from two measurement-burst diary studies

From the COVID-19 lockdown to the new normal: Two-year changes in daily stress and positive event processes

The emergence of the novel COVID-19 disease and the social distancing measures implemented to curb its spread affected most aspects of daily life. Past work suggests that during times of more severe stress, people respond to daily stressors with relatively higher negative affect. However, little is known about how people responded to daily stressors and positive events at different moments in time during the COVID-19 pandemic. Thus, we examined longitudinal changes in daily event-related affect (covariation of daily stressors or positive events with same-day affect) from Spring 2020 (wave 1) to 2022 (wave 2). The sample consisted of 324 adults aged 18-80 (mean = 52 years; 89% women) from the US and Canada who completed weeklong daily diaries at both waves. The results revealed improvements in affective well-being, stressor-related affect (i.e., smaller fluctuations in affect on stressor days vs. nonstressor days), and positive event-related affect (i.e., lower negative affect on days with vs. without positive events). Furthermore, as people gradually resumed their social activities from 2020 to 2022, people reported being exposed to an increased frequency of both stressors and positive events. This study highlights the potential influence of socio-historical phenomena, such as an ongoing pandemic, on the events that people encounter and how they emotionally respond to them.

Nocturnal hypoglycemia is associated with next day cognitive performance in adults with type 1 diabetes: Pilot data from the GluCog study

OBJECTIVE

 Individuals with type 1 diabetes (T1D) have increased risk for cognitive dysfunction and high rates of sleep disturbance. Despite associations between glycemia and cognitive performance using cross-sectional and experimental methods few studies have evaluated this relationship in a naturalistic setting, or the impact of nocturnal versus daytime hypoglycemia. Ecological Momentary Assessment (EMA) may provide insight into the dynamic associations between cognition, affective, and physiological states. The current study couples EMA data with continuous glucose monitoring (CGM) to examine the within-person impact of nocturnal glycemia on next day cognitive performance in adults with T1D. Due to high rates of sleep disturbance and emotional distress in people with T1D, the potential impacts of sleep characteristics and negative affect were also evaluated.

METHODS

 This pilot study utilized EMA in 18 adults with T1D to examine the impact of glycemic excursions, measured using CGM, on cognitive performance, measured via mobile cognitive assessment using the TestMyBrain platform. Multilevel modeling was used to test the within-person effects of nocturnal hypoglycemia and hyperglycemia on next day cognition.

RESULTS

 Results indicated that increases in nocturnal hypoglycemia were associated with slower next day processing speed. This association was not significantly attenuated by negative affect, sleepiness, or sleep quality.

CONCLUSIONS

 These results, while preliminary due to small sample size, showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive fluctuation in real world settings, an approach that may be utilized in other populations. Findings suggest reducing nocturnal hypoglycemia may improve cognition in adults with T1D.

Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis With Ambulatory Cognitive Tests: Protocol for the Longitudinal Observational CogDetect-MS Study

BACKGROUND

Cognitive dysfunction is a common problem in multiple sclerosis (MS). Progress toward understanding and treating cognitive dysfunction is thwarted by the limitations of traditional cognitive tests, which demonstrate poor sensitivity and ecological validity. Ambulatory methods of assessing cognitive function in the lived environment may improve the detection of subtle changes in cognitive function and the identification of predictors of cognitive changes and downstream effects of cognitive change on other functional domains.

OBJECTIVE

This paper describes the study design and protocol for the Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis (CogDetect-MS) study, a 2-year longitudinal observational study designed to examine short- and long-term changes in cognition, predictors of cognitive change, and effects of cognitive change on social and physical function in MS.

METHODS

Participants-ambulatory adults with medically documented MS-are assessed over the course of 2 years on an annual basis (3 assessments: T1, T2, and T3). A comprehensive survey battery, in-laboratory cognitive and physical performance tests, and 14 days of ambulatory data collection are completed at each annual assessment. The 14-day ambulatory data collection includes continuous wrist-worn accelerometry (to measure daytime activity and sleep); ecological momentary assessments (real-time self-report) of somatic symptoms, mood, and contextual factors; and 2 brief, validated cognitive tests, administered by smartphone app 4 times per day. Our aim was to recruit 250 participants. To ensure standard test protocol administration, all examiners passed a rigorous examiner certification process. Planned analyses include (1) nonparametric 2-tailed t tests to compare in-person to ambulatory cognitive test scores; (2) mixed effects models to examine cognitive changes over time; (3) mixed effects multilevel models to evaluate whether ambulatory measures of physical activity, sleep, fatigue, pain, mood, and stress predict changes in objective or subjective measures of cognitive functioning; and (4) mixed effects multilevel models to examine whether ambulatory measures of cognitive functioning predict social and physical functioning over short (within-day) and long (over years) time frames.

RESULTS

The study was funded in August 2021 and approved by the University of Michigan Medical Institutional Review Board on January 27, 2022. A total of 274 adults with MS (first participant enrolled on May 12, 2022) have been recruited and provided T1 data. Follow-up data collection will continue through March 2026.

CONCLUSIONS

Results from the CogDetect-MS study will shed new light on the temporal dynamics of cognitive function, somatic and mood symptoms, sleep, physical activity, and physical and social function. These insights have the potential to improve our understanding of changes in cognitive function in MS and enable us to generate new interventions to maintain or improve cognitive function in those with MS.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05252195; https://clinicaltrials.gov/study/NCT05252195.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59876.

Associations between Daily Stressors, Health, and Affective Responses among Older Adults: The Moderating Effect of Age

INTRODUCTION

Reactivity to daily stressors may change as a function of stressor type and age. However, prior research often excludes older adults or compares them to younger age groups (e.g., younger and middle-aged adults). Recognizing older adults as a heterogeneous population with shifting motivations, this study focused on individuals aged ≥65 years and tested age differences in associations between different types of daily stressors, affect, and physical symptoms.

METHODS

A total of 108 older adults aged 65-92 years (M = 73.11, SD = 5.92; 58% women) completed daily dairy questionnaires on daily stressors, positive and negative affect, and physical symptoms for 14 consecutive days. Multilevel models were employed, adjusting for sex, age, education, living situation, and day-in-study.

RESULTS

Findings revealed age-dependent variations in the associations between daily stressors and affect and physical symptoms. Specifically, external stressors (e.g., finance and traffic stressors) and health stressors were more strongly associated with daily affective states and with overall physical symptoms (respectively) among older age adults. Age did not moderate associations between social stressors and affect or physical symptoms.

CONCLUSION

These findings underscore the heterogeneous nature of older adults' responses to daily stressors based on stressor type and age. Specifically, the oldest-old might benefit from personalized support for dealing with challenges such as health and financial stressors.

Age Differences Among Within-Person Indicators of Stress and Depressive Affect

We examined age differences in the within-person relationships among perceived stress (PS), perceived stress reactivity (PSR), and depressive affect (DA) as well as potential mechanisms of depression with a longitudinal moderated mediation model. Participants from the Notre Dame Study of Health & Wellbeing (N = 572) completed two to four waves of yearly assessments. Sequentially built multilevel models, in which year was nested within person, illustrated that only midlife adults experience an exacerbated effect of within-person fluctuations in PSR on the relationship between within-person PS and DA levels (γ41 = -.004, p < .01). Findings further suggest that PSR accounts for the PS-DA relationship. Furthermore, older adults illustrate successful emotion regulation strategies at the yearly level-resisting the negative ramifications of years of greater PS and PSR, whereas midlife adults who experience years of greater PSR would particularly benefit from stress management interventions and monitoring of DA levels.

Feasibility and acceptability of measuring prenatal stress in daily life using smartphone-based ecological momentary assessment and wearable physiological monitors

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.

Brain control of dual-task walking can be improved in aging and neurological disease

The peak prevalence of multiple sclerosis has shifted into older age groups, but co-occurring and possibly synergistic motoric and cognitive declines in this patient population are poorly understood. Dual-task-walking performance, subserved by the prefrontal cortex, and compromised in multiple sclerosis and aging, predicts health outcomes. Whether acute practice can improve dual-task walking performance and prefrontal cortex hemodynamic response efficiency in multiple sclerosis has not been reported. To address this gap in the literature, the current study examined task- and practice-related effects on dual-task-walking and associated brain activation in older adults with multiple sclerosis and controls. Multiple sclerosis (n = 94, mean age = 64.76 ± 4.19 years) and control (n = 104, mean age = 68.18 ± 7.01 years) participants were tested under three experimental conditions (dual-task-walk, single-task-walk, and single-task-alpha) administered over three repeated counterbalanced trials. Functional near-infrared-spectroscopy was used to evaluate task- and practice-related changes in prefrontal cortex oxygenated hemoglobin. Gait and cognitive performances declined, and prefrontal cortex oxygenated hemoglobin was higher in dual compared to both single task conditions in both groups. Gait and cognitive performances improved over trials in both groups. There were greater declines over trials in oxygenated hemoglobin in dual-task-walk compared to single-task-walk in both groups. Among controls, but not multiple sclerosis participants, declines over trials in oxygenated hemoglobin were greater in dual-task-walk compared to single-task-alpha. Dual-task walking and associated prefrontal cortex activation efficiency improved during a single session, but improvement in neural resource utilization, although significant, was attenuated in multiple sclerosis participants. These findings suggest encouraging brain adaptability in aging and neurological disease.

Daily stigma and daily emotional well-being among people living with HIV: Testing a buffering hypothesis of social support during the COVID-19 pandemic

This study examined the relationship between daily perceived stigma and daily emotional well-being among people living with HIV/AIDS during the COVID-19 pandemic. Additionally, a buffering effect of perceived emotional support on this relationship was verified. The participants were 133 patients with a medically confirmed diagnosis of HIV infection. Data were collected using online diaries completed every evening for five consecutive weekdays in three bursts separated by 6 months. Dynamic multilevel analyses showed a significant positive autoregressive effect for daily stigma in each burst. Additionally, increased stigma predicts increased negative affect and decreased positive affect the next day. However, these effects differed across bursts. Thus, to some extent, daily HIV/AIDS stigma was found to predict a decrease in affective well-being the next day. The buffering effect of perceived emotional support reduced this decline but was also time-limited, probably because of the later established direction in these relationships at the individual level and/or because of changes in the course of the pandemic. The results provide insights on the role of daily stigma in shaping affective well-being, suggesting that it may be a significant source of short-term negative emotional consequences for PWLH.

Toxic sensation seeking? Psychological distress, cyberbullying, and the moderating effect of online disinhibition among adults

Cyberbullying among adults is barely studied, though its consequences may be as severe as in children and adolescents. The present study investigated the links between psychological distress, cyber-perpetration, and passive cyber-bystander behavior. We also explored the moderating role of toxic disinhibition in this regard. Our sample comprised 385 adults aged 19-66 (M = 28.35, SD = 11.22, 76.62% females). The results suggested that psychological distress was significantly associated with cyberbullying perpetration and passive bystander behavior. Also, higher psychological distress significantly predicted toxic disinhibition. Further moderation analyses suggested that at high and medium levels of toxic disinhibition, psychological distress significantly predicted cyberbullying perpetration but not passive cyber-bystander behavior. Finally, we discuss our results regarding their theoretical and practical implication for cyberbullying prevention among adults.

Emotional distress and multimorbidity patterns in Chinese Han patients with osteoporosis: a network analysis

With the aging of the population, the prevalence of osteoporosis and multimorbidity is increasing. Patients with osteoporosis often experience varying levels of emotional distress, including anxiety and depression. However, few studies have explored the patterns of multiple conditions and their impact on patients' emotional distress. Here, we conducted a network analysis to explore the patterns of multimorbidities and their impact on emotional distress in 13,359 Chinese Han patients with osteoporosis. The results showed that multimorbidity was prevalent in Chinese patients with osteoporosis and increased with age, and was more frequent in males than in females, with the most common pattern of multimorbidity being osteoporosis and essential (primary) hypertension. Finally, we found that patients' emotional distress increased with the number of multimorbidities, especially in female patients, and identified eight multimorbidities with high correlation to patients' emotional distress.

A precision neuroscience approach to estimating reliability of neural responses during emotion processing: Implications for task-fMRI

Recent work demonstrating low test-retest reliability of neural activation during fMRI tasks raises questions about the utility of task-based fMRI for the study of individual variation in brain function. Two possible sources of the instability in task-based BOLD signal over time are noise or measurement error in the instrument, and meaningful variation across time within-individuals in the construct itself-brain activation elicited during fMRI tasks. Examining the contribution of these two sources of test-retest unreliability in task-evoked brain activity has far-reaching implications for cognitive neuroscience. If test-retest reliability largely reflects measurement error, it suggests that task-based fMRI has little utility in the study of either inter- or intra-individual differences. On the other hand, if task-evoked BOLD signal varies meaningfully over time, it would suggest that this tool may yet be well suited to studying intraindividual variation. We parse these sources of variance in BOLD signal in response to emotional cues over time and within-individuals in a longitudinal sample with 10 monthly fMRI scans. Test-retest reliability was low, reflecting a lack of stability in between-person differences across scans. In contrast, within-person, within-session internal consistency of the BOLD signal was higher, and within-person fluctuations across sessions explained almost half the variance in voxel-level neural responses. Additionally, monthly fluctuations in neural response to emotional cues were associated with intraindividual variation in mood, sleep, and exposure to stressors. Rather than reflecting trait-like differences across people, neural responses to emotional cues may be more reflective of intraindividual variation over time. These patterns suggest that task-based fMRI may be able to contribute to the study of individual variation in brain function if more attention is given to within-individual variation approaches, psychometrics-beginning with improving reliability beyond the modest estimates observed here, and the validity of task fMRI beyond the suggestive associations reported here.

Daily emotional dynamics and changes in posttraumatic growth and posttraumatic depreciation among people living with HIV

OBJECTIVE

Posttraumatic growth (PTG), and its negative reflection, posttraumatic depreciation (PTD), are two aspects of response to trauma. This study explores whether daily emotional dynamics (inertia and innovation) can translate into positive versus negative changes among people living with HIV (PLWH) in the form of long-term changes in PTG or PTD.

METHODS

The study combined a classical longitudinal approach with two assessments of PTG and PTD within one year and a measurement burst diary design with three weekly electronic diaries. In total, 249 PLWH participated in this study, filling out an expanded version of the Posttraumatic Growth and Depreciation Inventory (PTGDI-X) and a survey of sociodemographic and clinical data. In addition, they assessed their positive affect (PA) and negative affect (NA) at the end of each day in online diaries using a shortened version of the PANAS-X.

RESULTS

Although we observed stable significant inertia and innovation of PA and NA across all bursts, these parameters of daily emotional dynamics were unrelated to the longitudinal changes in PTG and PTD. The same null results were also noted for the average levels of NA and PA.

CONCLUSIONS

The results indicated the relative stability of emotion regulation in PLWH over the course of one year and contributed to understanding its dynamic mechanisms in terms of trait-like characteristics. The null result of the relationship between the PTG and PTD change might suggest a weak role of emotion regulation in shaping these trajectories as well as a lack of validity of the PTG/PTD measures.

Sometimes you just can't: within-person variation in working memory capacity moderates negative affect reactivity to stressor exposure

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.

Reactivity toward daily events: Intraindividual variability and change in recurrent depression - A measurement burst study

In Major Depressive Disorder, first evidence shows heightened mood-reactivity toward daily events. Related longitudinal studies in remitted patients with recurrent major depression are lacking. Long-term changes in such short-term within-person associations can be analysed via measurement burst designs. Two bursts, separated by approximately 4.4 years, consisted of a baseline session and an Ambulatory Assessment (burst-1: 3 days, burst-2: 5 days). Via smartphone, 54 initially remitted patients with recurrent major depression indicated their negative and positive affect, rumination, self-acceptance, and the occurrence of negative and positive daily events ten times and collected saliva cortisol samples five times per day. In bursts with higher depression levels, patients showed blunted negative affect- and cortisol-reactivity and stronger decreases in positive affect and self-acceptance toward negative daily events, as well as stronger increases in self-acceptance following positive daily events. However, patients with higher depression levels demonstrated stronger ruminative stress-reactivity within bursts. Furthermore, patients with higher depression levels showed an increase of affective stress-reactivity over bursts, such that negative affect more strongly increased and positive affect more strongly decreased following negative daily events over bursts. Following positive daily events, patients with higher depression levels showed stronger decreases in negative affect within bursts and a decrease of self-acceptance-reactivity over bursts. To conclude, measurement burst designs enable to examine intraindividual variability and change of micro-level processes, and possible moderators thereof, potentially providing prognostic information for the course of recurrent major depression.

Accurate Prediction of Momentary Cognition From Intensive Longitudinal Data

BACKGROUND

Deficits in cognitive performance are implicated in the development and maintenance of psychopathology. Emerging evidence further suggests that within-person fluctuations in cognitive performance may represent sensitive early markers of neuropsychiatric decline. Incorporating routine cognitive assessments into standard clinical care-to identify between-person differences and monitor within-person fluctuations-has the potential to improve diagnostic screening and treatment planning. In support of these goals, it is critical to understand to what extent cognitive performance varies under routine, remote assessment conditions (i.e., momentary cognition) in relation to a wide range of possible predictors.

METHODS

Using data-driven, high-dimensional methods, we ranked strong predictors of momentary cognition and evaluated out-of-sample predictive accuracy. Our approach leveraged innovations in digital technology, including ambulatory assessment of cognition and behavior 1) at scale (n = 122 participants, n = 94 females), 2) in naturalistic environments, and 3) within an intensive longitudinal study design (mean = 25.5 assessments/participant).

RESULTS

Reaction time (R2 > 0.70) and accuracy (0.56 >R2 > 0.35) were strongly predicted by age, between-person differences in mean performance, and time of day. Effects of self-reported, intraindividual fluctuations in environmental (e.g., noise) and internal (e.g., stress) states were also observed.

CONCLUSIONS

Our results provide robust estimates of effect size to characterize sources of cognitive variability, to support the identification of optimal windows for psychosocial interventions, and to possibly inform clinical evaluation under remote neuropsychological assessment conditions.

Tamoxifen Effects on Cognition and Language in Women with Breast Cancer

Cognitive changes following adjuvant treatment for breast cancer (BC) are well documented following chemotherapy. However, limited studies have examined cognitive and/or language functions in chemotherapy-naive women with BC taking tamoxifen (TAM). Using ambulatory cognitive assessment, we investigated the trajectory of cognitive and language changes during early period of adjuvant endocrine treatment (TAM) in women with BC at two time periods (pretreatment and 2 months after treatment began). Four women with BC and 18 cognitively healthy age-matched controls completed three cognitive tasks using smartphones, during a short time period (5 days) and repeated them at two time periods. To determine language ability, language samples were collected at two time periods, where the participants described two stories from two wordless picture books and samples were assessed using core lexicon analyses. Wilcoxon-signed rank tests were computed to identify differences in linguistic and cognitive performances of both the groups at two time periods. No significant within-group or between-group differences were seen on the cognitive and language tasks at the two time periods; however, women with BC performed more poorly compared to the control group. We did see decline in some women with BC and not in others, in cognition and language during initial course of TAM treatment. However, the approach we used to assess these changes is valuable and innovative. This approach will help refine current research paradigms for determining cognitive and linguistic changes and will help determine if women with BC might require language intervention in the future.

Associations of SLC6A4 methylation with salivary cortisol, salivary alpha-amylase, and subjective stress in everyday life

Dysregulations of the hypothalamic-pituitary-adrenal (HPA) and sympatho-adrenal medullary (SAM) axis are associated with mental and somatic illness. However, there is lack of knowledge regarding the molecular mechanisms underlying these effects. Epigenetic states in the serotonin transporter gene (SLC6A4) were shown to be associated with stress in various forms. We hypothesized that levels of DNA methylation (DNAm) of SLC6A4 would be associated with altered SAM- and HPA regulation in daily life. N = 74 healthy persons participated in the study. An ecological momentary assessment (EMA) approach was used to assess indicators of stress in daily life. Each day included six concurrent assessments of saliva, to quantify cortisol (sCort; HPA axis) and alpha-amylase (sAA; SAM axis), and to assess self-reports on subjective stress. To assess SLC6A4 DNAm, peripheral blood was drawn and analyzed via bisulfite pyrosequencing. All data were assessed in two waves three months apart, each including two days of EMA and the assessment of SLC6A4 DNAm. Data were analyzed using multilevel models. On the between-person level, higher average levels of SLC6A4 DNAm were associated with higher average levels of sAA, but not with average levels of sCort. On the within-person level, higher levels of SLC6A4 DNAm were associated with lower levels of sAA and sCort. There were no associations of subjective stress with SLC6A4 DNAm. The results help to clarify the association between environmental stress and stress axes regulation, pointing towards an important role of differential within- and between-person effects of SLC6A4 DNAm, which might shape this association.

Longitudinal change in daily stress across 20 years of adulthood: Results from the national study of daily experiences

This study examined age-related patterns in exposure and affective reactivity to daily stressors across a 20-year time span among adults who were between 22 and 77 years old at their baseline interview. Longitudinal data from the National Study of Daily Experiences (NSDE) consisted of three bursts of eight consecutive nightly interviews of stress and affect. Analyses made use of all available data from a U.S. National sample of respondents who participated in any of the three NSDE bursts (N = 2,845; number of daily assessments = 33,688). Findings revealed increasing age-related benefits. Younger adults (< 30 years) reported the highest levels of stressor exposure and reactivity, but their stress profile improved with age. Over time, adults averaged an 11% reduction in the occurrence of stressor days, and the younger adults exhibited an even steeper decline (a 47% reduction) in their levels of stressor reactivity. For people in midlife and old age, stressor occurrence continued to decrease over time, yet among adults aged 54 years or older at baseline, stress reactivity remained stable across time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Additive Effects of Stress and Alcohol Exposure on Accelerated Epigenetic Aging in Alcohol Use Disorder

BACKGROUND

Stress contributes to premature aging and susceptibility to alcohol use disorder (AUD), and AUD itself is a factor in premature aging; however, the interrelationships of stress, AUD, and premature aging are poorly understood.

METHODS

We constructed a composite score of stress from 13 stress-related outcomes in a discovery cohort of 317 individuals with AUD and control subjects. We then developed a novel methylation score of stress (MS stress) as a proxy of composite score of stress comprising 211 CpGs selected using a penalized regression model. The effects of MS stress on health outcomes and epigenetic aging were assessed in a sample of 615 patients with AUD and control subjects using epigenetic clocks and DNA methylation-based telomere length. Statistical analysis with an additive model using MS stress and a MS for alcohol consumption (MS alcohol) was conducted. Results were replicated in 2 independent cohorts (Generation Scotland, N = 7028 and the Grady Trauma Project, N = 795).

RESULTS

Composite score of stress and MS stress were strongly associated with heavy alcohol consumption, trauma experience, epigenetic age acceleration (EAA), and shortened DNA methylation-based telomere length in AUD. Together, MS stress and MS alcohol additively showed strong stepwise increases in EAA. Replication analyses showed robust association between MS stress and EAA in the Generation Scotland and Grady Trauma Project cohorts.

CONCLUSIONS

A methylation-derived score tracking stress exposure is associated with various stress-related phenotypes and EAA. Stress and alcohol have additive effects on aging, offering new insights into the pathophysiology of premature aging in AUD and, potentially, other aspects of gene dysregulation in this disorder.

Perceived stress trajectories from age 25 to 50 years

Trajectories of perceived stress from the transition to adulthood (age 25), during young adulthood (age 32), and into midlife (ages 43 and 50) were examined with four waves of longitudinal survey data ( N = 688; 49% female, 37% with a university degree, 86% White). We explored how between- and within-person variation in perceived stress was associated with age 50 psychological well-being (life satisfaction and eudaimonic well-being), self-reported physical health, career satisfaction, and intimate partnership satisfaction. Growth curve analyses revealed stress followed a linear decreasing trajectory from the transition to adulthood into midlife with substantial variability underlying the average pattern. Between- and within-person variation in perceived stress was associated with midlife functioning. Those with lower initial levels of and more decline in perceived stress reported better psychological and physical health and higher relationship satisfaction at age 50 compared to those with initially higher perceived stress and less decline over time. Higher than one’s own average perceived stress at ages 25, 32, 43, and 50 years was associated with lower psychological and physical health and intimate partnership satisfaction at age 50. These results support key contentions of developmental theory and may prove useful when designing interventions aimed at promoting well-being in midlife.

Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition

BACKGROUND

Individuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to study intraindividual variation over time, has only recently been used to deliver cognitive assessments in daily life, and many methodological questions remain. The Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) study uses EMA to deliver cognitive and self-report measures while simultaneously collecting passive interstitial glucose in adults with type 1 diabetes.

OBJECTIVE

We aimed to report the results of an EMA optimization pilot and how these data were used to refine the study design of the GluCog study. An optimization pilot was designed to determine whether low-frequency EMA (3 EMAs per day) over more days or high-frequency EMA (6 EMAs per day) for fewer days would result in a better EMA completion rate and capture more hypoglycemia episodes. The secondary aim was to reduce the number of cognitive EMA tasks from 6 to 3.

METHODS

Baseline cognitive tasks and psychological questionnaires were completed by all the participants (N=20), followed by EMA delivery of brief cognitive and self-report measures for 15 days while wearing a blinded continuous glucose monitor. These data were coded for the presence of hypoglycemia (<70 mg/dL) within 60 minutes of each EMA. The participants were randomized into group A (n=10 for group A and B; starting with 3 EMAs per day for 10 days and then switching to 6 EMAs per day for an additional 5 days) or group B (N=10; starting with 6 EMAs per day for 5 days and then switching to 3 EMAs per day for an additional 10 days).

RESULTS

A paired samples 2-tailed t test found no significant difference in the completion rate between the 2 schedules (t17=1.16; P=.26; Cohen dz=0.27), with both schedules producing >80% EMA completion. However, more hypoglycemia episodes were captured during the schedule with the 3 EMAs per day than during the schedule with 6 EMAs per day.

CONCLUSIONS

The results from this EMA optimization pilot guided key design decisions regarding the EMA frequency and study duration for the main GluCog study. The present report responds to the urgent need for systematic and detailed information on EMA study designs, particularly those using cognitive assessments coupled with physiological measures. Given the complexity of EMA studies, choosing the right instruments and assessment schedules is an important aspect of study design and subsequent data interpretation.

Preliminary effectiveness of an evidence-based mobile application to promote resilience among working adults in Singapore and Hong Kong: Intensive longitudinal study

Evidence-based mobile health (mHealth) applications on smartphones are a cost-effective way for employees to take proactive steps to improve well-being and performance. However, little is known about what sustains engagement on these applications and whether they could dynamically improve occupational outcomes such as resilience and mood. Using real-world data, this intensive longitudinal study examines (a) which employees would continually engage with a cognitive behavioural therapy-informed mHealth application ('Intellect'); and (b) if daily engagement of 'Intellect' would relate to better occupational outcomes on the following day. A total of 515 working adults in Singapore and Hong Kong (Mage = 32.4, SDage = 8.17) completed daily in-app items on mood and resilience components (i.e. sleep hours, sleep quality, physical activity, and stress levels). Our results revealed that employees with lower baseline resilience (β = -0.048, odds ratio (OR) = 0.953, p < 0.01), specifically poorer sleep quality (β = -0.212, OR = 0.809, p = 0.001) and/or higher stress levels (β = -0.255, OR = 0.775, p = 0.05), were more likely to resume engagement on the application. Among the 150 active users (i.e. ≥3 consecutive days of engagement) (Mage = 32.2, SDage = 8.17), daily engagement predicted higher resilience (β = 0.122; 95% confidence interval (CI) 0.039-0.206), specifically lower stress levels (β = 0.018; 95% CI 0.004-0.032), higher physical activity (β = 0.079; 95% CI 0.032-0.126), and mood levels (β = 0.020; 95% CI 0.012-0.029) on the following day even after controlling for same-day outcomes. Our preliminary findings suggest that engaging with a mHealth application was associated with higher dynamic resilience and emotional well-being in employees.

Daily Stress and Microvascular Dysfunction: The Buffering Effect of Physical Activity

Although often short-lived, emotional responsiveness to daily stressors ( i.e. , routine and sometimes unexpected everyday hassles) is associated with increased cardiovascular disease (CVD), morbidity, and mortality. Here, we present the novel hypothesis that a disruption of microvascular homeostasis is a key antecedent. In addition, we postulate that physical activity may mitigate the psychobiological consequences of daily stress, thereby limiting pathophysiological CVD-related sequelae.

Computing Components of Everyday Stress Responses: Exploring Conceptual Challenges and New Opportunities

Repeated assessments in everyday life enables collecting ecologically valid data on dynamic, within-persons processes. These methods have widespread utility and application and have been extensively used for the study of stressors and stress responses. Enhanced conceptual sophistication of characterizing intraindividual stress responses in everyday life would help advance the field. This article provides a pragmatic overview of approaches, opportunities, and challenges when intensive ambulatory methods are applied to study everyday stress responses in "real time." We distinguish between three stress-response components (i.e., reactivity, recovery, and pileup) and focus on several fundamental questions: (a) What is the appropriate stress-free resting state (or "baseline") for an individual in everyday life? (b) How does one index the magnitude of the initial response to a stressor (reactivity)? (c) Following a stressor, how can recovery be identified (e.g., when the stress response has completed)? and (d) Because stressors may not occur in isolation, how can one capture the temporal clustering of stressors and/or stress responses (pileup)? We also present initial ideas on applying this approach to intervention research. Although we focus on stress responses, these issues may inform many other dynamic intraindividual constructs and behaviors (e.g., physical activity, physiological processes, other subjective states) captured in ambulatory assessment.

Associations between trait and state perceived stress and daily moods: COVID-19 stressful experiences as a moderator

Drastically disrupting daily routines, the global pandemic of COVID-19 has posed critical mental health threats to adolescents and young adults worldwide. Many of the extant empirical findings, however, have focused on individuals' psychological adjustment during the initial phase of the pandemic. It is less clear how COVID-19 stressful experiences impact young people's daily lives in the post-pandemic "new normal." Drawing on 7-day diary reports, the present study fills this gap by examining: (1) how daily perceived stress impacted daily emotional adjustment; and (2) the moderating effects of COVID-19 stressful experiences on these associations among 582 Chinese young adults (M age = 18.12, SD = .65; 69% females). Results indicated that higher levels of both trait (i.e., average levels) and state (i.e., daily fluctuations) perceived stress were associated with greater negative and anxious moods, and that prior pandemic-related experiences exacerbated the adverse impact of both trait and state perceived stress on daily moods. Specifically, young adults reporting greater COVID-19 stressful experiences demonstrated poorer emotional adjustment (i.e., lower levels of positive mood and higher levels of negative mood) on days when they had more fluctuations in perceived stress; the aggravating impact was stronger when the average levels of perceived stress were higher. By illuminating the moderating effects of COVID-19 stressful experiences, this study contributes to the limited, but burgeoning, research examining the prolonged impact of the COVID-19 health crisis on daily emotional adjustment in post-pandemic life.

Five-Factor Model Personality Traits and 24-hour Urinary Cortisol in the Baltimore Longitudinal Study of Aging

Stress is implicated in models of personality and health as a mechanism that explains why traits like conscientiousness and neuroticism are associated with long-term health outcomes. Evidence for an association between personality and cortisol, a biological marker of stress, however, has been inconsistent. This study examined the association between Five-Factor Model personality traits and 24-h urinary cortisol (operationalised as a ratio of urinary free cortisol to creatinine) measured up to 12 times over intervals as long as 30 years in the Baltimore Longitudinal Study of Aging (M_age  = 61.21, SD = 15.46; 49% female). There was a modest association between conscientiousness and lower mean-level cortisol that was attenuated only slightly in the fully-adjusted model. Neuroticism and the other traits were unrelated to cortisol levels, and none of the traits was related to cortisol change over time. The null association for neuroticism suggests that its relation with long-term health may be primarily through pathways other than cortisol. The modest association between conscientiousness and 24-h urinary cortisol replicates a previous finding with a longer-term measure of cortisol measured from hair, which calls for more research on the robustness and replicability of this finding. Cortisol may be one pathway through which conscientiousness is associated with health outcomes.

Daily association of stressors with perceived cognitive performance: Moderating role of age

Stress can elicit both positive and negative impacts on cognition. Less is known about whether and how daily stressors are associated with perceived cognitive performance in healthcare workers. We examined daily associations between stressors and perceived cognitive performance in nurses and whether these associations differed by age or nursing tenure. Using 14-day smartphone-based ecological momentary assessment, 60 inpatient nurses at a U.S. cancer hospital reported the frequency and severity of daily stressors (e.g., arguments, accidents). Each day, participants subjectively evaluated their mental focus, memory, and processing speed. Multilevel modelling examined the within- and between-person associations of daily stressors with cognitive performance. More stressors were associated with poorer perceived cognitive performance at both within- and between-person levels for both daily stressor frequency and severity. For moderation by age, the within-person stressor severity-cognitive performance relationship was only significant for nurses who were younger, but not for those who were older. Similarly, the within-person associations of daily stressor frequency and severity with cognitive performance were only significant for nurses with a shorter tenure. Findings suggest daily stressors may degrade perceived cognitive performance in nurses and the impact may be stronger for those who are younger or with less experience on the job.

Awareness of age-related gains and losses as moderators of daily stress reactivity in middle- and older-adulthood

Objectives

Associations between awareness of one's own aging and wellbeing have received increasing attention in the field of gerontology over the last decade. The current study examines how between-person differences and within-person fluctuations of awareness of age-related change (AARC) relate to daily negative affect and vitality. Of key interest was the extent to which fluctuations in AARC moderated reactivity to stressor exposure. We predicted that higher positive perceptions of aging (AARC-gains) would buffer the relationship between daily stressors and negative affect/vitality. Conversely, we expected that higher negative perceptions (AARC-losses) may exacerbate the relationship between daily stressors and the outcome variables.

Methods

Data were collected from a community-based sample of 152 Australian adults aged 53-86 (M = 69.18, SD = 5.73). For 10 consecutive days, participants completed surveys on their smartphones measuring daily stressors, AARC, and affect (positive and negative). Bayesian hierarchical linear models were used to examine whether AARC-gains and AARC-losses moderated within-person associations of daily stressors and affect (i.e., stress reactivity).

Results

At the between-person level, higher AARC-gains was associated with lower negative affect and higher vitality, whereas those reporting higher AARC-losses scored higher on negative affect and lower on vitality. Within-person variables revealed that on days when AARC-gains was higher and AARC-losses was lower, this corresponded with lower negative affect and higher vitality. There was no evidence in support of individual moderating effects of within-person AARC-losses or within-person AARC-gains on stress reactivity. A trend was evident in support of a three-way WP Stress severity × WP AARC-gains × WP AARC-losses interaction in the prediction of negative affect, indicating that on days when AARC-losses was higher, the association of stress severity with negative affect was weaker if AARC-gains was higher. Follow-up analyses modeling quadratic stress severity revealed a trend suggesting an interaction of within-person stress severity and within-person AARC-losses.

Discussion

Results indicate that both individual differences and short-term fluctuations in AARC are associated with daily negative affect and vitality. The results provided qualified support for a possible protective role of AARC-gains in the context of stress reactivity.

Daily Environments During Emerging Adulthood and Gender Atypical Occupational Choices: The Role of Sexist Experiences

Past research on occupational choices often focuses on the role of personal attributes. Research is needed that examines whether daily environments and individuals’ reactivity to these environments contribute to occupational choices. This study utilizes experience sampling methodology to examine whether daily sexism and affective reactivity to sexism predict the gender typicality of desired occupations of emerging adults in male-dominated majors (MDMs). 40 women and 40 men college students in MDMs reported desired occupations and experiences of sexism and general mood during the past hour four times a day for 2 weeks – allowing for an examination of whether some individuals report a more negative mood when they recently experienced sexism (i.e., reactivity). Results indicated that higher reactivity to sexism (but not daily sexism) predicted women desiring more female-typed and men desiring more male-typed occupations. Results suggest that career counselors should consider the role of daily sexism in career development.

Resilience to early family risk moderates stress-affect associations: A 14-day ecological momentary assessment study

BACKGROUND

Resilience in children with early family life adversity is linked with successful adulthood psychological outcomes. However, whether resilience influences daily emotional responses to stress remains unclear. This study examined whether resilience capacity in the context of early family risks predicts better daily stress and affect outcomes during a stressful transition.

METHODS

International and interstate undergraduates (N = 98; aged 18-25 years) were grouped as Resilient (high family risk, high resilience), Vulnerable (high family risk, low resilience), or Control (low family risk, average anxiety and depression). Daily negative (NA) and positive affect (PA), perceived stress, and stressors were assessed 4-times daily across 14 consecutive days (4333 total surveys; 73.7% completion rate). Affect reactivity was operationalized as the NA and PA slopes on perceived stress from each survey.

RESULTS

The Resilient group did not differ from the Control group on all outcomes. The Vulnerable group reported significantly higher number of stressors, perceived stress levels, NA, and NA reactivity than the Resilient and Control groups (all p < .001); as well as significantly lower PA (p = .024) and PA reactivity (p = .003) than the Control group.

LIMITATIONS

Our findings are not generalizable to other populations and cannot determine causality.

CONCLUSIONS

Our findings suggest that resilience capacity is protective against the effects of early family risks on a daily basis. However, significant findings were limited to emotional distress outcomes and not supported for PA, suggesting resilience capacity may attenuate emotional distress but not positive emotions in response to stress in emerging adults with family risk.

Optimism, Daily Stressors, and Emotional Well-Being Over Two Decades in a Cohort of Aging Men

OBJECTIVES

Growing evidence supports optimism as a health asset, yet how optimism influences well-being and health remains uncertain. We evaluated 1 potential pathway-the association of optimism with daily stress processes-and tested 2 hypotheses. The stressor exposure hypothesis posits that optimism would preserve emotional well-being by limiting exposure to daily stressors. The buffering hypothesis posits that higher optimism would be associated with lower emotional reactivity to daily stressors and more effective emotional recovery from them.

METHODS

Participants were 233 men from the Veterans Affairs Normative Aging Study who completed the Minnesota Multiphasic Personality Inventory-2 Revised Optimism-Pessimism scale in 1986/1991 and participated in up to three 8-day daily diary bursts in 2002-2010 (age at first burst: M = 76.7, SD = 6.5). Daily stressor occurrence, positive affect (PA), and negative affect (NA) were assessed nightly. We evaluated the hypotheses using multilevel structural equation models.

RESULTS

Optimism was unrelated to emotional reactivity to or recovery from daily stressors. Higher optimism was associated with higher average daily PA (B = 2.31, 95% Bayesian credible interval [BCI]: 1.24, 3.38) but not NA, independent of stressor exposure. Lower stressor exposure mediated the association of higher optimism with lower daily NA (indirect effect: B = -0.27, 95% BCI: -0.50, -0.09), supporting the stressor exposure hypothesis.

DISCUSSION

Findings from a sample of older men suggest that optimism may be associated with more favorable emotional well-being in later life through differences in stressor exposure rather than emotional stress response. Optimism may preserve emotional well-being among older adults by engaging emotion regulation strategies that occur relatively early in the emotion-generative process.

The Affective Consequences of Minority Stress Among Bisexual, Pansexual, and Queer (Bi+) Adults: A Daily Diary Study

Bisexual, pansexual, and queer (bi+) individuals are at increased risk for depression and anxiety. These disparities are hypothesized to be due to the unique, minority-specific stressors that they experience. Prior research supports that bi+ stressors are associated with depression and anxiety, but nearly all studies have been cross-sectional, limiting our understanding of how experiencing bi+ stress influences individuals' levels of depression and anxiety as they occur in their day-to-day lives. To address this gap, we examined the daily associations between bi+ stressors (discrimination, internalized stigma, rejection sensitivity, and identity concealment) and depressed/anxious mood in a 28-day diary study. Participants were 208 bi+ individuals who completed daily measures of bi+ stressors and depressed/anxious mood. We tested unlagged (same-day) and lagged (next-day) associations, and we also tested whether internalized stigma, rejection sensitivity, and identity concealment functioned as mechanisms underlying the daily associations between discrimination and depressed/anxious mood. Participants reported higher depressed/anxious mood on days when they reported higher discrimination, internalized stigma, rejection sensitivity, and identity concealment. There were significant unlagged indirect effects of discrimination on depressed and anxious mood via internalized stigma and rejection sensitivity, and there was also a significant unlagged indirect effect of discrimination on anxiety via identity concealment. However, none of the lagged associations were significant. Results suggest that bi+ stress is related to same-day, but not next-day, depressed/anxious mood. The nonsignificant lagged associations could reflect that bi+ individuals are using adaptive coping skills in response to bi+ stress, or that other experiences throughout the day have stronger influences on next-day mood.

Daily Stressor Exposure and Daily Well-Being Among Sexual Minority and Heterosexual Adults in the United States: Results from the National Study of Daily Experiences (NSDE)

BACKGROUND

Daily stress plays a significant role in mental and physical health. Negative mood (e.g., hopelessness) and physical symptoms (e.g., headaches) are responses often associated with daily stressors. It is theorized that some people or populations are more vulnerable or reactive to daily stressors. We propose sexual orientation as one factor that is associated with daily stress exposure and reactivity.

PURPOSE

To understand whether sexual minorities (SMs) differ from heterosexuals in their exposure and reactivity to general, non-sexual minority-specific stressors (e.g., arguments/disagreements, job concerns).

METHODS

We used daily diary data (n = 3,323 heterosexuals [52% identified as female and 85% identified as White]; n = 98 SMs [50% identified as female and 93% identified as White]) from the National Study of Daily Experiences (NSDE). Participants completed eight consecutive evening daily diary interviews (n days = 24,773; mean days completed = 7.24) and reported daily stress exposure and daily well-being. We used multilevel modeling as an approach to examine whether sexual orientation interacted with daily stressors to predict daily negative affect and physical health.

RESULTS

SMs tended to experience more daily stressors compared to heterosexuals; specifically, SMs reported at least one stressor on nearly half (48%) of the study days they completed, and heterosexuals reported at least one stressor on about two-fifths (41%) of the study days they completed. SMs also tended to experience more negative mood when they experienced a daily stressor compared to heterosexuals when they experienced a daily stressor.

CONCLUSION

We emphasize the importance of SMs' exposure and reactivity to general daily stressors and the implications of our results for the day-to-day lives and health of SMs.

Daily social interactions and momentary loneliness: The role of trait loneliness and neuroticism

OBJECTIVES

Loneliness has been linked to poor mental and physical health outcomes in later life. Little is known about how daily social interactions relate to older adults' everyday experiences of loneliness. This study examined the dynamic associations between social interactions and the momentary feelings of loneliness in older adults' daily lives. We further examined whether individual differences in trait loneliness and neuroticism influenced the extent to which daily social interactions were related to moment-to-moment change in loneliness.

METHOD

Participants were 317 community-dwelling older adults (aged 70-90 years) who reported their social interactions and momentary feelings of loneliness 5 times daily for 14 consecutive days using smartphones.

RESULTS

Having more frequent, more pleasant, and in-person social interactions, as well as interactions with family and friends specifically, significantly predicted lower momentary loneliness a few hours later. Higher levels of momentary loneliness, in turn, predicted less likelihood of engaging in these types of social interactions subsequently. In addition, older adults with higher (vs. lower) trait loneliness and neuroticism experienced greater decreases in momentary feelings of loneliness after having more frequent or pleasant social interactions, or interactions with family members.

DISCUSSION

These results expand our understanding of the dynamic associations between daily social interactions and loneliness in later life and provide insights to inform future research, including the possibility of behavioral interventions that target social interactions to reduce the risk for loneliness.

Sleep, stress and aggression: Meta-analyses investigating associations and causality

Prior research suggests that sleep is associated with increased subjective stress and aggression, but important questions remain about the typical magnitude of these relationships, as well as their potential moderators. We therefore conducted the first meta-analysis of this literature. Across 340 associational and experimental studies, significant associations were identified between sleep with both subjective stress (r = 0.307, p < .001) and aggression (r = 0.258, p < .001) in individuals from the general population, as well as between sleep with subjective stress (r = 0.425, p < .001) in individuals with sleep disorders. Experimental sleep restriction also led to increased subjective stress (g = 0.403, p = .017) and aggression (g = 0.330, p = .042). These findings suggest that poorer sleep is associated with - and leads to - heightened levels of subjective stress and aggression. These findings, and their implications, are discussed in relation to neurobiological literature, which highlights the complex interplay between metabolic activity in the brain, hormonal changes, and behavior.

A Longitudinal Study of Age-Based Change in Blood Pressure Reactivity and Negative Affect Reactivity to Natural Stressors

OBJECTIVE

Aging is theoretically accompanied by emotional gains, but physiological self-regulatory losses. Emotional and physiological regulation can be operationalized as the extent of an increase in negative affect and blood pressure upon experiencing a stressor (i.e., reactivity). The direction of age-based changes in negative affect reactivity to stressors is uncertain. In addition, evidence for age-based increases in blood pressure reactivity to stressors is based largely on age-based differences observed in cross-sectional and laboratory-based studies. The present study is the first to examine long-term longitudinal changes in stress-related reactivity for both blood pressure and negative affect in the natural environment.

METHODS

A total of 375 healthy adults aged 50 to 70 years completed 6 days of hourly ambulatory blood pressure assessment and electronic diary reports of social conflict and task demand and control. Two hundred fifty-five participants repeated 3 days of assessment in a 6-year follow-up. With reactivity operationalized as the change in an outcome in association with momentary social conflict, task strain, or task demand (i.e., a model-derived slope parameter), multilevel models were used to assess aging-based change in blood pressure and negative affect reactivity over the course of the 6-year follow-up.

RESULTS

Aging is associated with increased diastolic blood pressure reactivity to social conflict and task demand (βsocial_conflict = 0.48, p = .007; βtask_demand = 0.19, p = .005), increases in negative affect reactivity to social conflict and task strain (βsocial_conflict = 0.10, p < .001; βtask_strain = 0.08, p = .016), and increases in systolic blood pressure reactivity to task-based stress (βtask_strain = 1.29, p = .007; βtask_demand = 0.23 p = .032).

CONCLUSION

Findings suggest age-based increases in affective and cardiovascular reactivity to natural stressors.

A domain-differentiated approach to everyday emotion regulation from adolescence to older age

Flexibly using different emotion-regulation (ER) strategies in different situational contexts, such as domains, has been argued to promote effective emotion regulation. Additionally, emotion regulation processes may change with age as narrowing time horizons shift emotion-regulation preferences. The purpose of the present study was to examine the occurrence and effectiveness of flexible emotion regulation in response to daily hassles from different domains within the age range from adolescence to old age. Participants, ranging from 14 to 88 years old (N = 325), completed an experience-sampling study of approximately 9 days over a 3-week period. At each momentary assessment, participants reported on their hassles, emotion-regulation strategies, and affect. As expected, strategy use varied across individuals and domains. For example, emotion expression and suppression were typical responses to interpersonal hassles, whereas social sharing was often used in response to work/school hassles. In situations wherein hassles included multiple life domains, participants reported the use of more emotion-regulation strategies than for single-domain hassles. Although flexible emotion regulation was evident in participants' responses to hassles, the expectation that it would be associated with lower hassle reactivity was not confirmed. These patterns were, for the most part, consistent across ages. This study contributes new insights into situational characteristics that are associated with emotion-regulation flexibility, showing that hassles domains are important for strategy selection, and that this holds from adolescence to old age. It also suggests that such defined emotion-regulation flexibility is not as strongly linked to emotion-regulation effectiveness as has been previously suggested. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Resolution Status and Age as Moderators for Interpersonal Everyday Stress and Stressor-Related Affect

OBJECTIVES

To examine stressor characteristics (i.e., stressor resolution) and individual differences (i.e., age) as moderators of affective reactivity and residue associated with everyday interpersonal stressors, including arguments and avoided arguments.

METHOD

A sample of 2,022 individuals participated in the second wave of the National Study of Daily Experiences (meanage = 56.25, range = 33-84). Over 8 consecutive evenings, participants completed the Daily Inventory of Stressful Experiences and self-report measures of stressor resolution status and daily negative affect (NA) and positive affect (PA). Using multilevel modeling, we examined whether increases in daily NA and decreases in daily PA associated with arguments and avoided arguments occurring on the same day (i.e., reactivity) or the day before (i.e., residue) differed depending on resolution of the interpersonal stressor. We further examined whether such stressor resolution effects were moderated by age.

RESULTS

Resolution significantly dampened NA and PA reactivity and residue associated with arguments; NA reactivity associated with avoided arguments (ps < .05). Older age was associated with being more likely to resolve both arguments and avoided arguments (ps < .05) and did reduce reactivity associated with avoided arguments. Older age did not moderate PA reactivity or NA or PA residue associated with either arguments or avoided arguments (ps > .05).

DISCUSSION

Unresolved everyday arguments and avoided arguments are differentially potent in terms of affective reactivity and residue, suggesting resolution may be crucial in emotional downregulation. Future work should focus on exploring resolution of other everyday stressors to garner a comprehensive understanding of what characteristics impact stressor-affect associations and for whom.

Association Between Caregiver Depression and Elder Mistreatment-Examining the Moderating Effect of Care Recipient Neuropsychiatric Symptoms and Caregiver-Perceived Burden

OBJECTIVES

To examine the association between caregiver (CG) depression and increase in elder mistreatment and to investigate whether change in care recipient (CR) neuropsychiatric symptoms (NPS) and change in CG-perceived burden influence this association.

METHODS

Using 2-year longitudinal data, we analyzed a consecutive sample of 800 Chinese primary family CGs and their CRs with mild cognitive impairment or mild-to-moderate dementia recruited from the geriatric and neurological departments of 3 Grade-A hospitals in the People's Republic of China. Participatory dyads were assessed between September 2015 and February 2016 and followed for 2 years.

RESULTS

CG depression at baseline was associated with a sharper increase in psychological abuse and neglect. For CRs with increased NPS, having a depressed CG predicted a higher level of psychological abuse than for those CRs without NPS. For CGs with decreased burden, the level of depression was associated with a slower increase in neglect than for CGs who remained low burden.

DISCUSSION

This study showed the differential impact of CG depression on the increase in elder mistreatment depending on the change in CR NPS and CG-perceived burden. The present findings provide valuable insights into the design of a systematic and integrative intervention protocol for elder mistreatment that simultaneously focuses on treating CG depression and perceived burden and CR NPS.

Stress and Affect as Daily Risk Factors for Substance Use Patterns: an Application of Latent Class Analysis for Daily Diary Data

At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

Little evidence for sex or ovarian hormone influences on affective variability

Women were historically excluded from research participation partly due to the assumption that ovarian hormone fluctuations lead to variation, especially in emotion, that could not be experimentally controlled. Although challenged in principle and practice, relevant empirical data are limited by single measurement occasions. The current paper fills this knowledge gap using data from a 75-day intensive longitudinal study. Three indices of daily affective variability-volatility, emotional inertia, and cyclicity-were evaluated using Bayesian inferential methods in 142 men, naturally cycling women, and women using three different oral contraceptive formulations (that "stabilize" hormone fluctuations). Results provided more evidence for similarities between men and women-and between naturally cycling women and oral contraceptive users-than for differences. Even if differences exist, effects are likely small. Thus, there is little indication that ovarian hormones influence affective variability in women to a greater extent than the biopsychosocial factors that influence daily emotion in men.

COVID-19-Related Daily Stress Processes in College-Aged Adults: Examining the Role of Depressive Symptom Severity

Exposure to daily stressors specific to the COVID-19 pandemic (e.g., threat of infection) is associated with emotional distress, heightened stress reactivity, and increased depressive symptomology. Herein, we examined whether current depressive symptomology modulates the association between COVID-19-related daily stressor exposure and negative affective reactivity in young, otherwise healthy, college-aged adults. Fifty-eight adults (21 men; 22±3years) completed a daily web-based interview for eight consecutive days to assess COVID-19-related daily stress exposure and emotional responsiveness (September–November 2020). Depressive symptom severity was assessed using the Patient Health Questionnaire-9 (PHQ-9), and a score of ≥10 (range: 0–27) was used to define adults with a depressive episode (n=20). Participants reported at least one COVID-19-related stressor on 35.8% of interview days. Depressive symptomology did not predict the likelihood of exposure to a COVID-19-related stressor (p=0.46; OR=1.52; 95% CI: 0.492–4.718). However, negative affect (NA) was greater on days with an exposure to any COVID-19-specific daily stressor in adults with moderate-to-severe depressive symptoms (b=0.28, SE=0.093, p=0.003) but not in those without (b=0.009, SE=0.074, p=0.90), such that negative affective reactivity to COVID-19-related stressors was amplified in adults with a current depressive episode (p=0.019). Depressive symptomology did not moderate positive affective reactivity (p=0.686). Taken together, these data suggest that exposure to daily stressors related to COVID-19 further worsens NA in adults with a current depressive episode, potentially rendering them more susceptible to adverse mental health outcomes during the pandemic.

Relationships between daily mood states and real-time cognitive performance in individuals with bipolar disorder and healthy comparators: A remote ambulatory assessment study

OBJECTIVE

Neuropsychological impairments are observed in individuals with Bipolar Disorder (BD), yet knowledge of how cognitive deficits unfold in real-time remains limited. Given intraindividual variability in mood observed in people with BD, and the potential for mood and cognition to be mutually influential, we employed ambulatory assessment technologies to examine potential contemporaneous (same survey) and lagged (next survey) relationships of congition and mood.

METHODS

Outpatients with BD (n = 46) or no psychiatric disorders (heathy volunteers [HV]; n = 20) completed in-laboratory neurobehavioral assessments and 14 days of smartphone-administered mobile cognitive tests and ratings of affective variables. Linear mixed-effects models were used to analyze real-time relationships between mobile cognitive test performance and mood.

RESULTS

On in-laboratory tests, participants with BD showed worse cognitive performance than HVs as well as mild depression severity; mood and cognitive performance were unrelated. On mobile cognitive tests and surveys, participants with BD showed somewhat worse cognitive performance and ratings of lower energy and greater sadness relative to HV participants. Among those with BD, mania and sadness earlier in the day related to worse processing speed and better working memory performance, respectively, on the next survey. In contrast, same survey ratings of greater stress related to better working memory, and greater happiness related to better processing speed.

CONCLUSIONS

Real-time assessments of mood and cognition provide incremental information beyond what can be gleaned from laboratory assessments. Understanding how these affect-related changes in processing speed emerge and play out in daily life may provide clinically useful information for treatment planning.

A year in the social life of a teenager: Within-person fluctuations in stress, phone communication, and anxiety and depression

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.

Neighborhood safety concerns and daily well-being: A national diary study

People living in unsafe neighborhoods often report poor health. The reasons for this are multi-faceted, but one possibility is that unsafe neighborhoods create a situation of chronic stress, which may deplete people's resources to cope with the daily stressors of life. How people respond to daily stressors (e.g., with increased self-reported negative affect and physical symptoms) is positively associated with health problems and may thus be one pathway linking perceptions of neighborhood safety to poor health. The current study investigated the relationship between neighborhood safety concerns, daily stressors, affective well-being, and physical health symptoms in a national sample of adults from the Midlife in the United States Study II (n = 1748). In 2004, participants reported neighborhood safety concerns and history of chronic stress exposure. Across eight days, they also reported daily stressors, physical symptoms and negative affect. Greater neighborhood safety concerns were associated with higher negative affect and more physical symptoms, adjusting for other sources of chronic stress. Moreover, lower perceived neighborhood safety was related to greater increases in negative affect and physical symptoms on days during which stressors were reported, even after accounting for established interactions between daily stressors and other sources of chronic stress. Exposure to neighborhoods perceived as unsafe is associated with poorer daily well-being and exacerbated responses to daily stressors, which may serve as an individual-level pathway contributing to poorer health among people living in neighborhoods perceived as unsafe.

Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults

OBJECTIVE

To identify proximate causes ('triggers') of flares in adults with, or at risk of, knee osteoarthritis (OA), estimate their course and consequences, and determine higher risk individuals.

METHODS

In this 13-week web-based case-crossover study adults aged ≥40 years, with or without a recorded diagnosis of knee OA, and no inflammatory arthropathy who self-reported a knee flare completed a questionnaire capturing information on exposure to 21 putative activity-related, psychosocial and environmental triggers (hazard period, ≤72 h prior). Comparisons were made with identical exposure measurements at four 4-weekly scheduled time points (non-flare control period) using conditional logistic regression. Flare was defined as a sudden onset of worsening signs and symptoms, sustained for ≥24 h. Flare characteristics, course and consequence were analysed descriptively. Associations between flare frequency and baseline characteristics were estimated using Poisson regression.

RESULTS

Of 744 recruited participants (mean age [SD] 62.1 [10.2] years; 61% female), 376 reported 568 flares (hazards) and provided 867 valid control period measurements. Thirteen exposures (eight activity-related, five psychosocial/environmental) were positively associated with flare onset within 24 h (strongest odds ratio estimate, knee buckling: 9.06: 95% confidence interval [CI] 5.86, 13.99; weakest, cold/damp weather: 1.45: 95%CI 1.12, 1.87). Median flare duration was 5 days (IQR 3, 8), less common if older (incident rate ratio [IRR] 0.98: 95%CI 0.97, 0.99), more common if female (IRR 1.85: 95%CI 1.43, 2.39).

CONCLUSIONS

Multiple activity-related, psychosocial and environmental exposures are implicated in triggering flares. This evidence can help inform prevention and acute symptom management for patients and clinicians.

Does Chronic Stress Moderate Age Differences in Emotional Well-Being? Testing Predictions of Strength and Vulnerability Integration

OBJECTIVES

The Strength and Vulnerability Integration (SAVI) theory posits boundary conditions, such as chronic stress, which place constraints on positive emotional aging. We examine SAVI's prediction that higher levels of chronic stress will attenuate favorable age gradients for multiple indices of well-being.

METHODS

We used cross-sectional data from a diverse systematic probability sample of adults (n = 260, ages 25-65). Multiple regression analysis was used to examine age gradients and test age × chronic stress interactions on 5 measures of well-being relevant for SAVI's prediction: positive and negative affect, life satisfaction, emotional distress, and rumination.

RESULTS

Age was unrelated to well-being unless individual differences in health limitations were statistically controlled, in which case older age was associated with more favorable levels of well-being. Chronic stress significantly interacted with age for negative affect, emotional distress, rumination, and life satisfaction; examination of the interactions indicated that age was no longer associated with more favorable levels of well-being at higher levels of chronic stress.

DISCUSSION

Our findings support a key prediction of SAVI by demonstrating that high levels of chronic stress present a boundary condition for favorable age gradients on well-being. We discuss the implications of these findings for understanding the "paradox" of well-being.

Multiple imputation of missing data in multilevel models with the R package mdmb: a flexible sequential modeling approach

Multilevel models often include nonlinear effects, such as random slopes or interaction effects. The estimation of these models can be difficult when the underlying variables contain missing data. Although several methods for handling missing data such as multiple imputation (MI) can be used with multilevel data, conventional methods for multilevel MI often do not properly take the nonlinear associations between the variables into account. In the present paper, we propose a sequential modeling approach based on Bayesian estimation techniques that can be used to handle missing data in a variety of multilevel models that involve nonlinear effects. The main idea of this approach is to decompose the joint distribution of the data into several parts that correspond to the outcome and explanatory variables in the intended analysis, thus generating imputations in a manner that is compatible with the substantive analysis model. In three simulation studies, we evaluate the sequential modeling approach and compare it with conventional as well as other substantive-model-compatible approaches to multilevel MI. We implemented the sequential modeling approach in the R package mdmb and provide a worked example to illustrate its application.

Emotional Responses to Stressors in Everyday Life Predict Long-Term Trajectories of Depressive Symptoms

BACKGROUND

Individuals' emotional responses to stressors in everyday life are associated with long-term physical and mental health. Among many possible risk factors, the stressor-related emotional responses may play an important role in future development of depressive symptoms.

PURPOSE

The current study examined how individuals' positive and negative emotional responses to everyday stressors predicted their subsequent changes in depressive symptoms over 18 months.

METHODS

Using an ecological momentary assessment approach, participants (n = 176) reported stressor exposure, positive affect (PA), and negative affect (NA) five times a day for 1 week (n = 5,483 observations) and provided longitudinal reports of depressive symptoms over the subsequent 18 months. A multivariate multilevel latent growth curve model was used to directly link the fluctuations in emotions in response to momentary stressors in everyday life with the long-term trajectory of depressive symptoms.

RESULTS

Adults who demonstrated a greater difference in stressor-related PA (i.e., relatively lower PA on stressor vs. nonstressor moments) reported larger increases in depressive symptoms over 18 months. Those with greater NA responses to everyday stressors (i.e., relatively higher NA on stressor vs. nonstressor moments), however, did not exhibit differential long-term changes in depressive symptoms.

CONCLUSIONS

Adults showed a pattern consistent with both PA and NA responses to stressors in everyday life, but only the stressor-related changes in PA (but not in NA) predicted the growth of depressive symptoms over time. These findings highlight the important-but often overlooked-role of positive emotional responses to everyday stressors in long-term mental health.