Marriage, divorce, and the immune system

Interpersonal relationships, PNI, and health: Seeds in the 1980s, fruiting trees today

In this contribution to the Special Issue, I highlight how Janice Kiecolt-Glaser's research in the 1980s planted the seeds for two areas of social relationships and health research: loneliness and intimate/marital relationships. I review the foundational "seed" studies from the mid-to late-1980s, the research "saplings" that sprouted and grew during the subsequent twenty years, and the "mature trees" that have gone on to fruit and grow their respective areas of inquiry over the past twenty years. In addition to highlighting the mature trees that have borne rich empirical fruit, my other goal for this contribution is to draw attention to ideas and concepts from Kiecolt-Glaser's work and writing that merit further conceptual and empirical examination in the next generation of research on social relationships, psychoneuroendocrinology, psychoneuroimmunology, and health.

Sex-differences in the association of social health and marital status with blood-based immune and neurodegeneration markers in a cohort of community-dwelling older adults

BACKGROUND

The immune system has been proposed to play a role in the link between social health and all-cause dementia risk. We explored cross-sectional and longitudinal associations between social health, immune system balance and plasma neurodegeneration markers in community-dwelling older adults, and explored whether the balance between innate and adaptive immunity mediates associations between social health and both cognition and total brain volume.

METHODS

Social health markers (social support, marital status, loneliness) were measured in the Rotterdam Study between 2002-2008. Immune system cell counts and balance were assessed repeatedly from 2002 to 2016 using white blood-cell-based indices and individual counts (granulocyte-to-lymphocyte ratio (GLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)). Plasma neurodegeneration biomarkers (amyloid-β40, amyloid-β42, total tau and neurofilament light chain) were measured once from blood samples collected between 2002-2008. Global cognitive function and total brain volume (MRI) were measured at the follow-up visit between 2009-2014. We used linear mixed models to study longitudinal associations and performed causal mediation analyses.

RESULTS

In 8374 adults (mean age 65.7, 57 % female), never married participants (n = 394) had higher GLR, PLR and SII compared to married peers at baseline and during follow-up, indicating imbalance towards innate immunity. Being never married was associated with higher plasma amyloid-β40, and being widowed or divorced with higher plasma total tau levels at baseline. Widowed or divorced males, but not females, had higher GLR, PLR and SII at baseline. Higher social support was associated with lower PLR in females, but higher PLR in males. Loneliness was not associated with any of the immune system balance ratios. Never married males had higher levels of all plasma neurodegeneration markers at baseline. Immune system balance did not mediate associations between social health and cognition or total brain volume, but does interact with marital status.

CONCLUSION

This study indicates that marital status is associated with blood-based immune system markers toward innate immunity and higher levels of plasma neurodegeneration markers. This is particularly evident for never married or previously married male older adults compared to married or female peers.

Laboratory features and pharmacological management of early and late-onset primary Sjögren's syndrome

BACKGROUND

Primary Sjögren's Syndrome (pSS) is a systemic chronic autoimmune disorder that contributes to dry mouth (xerostomia) and eyes (xerophthalmia). It mainly affects females between 40 and 60 years old. So far, there is no treatment to cure SS; however, there is a list of medications that can ameliorate the symptoms. In addition, there has been no single test until now to detect pSS, but clinical and immunological investigations are applied as diagnostic tools. Therefore, this study aimed to explore the characteristics of pSS in Saudi patients based on the onset of the disease through laboratory findings and pharmaceutical management.

METHODOLOGY

This retrospective study examined diagnosed patients with pSS between 2018 and 2023 from the National Guard Hospital, Saudi Arabia. Data of pSS patients was categorized into two groups: early (under 40 years old) and late-onset (40 years old and above). Data on demographic information, mortality rate, and blood tests such as complete blood count (CBC), creatinine, erythrocyte sedimentation rate (ESR), and vitamin levels, in addition to prescribed medications, were collected from the patient's medical record. Chi-square and t-tests were mainly used, and statistical significance was determined at a P-value less than 0.05.

RESULTS

A total of 453 patients were included in the study, where the early-onset group comprised 136 and the late-onset group comprised 317 patients. The mean age of the early and late onset was 34.2 and 60.4, respectively. ESR was significantly higher in the early (46.3 mm/hr) and late-onset (49.8 mm/hr). The most common medication used by all pSS patients was hydroxychloroquine. However, artificial tears were mainly observed in the late-onset group. Other medications, such as pilocarpine, methotrexate, and azathioprine, were prescribed to pSS patients to a lesser extent.

CONCLUSION

This study suggests that the onset of pSS could occur even before the age of 40 among Saudi citizens. Notably, elevated ESR levels appeared to be a feature of pSS, which was consistent with other previous findings. The variability of some medications between early-onset and late-onset pSS may indicate disease progression. However, further investigations are required to confirm this observation.

Divorce and physical health: A three-level meta-analysis

Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.

Psychoneuroimmunology in multiple myeloma and autologous hematopoietic stem cell transplant: Opportunities for research among patients and caregivers

Multiple myeloma (MM) is an incurable cancer and is the leading indication for autologous hematopoietic stem cell transplantation (HSCT). To be eligible for HSCT, a patient must have a caregiver, as caregivers play a central role in HSCT preparation and recovery. MM patients remain on treatment indefinitely, and thus patients and their caregivers face long-term challenges including the intensity of HSCT and perpetual therapy after transplant. Importantly, both patients and their caregivers show heightened depressive and anxiety symptoms, with dyadic correspondence evidenced and caregivers' distress often exceeding that of patients. An extensive psychoneuroimmunology (PNI) literature links distress with health via immune and neuroendocrine dysregulation as well as biological aging. However, data on PNI in the context of multiple myeloma - in patients or caregivers - are remarkably limited. Distress in MM patients has been associated with poorer outcomes including higher inflammation, greater one year post-HSCT hospital readmissions, and worse overall survival. Further, anxiety and depression are linked to biological aging and may contribute to the poor long-term health of both patients and caregivers. Because MM generally affects older adults, individual differences in biological aging may represent an important modifier of MM biology and HSCT treatment outcomes. There are a number of clinical scenarios in which biologically younger people could be prescribed more intensive therapies, with potential for greater benefit, by using a personalized cancer therapy approach based on the quantification of physiologic reserve. Further, despite considerable psychological demands, the effects of distress on health among MM caregivers is largely unexamined. Within this context, the current critical review highlights gaps in knowledge at the intersection of HSCT, inflammation, and biological aging in the context of MM. Research in this area hold promise for opportunities for novel and impactful psychoneuroimmunology (PNI) research to enhance health outcomes, quality of life, and longevity among both MM patients and their caregivers.

Mitochondrial Health, Physical Functioning, and Daily Affect: Bioenergetic Mechanisms of Dementia Caregiver Well-Being

OBJECTIVE

Chronic stress adversely affects mental and physical well-being. However, health outcomes vary among people experiencing the same stressor. Individual differences in physical and emotional well-being may depend on mitochondrial biology, as energy production is crucial for stress regulation. This study investigated whether mitochondrial respiratory capacity corresponds to individual differences in dementia spousal caregivers' mental and physical health.

METHODS

Spousal caregivers of individuals with Alzheimer's disease and related dementias ( N = 102, mean age = 71, 78% female, 83% White) provided peripheral blood samples and completed self-report questionnaires on quality of life, caregiver burden, and a 7-day affect scale. Multiple and mixed linear regressions were used to test the relationship between mitochondrial biology and well-being.

RESULTS

Spare respiratory capacity ( b = 12.76, confidence interval [CI] = 5.23-20.28, p = .001), maximum respiratory capacity ( b = 8.45, CI = 4.54-12.35, p < .0001), and ATP-linked respiration ( b = 10.11, CI = 5.05-15.18, p = .0001) were positively associated with physical functioning. At average ( b = -2.23, CI = -3.64 to -0.82, p = .002) and below average ( b = -4.96, CI = -7.22 to 2.70, p < .0001) levels of spare respiratory capacity, caregiver burden was negatively associated with daily positive affect. At above average levels of spare respiratory capacity, caregiver burden was not associated with positive affect ( p = .65).

CONCLUSIONS

Findings suggest that higher mitochondrial respiratory capacity is associated with better psychological and physical health-a pattern consistent with related research. These findings provide some of the earliest evidence that cellular bioenergetics are related to well-being.

Sociodemographic predictors of parenting stress among mothers in socio-economically deprived settings in rural and urban Kenya and Zambia

Parental stress occurs when parenting demands exceed the resources available to cope with parenting. Previous research has identified household wealth, educational level, marital status, age, and number of dependent children as predictors of parental stress. However, limited evidence exists from sub-Saharan Africa. This study investigated the sociodemographic predictors of parenting stress among mothers in Kenya and Zambia. This cross-sectional study utilised baseline secondary data from parenting intervention programs implemented in Kisumu County (rural Kenya), Nairobi County (Urban Kenya), and Chisamba District (rural Zambia). Out of 913 caregivers recruited for the parenting program, 844 with complete data were included in the analysis. The mean age was 1.0 (SD = 0.7) years. Parental stress was measured using the Parental Stress Score (PSS) tool and demographic questionnaires were used to collect demographic information. Mean PSS were compared across study sites, and a multiple linear regression model was used to examine associations between sociodemographic predictors (household income, educational level, marital status, maternal age, child age, and number of children aged < 5 years) and PSS, adjusting for clustering and other predictors. From the results, the mean PSS in rural Kenya was 37.6 [SD = 11.8], in urban Kenya was 48.4 [SD = 4.2], and in rural Zambia was 43.0 [SD = 9.1]. In addition, the significant association between PSS and mothers' income and educational level was only observed in Kenyan study sites (income: Kenya rural β = -0.40, p < 0.001**; Kenya urban, β = - 0.33, p = .02*; Zambia rural, β = - 0.01, p = 0.7) education: Kenya rural, β = - 0.25, p = .005**; Kenya urban, β = - 0.14, p = 0.07; Zambia rural, β = 0.04, p = 0.3). However, marital status, mother's age, child's age, and the number of children below five years were not associated with PSS. The results revealed that mothers' income and education level were negatively associated with PSS, indicating that higher socioeconomic status can buffer the effects of parental stress.Trial registration Pan African Clinical Trials Registry ( https://pactr.samrc.ac.za/ ) database (ID Number: PACTR20180774832663 Date: 26/July/2018; (ID number: PACTR201905787868050 Date: 06/May/2019.

Pretreatment relationship characteristics predict outcomes from an uncontrolled trial of intensive, multicouple group PTSD treatment

Cognitive behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is associated with improvements in patients' and partners' mental health and relationship satisfaction. Some pretreatment relationship characteristics have predicted CBCT for PTSD outcomes for patients, but findings were limited to a single community sample consisting primarily of female patients with male partners. A better understanding of whether pretreatment relationship characteristics predict outcomes in other patient populations and whether there are partners who may be particularly responsive to couple therapy for PTSD could optimize treatment matching. This study investigated whether pretreatment partner accommodation and relationship satisfaction predicted patient and partner treatment outcomes from an uncontrolled trial of an abbreviated, intensive, multicouple group version of CBCT for PTSD conducted with 24 active-duty military or veteran couples (96% male patients/female partners). In general, changes in patients' PTSD and comorbid symptoms and relationship satisfaction did not vary by pretreatment partner accommodation or patients' own pretreatment relationship satisfaction. In contrast, pretreatment relationship characteristics predicted partner outcomes. Partners who engaged in higher levels of accommodation pretreatment and partners who reported lower levels of pretreatment relationship satisfaction experienced greater declines in psychological distress following treatment. Also, partners who began the study relationally distressed exhibited significant increases in relationship satisfaction following treatment, whereas those who were not relationally distressed did not. Findings suggest that improvements generally do not vary by pretreatment relationship characteristics for patients, whereas partners who begin treatment with elevated relationship risk factors may be especially likely to experience improvement across outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationship between physical activity and risk of depression in a married group

BACKGROUND

Currently, there are many different findings on the relationship between physical activity and depression, and there may be differences between genders. This study therefore focused on gender differences to understand the relationship between physical activity behaviour and the risk of depression in married individuals.

METHODS

15607 married people in the China Family Panel Studies 2020 (CFPS 2020) were used to understand the relationship between physical activity and depression risk in different populations, and the chi-square test, Mann-Whitney U-test, and binary logistic regression were used to explore the relationship between physical activity and depression risk in the married population.

RESULTS

527 (6.64%) women were at high risk of depression and 365 (4.76%) men were at high risk of depression; physical activity was associated with the risk of depression in the married population, but after incorporating demographic and relevant cognitive variables, physical activity was negatively associated with the risk of depression in women (OR = 0.94, P < 0.01) but not statistically significant with the risk of depression in men (OR = 0.96, P > 0.05).

CONCLUSION

Physical activity was directly related to the risk of depression in married women, but not in married men.

Immune-neuroendocrine patterning and response to stress. A latent profile analysis in the English longitudinal study of ageing

Psychosocial stress exposure can disturb communication signals between the immune, nervous, and endocrine systems that are intended to maintain homeostasis. This dysregulation can provoke a negative feedback loop between each system that has high pathological risk. Here, we explore patterns of immune-neuroendocrine activity and the role of stress. Using data from the English Longitudinal Study of Ageing (ELSA), we first identified the latent structure of immune-neuroendocrine activity (indexed by high sensitivity C-reactive protein [CRP], fibrinogen [Fb], hair cortisol [cortisol], and insulin growth-factor-1 [IGF-1]), within a population-based cohort using latent profile analysis (LPA). Then, we determined whether life stress was associated with membership of different immune-neuroendocrine profiles. We followed 4,934 male and female participants, with a median age of 65 years, over a four-year period (2008-2012). A three-class LPA solution offered the most parsimonious fit to the underlying immune-neuroendocrine structure in the data, with 36 %, 40 %, and 24 % of the population belonging to profiles 1 (low-risk), 2 (moderate-risk), and 3 (high-risk), respectively. After adjustment for genetic predisposition, sociodemographics, lifestyle, and health, higher exposure to stress was associated with a 61 % greater risk of belonging to the high-risk profile (RRR: 1.61; 95 %CI = 1.23-2.12, p = 0.001), but not the moderate-risk profile (RRR = 1.10, 95 %CI = 0.89-1.35, p = 0.401), as compared with the low-risk profile four years later. Our findings extend existing knowledge on psychoneuroimmunological processes, by revealing how inflammation and neuroendocrine activity cluster in a representative sample of older adults, and how stress exposure was associated with immune-neuroendocrine responses over time.

A wide landscape of morbidity and mortality risk associated with marital status in 0.5 million Chinese men and women: a prospective cohort study

Background

A comprehensive depiction of long-term health impacts of marital status is lacking.

Methods

Sex-stratified phenome-wide association analyses (PheWAS) of marital status (living with vs. without a spouse) were performed using baseline (2004-2008) and follow-up information (ICD10-coded events till Dec 31, 2017) from the China Kadoorie Biobank (CKB). We estimated adjusted hazard ratios (aHRs) to evaluate the associations of marital status with morbidity risks of phenome-wide significant diseases or sex-specific top-10 death causes in China documented in 2017. Additionally, the association between marital status and mortality risks among participants with major chronic diseases at baseline was assessed.

Findings

During up to 11.1 years of the median follow-up period, 1,946,380 incident health events were recorded among 210,202 men and 302,521 women aged 30-79. Marital status was found to have phenome-wide significant associations with thirteen diseases among men (p < 9.92 × 10-5) and nine diseases among women (p < 9.33 × 10-5), respectively. After adjusting for all disease-specific covariates in the final model, participants living without a spouse showed increased risks of schizophrenia, schizotypal and delusional disorders (aHR [95% CI]: 2.55, [1.83-3.56] for men; 1.49, [1.13-1.97] for women) compared with their counterparts. Additional higher risks in overall mental and behavioural disorder (1.31, 1.13-1.53), cardiovascular disease (1.07, 1.04-1.10) and cancer (1.06, 1.00-1.12) were only observed among men without a spouse, whereas women living without a spouse were at lower risks of developing genitourinary diseases (0.89, 0.85-0.93) and injury & poisoning (0.93, 0.88-0.97). Among 282,810 participants with major chronic diseases at baseline, 39,166 deaths were recorded. Increased mortality risks for those without a spouse were observed in 12 of 21 diseases among male patients and one of 23 among female patients. For patients with any self-reported disease at baseline, compared with those living with a spouse, the aHRs (95% CIs) of mortality risk were 1.29 (1.24-1.34) and 1.04 (1.00-1.07) among men and women without a spouse (pinteraction<0.0001), respectively.

Interpretation

Long-term associations of marital status with morbidity and mortality risks are diverse among middle-aged Chinese adults, and the adverse impacts due to living without a spouse are more profound among men. Marital status may be an influential factor for health needs.

Funding

The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology, and the UK Wellcome Trust.

Partnership status and positive DNA methylation age acceleration across the adult lifespan in the UK

Although a significant body of research has shown that married people are healthier and live longer, empirical research on sex differences in the link between marital status and health suggests results are mixed. Moreover, the sex disparities in marital status and health relationships vary across adulthood. The literature on partnership status and measures of ageing is largely focused on older age groups and is limited in its view of early adulthood. Data from waves 2 and 3 (2010-2012) of Understanding Society: UKHLS were used to examine the association of current partnership status with epigenetic age acceleration (AA) assessed with DNA methylation (DNAm) algorithms 'Phenoage' and ' DunedinPACE ' in 3492 participants (aged 16-97). Regression models were estimated separately for men and women, and further stratified by age groups. Divorced/separated and widowed people showed positive age acceleration compared to the married/cohabiting people (reference group). Some sex differences were apparent, especially, among the single and divorced/separated groups. Age differences were also apparent, for example in men, being single was negatively associated with DNAmAA in the youngest group, but positively in the oldest group compared to partnered counterparts. These findings illustrate the importance of partnerships on the ageing process, in particular marital change through divorce and widowhood for positive age acceleration in adults. For single groups, observations were heterogenous by age and sex.

Cohabitation as a determinant of adaptive and innate immune cell profiles: Findings from the Health and Retirement Study

Introduction

Non-genetic factors are important but poorly understood determinants of immune profiles. Age and Cytomegalovirus (CMV) infection remain two well documented non-genetic determinants of the immune profile. Recently, one study identified cohabitation in the same household as an important determinant of immune profiles.

Methods

We used immunophenotyping data from the Health and Retirement Study (HRS) to evaluate the association between cohabitation and the adaptive (subsets of T-cells, B-cells) and innate immune profiles (subsets of monocytes, natural killer cells and neutrophils). We compared adaptive and innate immune cell profiles using immunophenotyping data from 1184 same-household pairs (cohabitating partners) to 1184 non-household pairs to evaluate the association between cohabitation and adaptive immune cell profiles. We used data from 1737 same-household pairs and 1737 non-household pairs to evaluate the association between cohabitation and innate cell profiles. Household and non-household pairs were matched on age (±2years), educational background and race/ethnicity to minimize confounding due to these factors. The adaptive immune cells and innate immune cell profiles were compressed to two coordinates using multidimensional scaling (MDS). The Euclidean distances between same-household pairs were compared to the distances between non-household pairs for the adaptive and innate cell profiles separately using two sample independent t-tests. We also performed additional adjustment for age and BMI differences, CMV serostatus and smoking concordance/discordance status among household members.

Results

For adaptive immune cell profiles, the mean Euclidean distance between same-household pairs was 4% lower than the non-household pairs (p = 0.03). When stratified by concordance for CMV serostatus among household pairs, the Euclidean distance was significantly lower by 8% in the same-household pairs as compared to non-household pairs among those who were discordant for CMV serostatus (p = 0.01) and among same-household pairs who were CMV seronegative (p = 0.02) after covariate adjustment. The mean Euclidian distance between same-household pairs was also 8% lower than non-household pairs for the innate immune cell profiles (p-value <0.0001) and this difference remained consistent across all strata of CMV infection.

Discussion

This study confirms that cohabitation is associated with similarity in immune cell profiles. The differential effects of cohabitation on the adaptive and innate immune profiles suggest that further studies into the common environmental factors that influence individual immune cell subsets need to be evaluated in greater detail.

Marital Histories and Associations With Later-Life Dementia and Mild Cognitive Impairment Risk in the HUNT4 70+ Study in Norway

Objectives: Earlier studies suggest that being married in later life protects against dementia, and that being single in old age increases the risk of dementia. In this study, we examine midlife marital status trajectories and their association with dementia and mild cognitive impairment (MCI) at ages 70 plus using a large population based sample from Norway. Methods: Based on a general population sample linked to population registries (N = 8706), we used multinomial logistic regression to examine the associations between six types of marital trajectories (unmarried, continuously divorced, intermittently divorced, widowed, continuously married, intermittently married) between age 44 and 68 years from national registries and a clinical dementia or a MCI diagnosis after age 70. We estimated relative risk ratios (RRR) and used mediation analyses adjusting for education, number of children, smoking, hypertension, obesity, physical inactivity, diabetes, mental distress, and having no close friends in midlife. Inverse probability weighting and multiple imputations were applied. The population attributable fraction was estimated to assess the potential reduction in dementia cases due to marital histories. Results: Overall, 11.6% of the participants were diagnosed with dementia and 35.3% with MCI. Dementia prevalence was lowest among the continuously married (11.2%). Adjusting for confounders, the risk of dementia was higher for the unmarried (RRR = 1.73; 95% CI: 1.24, 2.40), continuously divorced (RRR = 1.66; 95% CI: 1.14, 2.43), and intermittently divorced (RRR = 1.50; 95% CI: 1.09, 2.06) compared to the continuously married. In general, marital trajectory was less associated with MCI than with dementia. In the counterfactual scenario, where all participants had the same risk of receiving a dementia diagnosis as the continuously married group, there would be 6.0% fewer dementia cases. Discussion: Our data confirm that staying married in midlife is associated with a lower risk of dementia and that divorced people account for a substantial share of dementia cases.

Inflammatory myopathy in adults, health-related quality of life, and wellbeing: a round trip between immune disease and wellness

INTRODUCTION

Health-related quality of life (HRQoL) and wellbeing are poorer in patients with chronic conditions than in the general population, and this is the case of individuals with myositis. Research has shown a negative relationship between this disease and wellbeing, but there is little data on the effect that enhanced wellbeing has on the disease course.

AREAS COVERED

HRQoL, wellbeing, and other related concepts are examined here with special emphasis on the benefits of positive status in the physical, environmental, psychological, and social function areas for reducing the severity of the clinical course and organ damage in a chronic condition such as myositis. The factors affecting HRQoL, and wellbeing are analyzed to delineate specific strategies that will lead to improvements in the life of adult patients with myositis. The mechanisms implicated in these changes are also discussed.

EXPERT OPINION

Myositis refers to a heterogeneous group of chronic systemic autoimmune diseases. HRQoL and wellbeing are poor in these patients, and evidence suggests that improvements in this line can have positive repercussions on the course and outcome of the disease. Strategies to improve HRQoL and wellbeing should be designed for adults with myositis.

Spinning Your Wheels: Psychological Overinvolvement and Actigraphy-Assessed Sleep Efficiency Following Marital Separation

BACKGROUND

This study investigated the ways in which adults reflect on their psychological experiences amid a recent marital separation and how these patterns of thought, manifest in language, are associated with self-reported negative affect and actigraphy-assessed sleep disturbance.

METHODS

In a sample of 138 recently separated adults assessed three times over five months, we examined within- and between-person associations among psychological overinvolvement (operationalized using verbal immediacy derived as a function of the language participants used to discuss their relationship history and divorce experience), continued attachment to an ex-partner, negative affect, and sleep efficiency.

RESULTS

The association between psychological overinvolvement and negative affect operated at the within-person level, whereas the associations between psychological overinvolvement and sleep disturbance, as well as negative affect and sleep disturbance, operated at the between-person level.

CONCLUSIONS

These findings shed light on the intraindividual processes that may explain why some people are more susceptible to poor outcomes after separation/divorce than others. Our findings suggest that individuals who express their divorce-related thoughts and feelings in a psychologically overinvolved manner may be at greatest risk for sleep disturbances after marital separation/divorce.

RACIAL DISCRIMINATION AND THE WEATHERING OF NONMARITAL RELATIONSHIPS

Objective

The purpose of this study was to assess the impact of perceived racial discrimination on the satisfaction and dissolution of different-gender, nonmarital relationships among African American young adults.

Background

Racial discrimination has proven detrimental to relationship quality among married couples. Racial disparities in relationship processes begin long before marriages form, however. Racial discrimination may also weather and disrupt nonmarital relationships earlier in the life course.

Method

Survey data from African American young adult couples (N = 407) from the Family and Community Health Study were used to assess the associations between each partner's experience of racial discrimination, relationship satisfaction, and relationship dissolution using structural equation modeling.

Results

Results support a stress spillover perspective in that racial discrimination experienced by both men and women increased the likelihood of relationship dissolution through reduced satisfaction. No support was found for a stress buffering perspective.

Conclusion

Racial discrimination appears to distress and, ultimately, disrupt nonmarital relationships among African American young adult couples.

Implications

Given the role of relationship quality and stability in promoting health and well-being, understanding how discrimination impacts the unfolding of relationships, or linked lives, across the life course is essential to untangling and addressing the "chains of disadvantage" identified by Umberson et al. (2014) as central to racial disparities in health and well-being.

Marital status and gambling disorder: a longitudinal study based on national registry data

BACKGROUND

Marital status is a robust correlate of disordered gambling, but few studies have examined the direction of this association.

METHODS

The present study used a case-control design by including all adults receiving their first gambling disorder (GD) diagnosis between January 2008 to December 2018 (Norwegian Patient Registry, n = 5,121) and compared them against age and gender matched individuals with other somatic/psychiatric illnesses (Norwegian Patient Registry, n = 27,826) and a random sample from the general population (FD-Trygd database, n = 26,695). The study examined marital status before GD, getting divorced as a risk factor for future GD, and becoming married as a protective factor of future GD.

RESULTS

The findings indicated an 8-9 percentage points higher prevalence of unmarried people and about a 5 percentage points higher prevalence of separation/divorce among those that subsequently experienced GD compared to controls. Logistic regressions showed that transition through divorce was associated with higher odds of future GD compared to illness controls (odds ratio [OR] = 2.45, 95% CI [2.06, 2.92]) and the general population (OR = 2.41 [2.02, 2.87]). Logistic regressions also showed that transition through marriage was associated with lower odds of future GD compared to illness controls (OR = 0.62, CI [0.55, 0.70]) and the general population (OR = 0.57, CI [0.50, 0.64]).

CONCLUSIONS

Social bonds have previously been shown to impact physical and mental health, and the findings of the study emphasize the importance of considering social network history and previous relationship dissolution among individuals with GD.

Marital negativity's festering wounds: The emotional, immunological, and relational toll of couples' negative communication patterns

BACKGROUND

Dyadic stress theories and research suggest that couples' negative communication patterns threaten immune and emotional health, leaving partners vulnerable to illness. Spouses' relationship perceptions can also color how they see and react to marital discussions. To identify pathways linking distressed marriages to poor health, this study examined how self-reported typical communication patterns augmented discussion-based behavioral effects on spouses' blister wound healing, emotions, and discussion evaluations.

METHODS

Married couples completed two 24-hour in-person visits where they had their blood drawn to measure baseline interleukin-6 (IL-6), received suction blister wounds, reported their typical communication patterns (demand/withdraw strategies, mutual discussion avoidance, mutual constructive communication), and engaged in marital discussions. Discussions were recorded and coded for positive and negative behaviors using the Rapid Marital Interaction Coding System (RMICS). Immediately after the discussions, spouses rated their emotions and evaluated the discussion tone and outcome. Wound healing was measured for 12 days.

RESULTS

Couples who reported typically using more demand/withdraw or mutual avoidance patterns had higher baseline IL-6, slower wound healing, greater negative emotion, lower positive emotion, and poorer discussion evaluations. In contrast, couples reporting more mutual constructive patterns reported more favorable discussion evaluations. Additionally, couples' more negative and less positive patterns exacerbated behavioral effects: Spouses had wounds that healed more slowly, reported lower positive emotion, and evaluated the discussions less positively if their typical patterns and discussion-based behaviors were more negative and less positive.

CONCLUSIONS

Couples' typical communication patterns-including how often they use demand/withdraw, mutual avoidance, and mutual constructive patterns-may color spouses' reactions to marital discussions, amplifying the biological, emotional, and relational impact. These findings help explain how distressed marriages take a toll on spouses' health.

Mental health benefits of cohabitation and marriage: A longitudinal analysis of Norwegian register data

The aim is to examine how mental health is affected by cohabitation and marriage. Individual fixed-effects models are estimated from Norwegian register data containing information about consultations with a general practitioner because of mental health conditions in 2006-19. Mental health, as indicated by annual number of consultations, improves over several years before cohabitation. For those marrying their cohabiting partner, there is a weak further reduction in consultations until the wedding, but no decline afterwards. In other words, formalization of the union does not seem to confer additional mental health benefits. However, marriage may be considered a marker of favourable earlier development in mental health. In contrast, there is further improvement after direct marriage, as well as stronger improvement over the years just preceding direct marriage. Patterns are quite similar for women and men. Overall, the results suggest that the mental health benefits of cohabitation and marriage are similar.Supplementary material for this article is available at: https://dx.doi.org/10.1080/00324728.2022.2063933. Note: numbers in brackets refer to supplementary notes that can be found at the end of the supplementary material.

A First Report on Side-Effects of COVID-19 Vaccines among General Population in Sudan: A Cross-Sectional Analysis

BACKGROUND

The process of mass immunization against COVID-19 may be impacted by vaccine reluctance despite intense and ongoing efforts to boost vaccine coverage. The COVID-19 vaccine is a crucial component for controlling the pandemic. To the best of our knowledge, we did not come across any study presenting the post-vaccination side-effect profile among the Sudanese population. Developing strategies to improve the vaccine acceptability and uptake necessitate evidence-based reports about vaccine's side effects and acceptance. In this regard, this study aimed at estimating the prevalence of COVID-19 vaccine side-effects among the general population in Sudan.

METHODOLOGY

A cross-sectional web-based quantitative study was conducted among the general population aged ≥18 years and residing in the Khartoum state of Sudan. A 30-item survey tool recorded the demographics, chronic diseases, allergy to other vaccines and COVID-19 vaccine side-effects after the first, second and booster doses. The data on the onset and duration of side-effects after each dose were also recorded. The distribution of side-effect scores after each dose of COVID-19 vaccine was compared using appropriate statistical methods.

RESULTS

A total of 626 participants were approached for this study. There was a preponderance of females (57.7%), and 19% of respondents had chronic diseases. The vaccination rate against COVID-19 was 55.8% (n = 349/626). The prevalence of side-effects after the first, second and booster doses were 79.7, 48 and 69.4%, respectively. Pain at the injection site, headache, fatigue, exhaustion and fever were the common side-effects after the first and second doses, while pain at the injection site, fatigue, headache and muscle pain were frequently reported after the booster dose. Most of these side-effects appeared within 6 h and resolved within one or two days following the administration of the vaccine dose. The average side-effects scores were 4.1 ± 4.4 (n = 349), 2.2 ± 3.6 (n = 202) and 3.5 ± 4.1 (n = 36) after the first, second and booster doses, respectively. The female gender had significantly higher side-effects after primary and booster doses. The age group 18-24 years indicated higher side-effects after the first dose compared to participants with ages ranging from 31 to 40 years (p = 0.014). Patients with chronic disease indicated significantly higher (p = 0.043) side-effects compared to those without any comorbid illness.

CONCLUSIONS

This study showed a high prevalence of transient COVID-19 vaccine-related side-effects after primary and booster doses. However, these side-effects waned within 48 h. Pain at the injection site was the most common local side-effect, while fatigue, fever, headache and muscle pain were frequently reported systemic side-effects. The frequency of side-effects was more profound among females, young adults and those with comorbid conditions. These findings indicate that COVID-19 vaccines are safe and have side-effects as reported in the clinical trials of the vaccines. These results aid in addressing the ongoing challenges of vaccine hesitancy in the Sudanese population that is nurtured by widespread concerns over the safety profile.

Marital dissolution and associated factors in Hosanna, Southwest Ethiopia: a community-based cross-sectional study

BACKGROUND

Marriage dissolution, divorce, or separation from a spouse or common-law partner is a serious public health concern due to its increasing prevalence and devastating health and socio-economic consequences. Evidence suggests an increased risk of marital instability in Ethiopia. In addition, the extent of marital dissolution and other related factors have increased in the study area. Despite these, the prevalence of marital dissolution and the influence of associated factors (main reason for marriage, and parental history of marital dissolution) on marital dissolution has not been assessed in the study area. Therefore, the aim of this study was to investigate the prevalence of marital dissolution and its associated factors among residents of Hosanna town in southwestern Ethiopia in 2022.

METHODS

We conducted a community-based cross-sectional study among 459 randomly selected Hosanna Township residents. We used structured questionnaires to collect data. Descriptive statistics and logistic regression were performed to describe the data and test-associated factors, respectively. A p-value less than 0.05 was used to define statistical significance. We used STATA 14 and IBM SPSS 25.0 computer packages to process data.

RESULTS

Out of the 459 potentially eligible individuals, 450 participants properly responded to the questionnaires yielding a response rate of 98.04%. Of these, 218 (52.9%) were female. The commonly reported reason for marriage was to have children 150 (36.9%). The prevalence rate of marital dissolution was 26.0% (95% CI: (21.7%, 30.3%)). The participant's level of education and the primary reasons (motives) why they get married were statistically significantly associated with marital dissolution. The odds of marital dissolution was higher among participants who completed secondary education (AOR = 3.2, 95% CI = 1.26-8.17) compared to those having no formal education. The participants who married for companionship reasons (AOR = 0.31, 95% CI = 0.11-0.83) had significantly lower odds of marriage dissolution compared with those who married for financial security.

CONCLUSIONS

In this study, the prevalence of marital dissolution was high. The participant's level of education and the primary reasons (motives) why they getting married were significantly associated with marital dissolution. Therefore, an integrated, community-based approach should be developed to prevent marital dissolution.

Current Marital Status and Epigenetic Clocks Among Older Adults in the United States: Evidence From the Health and Retirement Study

Objectives: This study examines how current marital status is associated with epigenetic aging. Methods: Data from the 2016 Health and Retirement Study were used to examine marital status differences in the four epigenetic clocks, that is, GrimAge, DunedinPoAm, PhenoAge, and Zhang (N = 3765). Weighted ordinary least square regression models were estimated separately for men and women. Results: Remarried, cohabiting, divorced/separated and widowed older adults showed greater epigenetic aging than the continuously married similarly among men and women. Distinct sex difference was observed among the never married. While never-married women exhibited greater epigenetic aging than their continuously married counterparts, older men in lifelong singlehood showed comparable epigenetic aging to their continuously married peers. Discussion: The findings speak to the importance of marital context for epigenetic aging in later life and the biological risk associated with lifelong singlehood for older women in the US.

Effects of intranasal oxytocin and positive couple interaction on immune factors in skin wounds

BACKGROUND

Intimate social relationships improve individual health and longevity, an effect which is supposed to be mediated through stress-sensitive endocrine and immune mechanisms in response to positive interaction behavior. On a neuroendocrine level, oxytocin (OT) buffers stress responses, modulates social attachment behavior and has been associated with cytokine expression. Consequently, the aim of the present study was to investigate instructed positive couple interaction, observed behavior, and OT in their effect on immune function.

METHODS

In a 4-group design, 80 healthy couples (N = 160 individuals) received four standard dermal suction blister wounds and were randomized to instructed positive interaction/control and intranasal OT/placebo. Unstimulated cytokines (IL-1β, IL-6, TNF-α) were assessed from wound liquid at 40 min, 105 min and 24 hrs after wounding.

RESULTS

Overall, group assignment did not affect friendly or dominant behavior during the interaction sequence. IL-1β and IL-6 levels, however, were moderated by group assignment with lowest levels in women in the positive interaction and OT condition in IL-1 and highest levels in IL-6. TNF-α responses to wounding were not affected from group assignment, however observed friendliness in women was associated with lower TNF-α levels.

DISCUSSION

These findings support the immune-regulating role of friendly behavior in romantic couples. Above this, the data provide the first empirical evidence that an intervention that simultaneously targets neuroendocrine mediators and behavior could affect immune function in a sex specific manner and with potential long-term health relevance.

Demographic profile, management, and survival of primary Gastrointestinal Kaposi Sarcoma: A USA Nationwide SEER-based study

Kaposi Sarcoma (KS) is a Human Herpes Virus-8 (HHV-8) associated angio-proliferative disorder commonly seen in patients with HIV. It most commonly involves the skin as classic purple lesions but occasionally involves the gastrointestinal (GI) tract. To date, published data is scarce on primary GI KS. Using a national database, this study analyzes the incidence, demographics, and survival of primary GI KS. We conducted a retrospective analysis (1975-2019) on biopsy-proven primary GI KS cases from 17 registries from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 685 patients with GI KS were identified. Female gender, Non-Hispanic Asian or Pacific Islander (NHAPI), married marital status, and large bowel site-specific primary KS to have better overall survival. Luminal gastrointestinal KS was more frequent (84.96%) than solid organ involvement (3.07% of all cases). This study is the most extensive population-based study about the epidemiological and survival data of patients with primary GI KS, revealing GI KS to be a young male disease with best outcomes in the large bowel and anal canal KS while inferior outcomes in extraintestinal GI KS.

Three Pathways Into Chronic Lack of Energy as a Mental Health Complaint

Abstract. Many disturbances of physical, social, and mental health have conditions involving lack of energy, difficulty in making decisions, and low interest or motivation. Laboratory studies of willpower depletion have produced similar states in a temporary fashion. The present review uses extant literature to develop and test three theories about how temporary states of low willpower could become chronic. The first is ongoing and repeated exposure to depleting circumstances, such as caregiver fatigue, burdensome financial debts, and high-stress jobs. The second focuses on inadequate recoveries, such as poor sleep, insufficient nutrition, or unsatisfying vacations. The third invokes dispositional vulnerabilities that predispose some people to become depleted more frequently than others. A wide-ranging search for evidence concluded that the first two theories have more support than the third, though all further merit research. Additional possible contributions to chronicity are discussed, such as the emergence of vicious circles.

The Impact of ADHD on Maternal Quality of Life

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.

Loneliness and diurnal cortisol levels during COVID-19 lockdown: the roles of living situation, relationship status and relationship quality

Loneliness and social isolation have become increasing concerns during COVID-19 lockdown through neuroendocrine stress-reactions, physical and mental health problems. We investigated living situation, relationship status and quality as potential moderators for trait and state loneliness and salivary cortisol levels (hormonal stress-responses) in healthy adults during the first lockdown in Germany. N = 1242 participants (mean age = 36.32, 78% female) filled out an online questionnaire on demographics, trait loneliness and relationship quality. Next, N = 247 (mean age = 32.6, 70% female) completed ecological momentary assessment (EMA), collecting twelve saliva samples on 2 days and simultaneously reporting their momentary loneliness levels. Divorced/widowed showed highest trait loneliness, followed by singles and partnerships. The latter displayed lower momentary loneliness and cortisol levels compared to singles. Relationship satisfaction significantly reduced loneliness levels in participants with a partner and those who were living apart from their partner reported loneliness levels similar to singles living alone. Living alone was associated with higher loneliness levels. Hierarchical linear models revealed a significant cross-level interaction between relationship status and momentary loneliness in predicting cortisol. The results imply that widowhood, being single, living alone and low relationship quality represent risk factors for loneliness and having a partner buffers neuroendocrine stress responses during lockdown.

Contextual and individual factors associated with depressive symptoms in Latin American residents from eleven cities: Multilevel analysis

Depression is one of the most prevalent mental illnesses in the world. Its associated factors have been scarcely studied in the Latin American population. Our aim was to determine the contextual and individual factors associated with depressive symptoms (DS) in residents of 11 Latin American cities according to the 2019 CAF Survey (ECAF, acronym in Spanish). A multilevel analysis was performed to identify individual and contextual factors associated with DS. DS were measured by the short version of the Center for Epidemiological Studies Depression Scale (CES-D-10). Of the 10,206 participants, 42.0% had DS in the week prior to the survey. Regarding the individual factors studied, women (OR = 1.81, 95% CI: 1.65-1.99), smokers (OR = 1.30, 95% CI: 1.16-1.45), obese, junk food eaters more than twice a week, single people, and a greater number of people in the household were associated with greater probabilities of having DS. On the other hand, a secondary (OR = 0.77; 95% CI: 0.67-0.88) or superior educational level (OR = 0.58; 95% CI: 0.50-0.68) were associated as protective factors. Regarding contextual factors, higher contamination levels (OR = 1.07, 95% CI: 1.01-1.13) were associated with DS. Our study reports associations between individual and environmental factors and DS in residents of Latin America. These findings will allow the adoption of the necessary measures for decision-making and research to face this growing problem in developing countries.

Psychoneuroimmunology in the time of COVID-19: Why neuro-immune interactions matter for mental and physical health

The brain and immune system are intricately connected, and perturbations in one system have direct effects on the other. This review focuses on these dynamic psychoneuroimmune interactions and their implications for mental and physical health in the context of the COVID-19 pandemic. In particular, we describe how psychological states influence antiviral immunity and the vaccine response, and how immune changes triggered by COVID (either via infection with SARS-CoV-2 or associated stressors) can influence the brain with effects on cognition, emotion, and behavior. We consider negative psychological states, which have been the primary focus of psychological research in the context of COVID-19 (and psychoneuroimmunology more generally). We also consider positive psychological states, including positive affect and eudaimonic well-being, given increasing evidence for their importance as modulators of immunity. We finish with a discussion of interventions that may be effective in improving immune function, the neuro-immune axis, and ultimately, mental and physical health.

Quarreling After a Sleepless Night: Preliminary Evidence of the Impact of Sleep Deprivation on Interpersonal Conflict

Although poor sleep has been found to correlate with deteriorations in romantic relationships, its causal impact on interpersonal conflict has not previously been studied. Therefore, 30 couples were randomly assigned to either a single night of total sleep deprivation or a night of normal sleep to test the effects of sleep deprivation on couples’ conflict. After the experimental night, all participants discussed a topic of recurrent conflict for 15 min. We collected pre- and post-conflict measures of cortisol, self-reports of feelings, and satisfaction with the conflictual discussion. Multilevel analyses revealed higher cortisol levels during conflict and less positive affect prior to and after the conflict for sleep-deprived couples compared to couples in the control condition. These findings provide initial evidence for a causal negative impact of sleep deprivation on couples’ conflicts.

Psychic Life-Biological Molecule Bidirectional Relationship: Pathways, Mechanisms, and Consequences for Medical and Psychological Sciences—A Narrative Review

Today, it is possible to investigate the biological paths and mechanisms that link mental life to biological life. Emotions, feelings, desires, and cognitions influence biological systems. In recent decades, psychoneuroendocrinoimmunology research has highlighted the routes linking the psyche–brain–immune systems. Recently, epigenetics research has shown the molecular mechanisms by which stress and mental states modulate the information contained in the genome. This research shapes a new paradigm considering the human being as a whole, integrating biology and psychology. This will allow us to progress towards personalized precision medicine, deeply changing medical and psychological sciences and clinical practice. In this paper, we recognize leading research on both bidirectional relations between the psyche–brain–immunity and molecular consequences of psychological and mental states.

Partner's Perceived Social Support Influences Their Spouse's Inflammation: An Actor-Partner Analysis

Social support has been linked to lower cardiovascular morbidity and mortality. However, most studies have examined perceived support as an intrapersonal construct. A dyadic approach to social support highlights how interdependence between individuals within relationships, including partner perceptions and interactions, can influence one's health. This study's overall purpose was to test actor-partner models linking perceived social support to inflammation. Ninety-four cisgender married couples completed perceived support measures and had their blood drawn for CRP and IL-6 to produce an overall inflammatory index. The primary results indicate that only a partner's level of perceived support was related to lower inflammation in their spouse. Our sample size, although moderate for inflammatory studies, was probably not large enough to detect actor influences. These data highlight the importance of taking a dyadic perspective on modeling perceived support and its potential mechanism.

Do partnership dissolutions and living alone affect systemic chronic inflammation? A cohort study of Danish adults

BACKGROUND

Partnership breakups and living alone are associated with several adverse health outcomes. The aim of this study, carried out in Denmark, is to investigate whether accumulated numbers of divorces/partnership breakups or years lived alone across 26 years of adult life are associated with levels of inflammation, and if vulnerability with regards to gender or educational level can be identified.

METHODS

4835 participants from the Copenhagen Aging and Midlife Biobank (CAMB) aged 48-62 years were included. Data on accumulated numbers of partnership breakups and years living alone were retrieved from a national standardised annual register. Inflammatory markers interleukin 6 (IL-6) and high sensitivity C-reactive protein (hsCRP) were measured in blood samples. Multivariate linear regression analyses were adjusted for age, educational level, early major life events, body mass index, chronic diseases, medicinal intake affecting inflammation, acute inflammation and personality scores.

RESULTS

For men, an association was found between an increasing number of partnership breakups or number of years living alone and higher levels of inflammatory markers. No such association was found for women, and no evidence of partnership breakups and educational level having a joint effect was found for either gender.

CONCLUSION

The findings suggest a strong association between years lived alone or accumulated number of partnership breakups and low-grade inflammation for middle-aged men, but not for women. Among those of either sex with a lower level of education, no specific vulnerability to accumulated years lived alone or number of breakups was identified.

Independent Associations of Serum 25-hydroxyvitamin D3 and D2 with Depressive Symptoms in Females

BACKGROUND

The role of vitamin D in depression has been gaining increased research interest. However, little is known about the independent associations of serum 25-hydroxyvitamin D₃ (25(OH)D₃) and D₂ (25(OH)D₂) with depressive symptoms. The goal of this study was to examine the metabolites of vitamin D and their associations with depression.

METHODS

This study was conducted in US females using data from the National Health and Nutrition Examination Survey 2011-2014. Depressive symptoms were assessed using a nine-item Patient Health Questionnaire, and serum 25(OH)D₃ and 25(OH)D₂ levels were measured using liquid chromatography-tandem mass spectrometry. Linear regression and generalized additive models were applied to evaluate the associations between 25(OH)D₃, 25(OH)D₂ and depression.

RESULTS

A negative association between serum 25(OH)D₃ and depressive symptoms was observed in the fully adjusted model. This association was also found among widowed, divorced, separated, and never-married individuals. The association between 25(OH)D₂ and depressive symptoms was not statistically significant, but the dose-response analysis revealed an inverted U-shaped relationship between them with an inflection point at 56.2 nmol/L. To the left of the inflection point, we detected a positive association between 25(OH)D₂ and depressive symptoms, whereas a negative association was observed to the right of the inflection point.

LIMITATIONS

The study used a cross-sectional approach, so causation cannot be determined.

CONCLUSIONS

Our study shows an inverse linear association between serum 25(OH)D₃ and depressive symptoms in US females. The association between 25(OH)D₂ and depression follows an inverted U-shaped curve with the inflection point at 56.2 nmol/L.

Good Theories in Need of Better Data: Combining Clinical and Social Psychological Approaches to Study the Mechanisms Linking Relationships and Health

The study of intimate relationships and health is a fast-growing discipline with numerous well-developed theories, many of which outline specific interpersonal behaviors and psychological pathways that may give rise to good or poor health. In this article, we argue that the study of relationships and health can move toward interrogating these mechanisms with greater precision and detail, but doing so will require a shift in the nature of commonly used research methods in this area. Accordingly, we draw heavily on the science of behavior change and discuss six key methodologies that may galvanize the mechanistic study of relationships and health: dismantling studies, factorial studies, experimental therapeutics, experimental mediation research, multiple assessments, and recursive modeling. We provide empirical examples for each strategy and outline new ways in which a given approach may be used to study the mechanisms linking intimate relationships and health. We conclude by discussing the key challenges and limitations for using these research strategies as well as novel ideas about how to integrate this work into existing paradigms within the field.

Parenting costs time: Changes in pair bond maintenance across pregnancy and infant rearing in a monogamous primate (Plecturocebus cupreus)

Relationships support social animals' health, but maintaining relationships is challenging. When transitioning to parenthood, new parents balance pair-bond maintenance with infant care. We studied pair-bond maintenance via affiliation in 22 adult titi monkey pairs (Plecturocebus cupreus) for 16 months centered around their first offspring's birth. Pair affiliation peaked during pregnancy, decreased across the postpartum period, and rose after reaching minimum affiliation 32.6 weeks postpartum. Pairs in which fathers carry infants more than average had lower affiliation at the infant's birth and return to an increase in affiliation sooner. Parents of infants who were slow to independence had higher rates of affiliation. Titi monkey infants actively prefer their fathers; mothers may avoid their infant-carrying mate, suggesting infants play an active role in parental affiliative decline. Our data supports previous findings that affiliation between partners declines following an infant's birth, but demonstrates new knowledge about the extent and duration of affiliative decline.

Loneliness in older parents: marital transitions, family and social connections, and separate bedrooms for sleep

OBJECTIVES

This research innovatively analyzed the marital transitions (i.e., divorce and widowhood) of older Taiwanese parents, their sleep problems and spousal specific characteristics (i.e., separate bedrooms for sleep and marital relationships) as well as their social and family connections, all of which were simultaneously reflected in emotional and social domains of loneliness.

METHODS

Data are from 1645 older parents from Northern Taiwan. Loneliness was assessed by a De Jong-Gierveld short scale with emotional and social domains. We conducted multivariate logistic regression to examine the associations of marital transitions and family/social connections regarding sleep problems and psychological well-being with loneliness in social and emotional domains. Besides sleep problems and individual socioeconomic status, we included data on couples' sleeping arrangements and marital relationships.

RESULTS

Social loneliness was significantly associated with being divorced (AOR = 1.80, 95% CI 1.13-2.86) and living alone (AOR = 1.50, 95% CI 1.02-2.23). In contrast, strong family cohesion and frequent weekly contact with friends were associated with lower social loneliness. Married parents who slept in separate bedrooms were more likely than bed-sharing couples to feel emotional and social loneliness, despite adjusting for their sleep problems. Furthermore, satisfactory spousal relationships significantly decreased the magnitude of associations in the social domain.

DISCUSSION

Our findings support significant associations between loneliness in later life and major marital transitions, family and social connections and sleep problems which differ in social and emotional domains. Independent of relationship satisfaction, separate bedrooms relate to higher risks of emotional loneliness in older adults.

The health consequences of stress in couples: A review and new integrated Dyadic Biobehavioral Stress Model

Despite marriage's health benefits, all couples experience stress that can increase morbidity and mortality risks. Marital stress can alter endocrine, cardiovascular, and immune function-key pathways from troubled relationships to poor health. This review discusses how partners "get under each other's skin" to influence psychological, behavioral, and biological health. Then, I offer a comprehensive Dyadic Biobehavioral Stress Model to build on this foundational work and inspire transdisciplinary research integrating psychoneuroimmunological and relational lenses. This conceptual and empirically driven model provides promising new directions to investigate mechanisms linking individuals' relationships behaviors to their own and their partners' health, with particular emphasis on biological pathways. These mechanisms may impact each partner's physical health outcomes, such as disease development, illness severity, and accelerated biological aging. Risk and protective factors across developmental stages and diverse contexts are also discussed to help explain how, and under what conditions, partners influence each other's health. Research applying this model can push the boundaries of our current understanding on dyadic stress its far-reaching health effects on self-report and biological markers across the lifespan.

Association of Long Working Hours With Marital Status Changes in South Korea: A Cohort Study

OBJECTIVE

This study investigated the relationship between long working hours and the incidence of divorce or separation among Korean female and male workers.

METHODS

A cohort study was conducted in 125,108 Korean workers, married at baseline, who attended health examinations between 2012 and 2017 and had been followed annually or biennially until December 31, 2018. The weekly working hours and marital status changes were measured using self-administered questionnaires. This study was performed using sex stratification.

RESULTS

In a multivariable-adjusted model, by comparing working hours->52 hours/week with 35 to 40 hours/week-the hazard ratios (95% confidence intervals) for incidents of divorce or separation were 1.60 (1.03-2.49) and 0.86 (0.66-1.12) in females and males, respectively.

CONCLUSIONS

This study showed that long working hours could contribute to marital status changes in Korean female workers.

Sociodemographics and chronic stress in mother-toddler dyads living in poverty

Experiencing chronic stress early in life is associated with later health disparities, and poverty may be a significant stressor for both mothers and children. With a sample of primarily Black and White mothers (N = 75) and toddlers (N = 71) living in poverty in the United States, we examined the direct relations between sociodemographic conditions of poverty and chronic physiological stress. Mothers completed questionnaires on sociodemographics, including mother/toddler race, mother's education, father's education, poverty level, economic hardship, marital status, unemployment status, and toddler sex. Physiological chronic stress was measured by assaying the cortisol content of 4 cm samples of hair cut from the posterior vertex of mothers and toddlers (20-24 months of age) to represent 4 months of stress. Mothers' and toddlers' chronic stress was significantly, moderately, and positively associated. Toddlers had a trending relationship of moderately higher chronic stress if they were Black compared to not Black. Mothers had significantly, moderately higher chronic stress if they were Black or had a Black toddler (compared to not Black), not married (compared to married), or were working (compared to not working). The findings suggest that these mothers, simultaneously navigating poverty and parenting a toddler, need resources to reduce chronic stress.

Predictors of Depressive Symptoms in Caregivers of Children with Attention-Deficit/Hyperactivity Disorder: A One-Year Follow-Up Study

This 1-year follow-up study examined the predictive values of the demographics, depressive symptoms, stress-coping orientations, and perceived family support of caregivers as well as the internalizing, externalizing and ADHD symptoms of children with attention-deficit/hyperactivity disorder (ADHD) at baseline on the depressive symptoms of the caregivers after 1 year. A total of four hundred caregivers of children with ADHD were recruited. The baseline levels of the caregivers' depressive symptoms, stress-coping orientations, and perceived family support and the internalizing and externalizing problems of the children were assessed using the Center for Epidemiological Studies Depression Scale, the Coping Orientation to Problems Experienced, Family Adaptation, Partnership, Growth, Affection, Resolve Index, and the Child Behavior Checklist For Ages 6-18, respectively. Their predictions for the caregiver's depressive symptoms 1 year after the baseline were examined using linear regression analysis. In total, 382 caregivers of children with ADHD underwent the follow-up assessment 1 year from the baseline. A marital status of being separated or divorced, less effective coping and depressive symptoms orientation, and children with internalizing problems and ADHD symptoms at baseline were positively associated with the caregivers' depressive symptoms at follow-up, whereas the caregivers' perceived family support and an emotion-focused coping orientation at baseline were negatively associated with depressive symptoms at follow-up. Multiple characteristics of the caregivers and children with ADHD at baseline predicted the caregivers' depressive symptoms 1 year later.

Romantic Relationship Dissolution, Microbiota, and Fibers

Microbiota inhabit nearly every part of our body with the gut microbiota representing the greatest density and absolute abundance. The gut-microbiota-brain axis facilitates bidirectional communication between gut microbiota and the brain. For instance, romantic relationship not only brings joy, it is also associated with increased gut microbiota diversity and health benefits whereas reduced microbiota diversity is related to obesity, cardiac disease, type 2 diabetes, and inflammatory disorders. Research has shown that dietary fibers may increase microbiota diversity and exert antidepressant effect. Among a plethora of life stressors, romantic relationship dissolution is a relatively common and painful experience that people encounter from time to time. Depressed mood, social isolation and poor intake are all associated with romantic relationship dissolution. In this article, it is hypothesized that romantic relationship dissolution is accompanied by decreased gut microbiota diversity which could be corrected with the ingestion of dietary fibers with an additional antidepressant benefit.

Common Venues in Romantic Relationships of Adults With Symptoms of Autism and Attention Deficit/Hyperactivity Disorder

Introduction: Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) figures among the most common neurodevelopmental disorders. Despite having opposite stereotypes, both ADHD and ASD compromise, though in different ways, skills such as social interactions, communication skills, and social thinking, which may underlie difficulties in romantic relationships. Methods: We evaluated 306 adults about their romantic relationships and the intensity of their love. Participants were from one of four groups:, individuals with ASD-only traits, a group with symptoms of ADHD-only, participants with neither ADHD nor ASD symptoms (control) or from a fourth group of individuals with both ADHD and ASD traits. Results: The ASD traits group had fewer married people and more people who have never been married, while the rate of divorce was higher in the ADHD traits group. Regarding the intensity of love, the mean scores of the ADHD and the ADHD+ASD traits groups were higher in the Passionate Love Scale than the mean score of the control group. Passionate love in the ASD group was no different from the other groups. Small positive correlations were found between passionate love and ADHD and ASD behavioral problems. Conclusion: Marital status was distinct depending on symptoms of a neurodevelopmental disorder in adulthood. Also, ADHD and ASD symptoms were associated with greater passionate love. Therefore, ADHD and ASD behavioral dimensions may impact long-term and short-term experiences of a person's relationship with a significant other in distinct ways. Understanding how people with neurodevelopmental disorders experience love might help us to better clarify the mechanisms associated with their relationship patterns.

Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes

Background

Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting.

Methods

We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct between January 2008 and December 2015. Marital status before hct was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after hct.

Results

We identified 10,226 allogeneic and 5714 autologous hct cases with, respectively, a median follow-up of 37 months (range: 1-102 months) and 40 months (range: 1-106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2-4 acute graft-versus-host disease (gvhd), p < 0.001, and chronic gvhd, p = 0.04. The risk of grades 2-4 acute gvhd was increased in separated compared with married patients [hazard ratio (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 0.82; 95% ci: 0.67 to 0.99).

Conclusions

Overall survival after hct is not influenced by marital status, but associations were evident between marital status and grades 2-4 acute and chronic gvhd. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization.

How are Social Ties Protective?

Social ties are the most important resource human beings have. Although other people can be difficult and challenging, they can also provide protection, solace, and social support, among other benefits. However, some relationships can be toxic and because these adverse conditions can be physiologically taxing, they can negatively affect both mental and physical health. Changes such as these can operate in large part through alterations in the sympathetic nervous system, the hypothalamic-pituitary-adrenal system, and the immune system. Much of the benefit of social support is perceptual and stems from the comfort of believing that supportive others can or will be there when times are stressful. The abilities to gain and perceive social support begin early in life and are heavily influenced by the climate of the family. Social support depends, in part, on reciprocity, yet many challenges to receiving support exist. Giving support to others has its own psychological and physiological benefits, although at intense levels, such as demanding caregiving responsibilities, these benefits dwindle. Moreover, social support needs change over time with changing circumstances. Public policy efforts to help people build and capitalize on their potential support networks is essential to maximize the impact of social ties on mental and physical health.

Partnership Status and Living Situation in Persons Experiencing Physical Disability in 22 Countries: Are There Patterns According to Individual and Country-Level Characteristics?

Persons experiencing disabilities often face difficulties to establish and maintain intimate partnerships and the decision whether to live alone or with others is often not their own to make. This study investigates whether individual and country-level characteristics predict the partnership status and the living situation of persons with spinal cord injury (SCI) from 22 countries. We used data from 12,591 participants of the International SCI Community Survey (InSCI) and regressed partnership status and living situation on individual (sociodemographic and injury characteristics) and country-level characteristics (Human Development Index, HDI) using multilevel models. Females, younger persons, those with lower income, without paid work, more severe injuries, and longer time since injury were more often single. Males, older persons, those with higher income, paid work, less severe injuries, and those from countries with higher HDI more often lived alone. This study provides initial evidence for the claim that the partnership status and the living situation of people with SCI are influenced by sociodemographic and socioeconomic factors and are not merely a matter of choice, in particular for those with severe injuries.

Stress Reactivity: What Pushes Us Higher, Faster, and Longer - and Why It Matters

Brief everyday stressors can provoke cardiovascular, hormonal, and immune changes, with considerable variation in the magnitude and duration of these responses. Acute responses to daily stressors can vary widely among individuals experiencing the same stressor, and these physiological responses may not align with stress appraisals. This review highlights individual and dyadic factors that may heighten and prolong stress reactivity, and their implications for health. We discuss depression, rumination, early life adversity, and social evaluation as individual level factors, and interpersonal stress processes and relationship quality as dyadic level factors that may influence physiological stress responses. Heightened and prolonged stress reactivity can provide a gateway to the physiological dysregulation that underlies depression and chronic disease, which themselves alter stress reactivity - a vicious cycle. Interventions that may dampen physiological stress reactivity include yoga, meditation, health behaviors (diet, exercise, and sleep), and cognitive behavioral therapy.

Relationship satisfaction predicts lower stress and inflammation in breast cancer survivors: A longitudinal study of within-person and between-person effects

BACKGROUND

Breast cancer survivors with elevated inflammation have a greater risk for cancer recurrence, premature mortality, and comorbid disease development. The psychological stress survivors experience when confronted with a breast cancer diagnosis and cancer treatment can heighten inflammation. Identifying factors that reduce stress and inflammation could lead to improvements in survivors' long-term health. Accordingly, this study examined the health-enhancing effects of romantic relationships-a key health determinant-on breast cancer survivors' stress and inflammation.

METHODS

Breast cancer survivors (n = 139, stages 0-IIIC) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after treatment ended. Women completed self-report questionnaires assessing their romantic relationship satisfaction and perceived stress, and they provided a blood sample for serum markers of inflammation at each visit. The longitudinal design allowed for examination within and between survivors. We conducted multilevel mediation analyses to assess how changes in survivors' relationship satisfaction were related to changes in stress and inflammation from visit to visit (i.e., within-person effects), as well as how the average effects of relationship satisfaction were associated with average stress and inflammation levels throughout the study (i.e., between-person effects).

RESULTS

At the within-person level, at visits in which survivors were more satisfied with their relationships, they also perceived less stress, which in turn was related to lower than their own average levels of serum C-reactive protein and proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-1β). At the between-person level, survivors who had greater relationship satisfaction throughout the study had lower perceived stress, which was linked to lower levels of inflammation.

CONCLUSION

Breast cancer survivors in satisfying romantic relationships felt less stressed and in turn had lower inflammation throughout cancer treatment. This study illustrates the utility of a within-person approach to not only consider the average effects of relationship satisfaction, but also how changes in their own relationship satisfaction impact stress and inflammation over time. Our findings demonstrate important psychological and immunological pathways through which satisfying relationships may promote breast cancer survivors' long-term health.