Burden of psychosocial adversity and vulnerability in middle age: associations with biobehavioral risk factors and quality of life

Higher adherence to a Mediterranean-type diet is associated with reduced psychosocial stress levels in baby boomers: a cross-sectional study

BACKGROUND/OBJECTIVES

This study investigated the relationship between adherence to the Mediterranean diet among Korean baby boomers and their levels of psychosocial stress.

SUBJECTS/METHODS

The study included 1,656 adults (889 men and 797 women) born between 1955 and 1963 who participated in the 2005-2006 survey of the community-based Korean Genome and Epidemiology Study (KoGES). The Mediterranean-type diet score (MTDS) was calculated from the semi-quantitative food frequency questionnaire (SQFFQ) data. The psychosocial stress levels were calculated using the psychosocial well-being index-short form (PWI-SF). Logistic regression analyses were performed to analyze the association between the MTDS (tertiles) and the prevalence of high psychosocial stress by gender.

RESULTS

The ranges of the MTDS tertile groups were T1 (20-33 points), T2 (34-37 points), and T3 (38-39 points) for men, T1 (20-33 points), T2 (34-37 points), and T3 (38-48 points) for women. In both men and women, the consumption of whole grains, potatoes, fruits, vegetables, legumes, and fish increased with higher MTDS, while the consumption of red meat and dairy products decreased (P for trend < 0.05). As MTDS score increased the intake of energy, fiber, vitamins, and minerals (P for trend < 0.05). Men in the highest MTDS tertile had a 41% lower odds ratio (OR) of high psychosocial stress compared with those in the lowest tertile (OR, 0.59; 95% confidence interval [CI], 0.38-0.91). Similarly, women in the highest tertile of the MTDS had a 39% lower OR of high psychosocial stress compared with those in the lowest tertile (OR, 0.61; 95% CI, 0.40-0.95).

CONCLUSION

Promoting adherence to the Mediterranean diet among baby boomers may have a positive impact on reducing their levels of psychosocial stress.

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.

Racial/ethnic and nativity differences in adversity profiles among middle-aged and older adults

OBJECTIVES

Focusing on the nexus of race/ethnicity and nativity, this study examined profiles of adversity and their mental health implications in five groups of middle-aged and older adults: native-born whites, native-born blacks, native-born Hispanics, foreign-born whites, and foreign-born Hispanics.

METHODS

Data were from the 2018 psychosocial assessment of the HRS (N = 5,223). Latent class analysis (LCA) was employed to identify patterns of eleven adversity indicators and to compare the latent structures and class prevalence across the race/ethnicity and nativity groups. Regressions were used to examine the associations between adversity profiles and depression and life satisfaction, respectively.

RESULTS

Four adversity profiles emerged: low adversity (59.84%), low human capital (15.27%), socially marginalized (15.26%), and neighborhood adversity (9.63%). Regardless of nativity status, white older adults were most likely to have the low adversity profile (74 ∼ 75%). In contrast, all the racial/ethnic minority groups were more likely to have the other three adversity profiles. The adversity experienced by racial/ethnic minorities was further cofounded by their immigration status. Overall, having low adversity was associated with the best mental health outcomes and socially marginalized had the poorest outcomes. Even with the low adversity profile, native-born blacks had significantly more depressive symptoms than native-born whites.

CONCLUSION

Findings revealed heterogeneity in adversity profiles and their mental health implications in disadvantaged aging populations. Tailored programs are needed to address unique needs of different minority populations.

Anger and Dementia Caregiving: A Systematic Review of the Effects of Anger and Hostility on Caregivers' Physical Health

Background

Anger is commonly experienced by family caregivers of people living with dementia yet its effect on caregivers' physical health remains unknown.

Objective

The primary aim of this study was to systematically review current evidence on the effects of anger and hostility on caregivers' physical health.

Methods

We searched Medline, EMBASE, PubMed, and PsycINFO up to January 2022. Two review authors independently extracted data on study characteristics, study quality, and effect sizes of associations of anger and hostility with caregiver health outcomes.

Results

We found eight studies examining the effects of anger and hostility on caregivers' physical health reporting on a total of 937 participants, of which four were cross-sectional and four were longitudinal. Overall findings indicated that higher levels of anger and hostility exerted a negative effect on caregivers' physical health. Higher anger control was longitudinally associated with increased weight gain (β= 1.13, p < 0.001), whereas higher anger out predicted higher glucose dysregulation at long-term follow-up (r = 0.27, p < 0.05). Higher levels of caregiver hostility were associated with increased risk of chronic low-grade inflammation long-term (r = 0.18, p < 0.05), and increased risk of cognitive decline over time (r = -0.16, p < 0.05).

Conclusion

Our review provides the first systematic synthesis of the evidence demonstrating the harmful effects of anger and hostility on dementia caregivers' health and highlights the need for preventative interventions to support family caregivers experiencing high levels of anger.

Looking forward to a decade of the biopsychosocial model

The topic of this article is the biopsychosocial model. My main contention is that - notwithstanding doubts as to what exactly it is, or indeed whether it is anything - there is a coherent account of it, in terms of both applications to particular health conditions and mechanisms with wide application. There is accumulating evidence from recent decades that psychosocial as well as biological factors are implicated in the aetiology and treatment of a large range of physical as well as mental health conditions. The original proposer of the biopsychosocial model, George Engel, back in 1977, was substantially correct about what he saw was on its way.

Associations of Chronic Burden, Sleep Characteristics, and Metabolic Syndrome in the Coronary Artery Risk Development in Young Adults Study

OBJECTIVE

Chronic exposure to stress is associated with metabolic syndrome (MetS), but the mechanism is unclear. We investigated the associations between chronic burden, sleep, and MetS in the Coronary Artery Risk Development in Young Adults Study.

METHODS

Chronic burden was self-reported (2000-2001) according to experiences with stressors for longer than 6 months. Wrist actigraphy-measured sleep duration and sleep efficiency were collected for 6 days; sleep duration, sleep quality, and daytime sleepiness were self-reported (2003-2004). MetS was measured during the clinic visit, from 2005 to 2006. Multivariable logistic and Cox proportional hazard models were fit to determine the associations of interest. Mediation by sleep was assessed using the product of coefficients approach.

RESULTS

Among participants ( n = 606), the average (standard deviation) age was 40 (3.6) years, 58% were female, and 43% were Black. The prevalences of chronic burden, short sleep (≤6 hours), and MetS were 35%, 43% and 20.5%, respectively. High versus low chronic burden was associated with shorter self-reported sleep duration and higher daytime sleepiness. Chronic burden was associated with 1.85 higher odds (95% confidence interval = 1.11-3.09) of MetS. Sleep characteristics were not associated with MetS. There was no evidence that sleep mediated the chronic burden-MetS relation.

CONCLUSION

Burden of chronic stress may be an emerging novel risk factor for both poor sleep and MetS.

Explaining socioeconomic disparities in health behaviours: A review of biopsychological pathways involving stress and inflammation

The purpose of this article was to explore how individuals' position in a socioeconomic hierarchy is related to health behaviours that are related to socioeconomic disparities in health. We identified research which shows that: (a) low socioeconomic status (SES) is associated with living in harsh environments, (b) harsh environments are related to increased levels of stress and inflammation, (c) stress and inflammation impact neural systems involved in self-control by sensitising the impulsive system and desensitising the reflective system, (d) the effects are inflated valuations of small immediate rewards and deflated valuations of larger delayed rewards, (e) these effects are observed as increased delay discounting, and (f) delay discounting is positively associated with practicing more unhealthy behaviours. The results are discussed within an adaptive evolutionary framework which lays out how the stress response system, and its interaction with the immune system and brain systems for decision-making and behaviours, provides the biopsychological mechanisms and regulatory shifts that make widespread conditional adaptability possible. Consequences for policy work, interventions, and future research are discussed.

Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective "real world" data analysis of fibromyalgia patients

OBJECTIVE

To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM).

METHODS

In this cross-sectional, observational study, "real world" data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses.

RESULTS

The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (- 0.22), pain-related interference with everyday life (- 0.19), general activity (0.13), general health perception (0.11), punishing response from others (- 0.11), work status (- 0.10), vitality (- 0.11) and cognitive difficulties (- 0.12). Pain intensity or frequency was not an independent correlate.

CONCLUSIONS

More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

Can Hostile Attitudes and Hostile Affections Lead to Depressive Symptoms Under Stress? A Study Based on Racial/Ethnic and Gender Differences

BACKGROUND

Stress has a significant influence on the development of depressive symptoms. An individual's coping style and resilience may moderate the symptoms of depression. This study is aimed to investigate the role of coping styles and resilience to depressive symptoms when individuals are facing stress in life based on racial/ethnic and gender differences.

METHODS

Enrolled individuals were assessed using the Unfairness Scale, City Stress Inventory, Cook-Medley Hostility Scale, Conner-Davidson Resilience Scale, and Beck Depression Inventory (BDI).

RESULTS

Three hundred ninety-six individuals completed the rating scales. There were significant interactions between race and unfairness, city stress (P = 0.006, P < 0.001), and between gender and city stress (P = 0.016). AAs and males suffer more stress than EAs and females. Hostile attitudes and affects act as mediators and significantly affect the relationship between stress and depressive symptoms (indirect effect: B = 0.812, P < 0.001; direct effect: B = 1.015, P < 0.001). Individuals with high resilience reported lower BDI scores. AAs with high stress and medium resilience had a buffer effect on depressive symptoms, while EAs did not.

CONCLUSION

The racial and gender effects of stress on depressive symptoms were significant. Individuals who have frequently experienced stress exhibited a more hostile attitude/affect compared to those who have experienced less stress. Furthermore, individuals who had a more hostile attitude/affect were more likely to be affected by depressive symptoms. Resilience has a protective factor for all participants, and medium resilience had a better buffer effect for AAs compared to EAs. There should be training for boosting resilience in schools and in vulnerable communities.

Learning from Transmasculine Experiences with Health Care: Tangible Inlets for Reducing Health Disparities Through Patient-Provider Relationships

Purpose: We examined health care experiences of transmasculine young adults to clarify factors contributing to mistrust in the health care system and identify tangible and modifiable means to address health disparities through improved patient-provider interactions. Thematic analysis highlights patterns within historical relationships between medical models and transmasculine embodiment, and provides guidance for health care clinicians, researchers, and policy makers to deliver competent services for transgender and gender diverse (TGD) individuals. Methods: The study team used qualitative methodology guided by interpretive phenomenological analysis. Semistructured interviews with 12 participants who self-identified as transmasculine were conducted, transcribed, and coded thematically. Results: Participants were a community sample of 12 young adults 18-35 years of age (M=23, standard deviation=3.74), who self-identified as transmasculine. Three participants identified as a racial/ethnic minority. Participants were highly educated, with most completing at least some college. The superordinate thematic domain Perspectives on Health Care emerged, under which three subthemes were nested: (1) an essentialist, binary medical model is inaccurate and oppressive, (2) consequences of medicalizing gender (i.e., gender as a diagnosis), and (3) recommendations to improve health care. Conclusions: Qualitative analysis revealed specific ways in which the relationship between transmasculine individuals and current health care systems are fraught with difficulties, including the impact of stigma, gatekeeping, and inaccuracies, in current diagnostic criteria. Participants shared lived experiences and offered innovative ideas to improve health care delivery, such as challenging socialized biases, increased education, and immersion in TGD communities to advocate for change in research, practice, and policy.

Patient acceptance and outcome of mental health screening in Swedish adults with cystic fibrosis

PURPOSE

Anxiety and depression are common among adults with cystic fibrosis (CF), and the International Committee on Mental Health in CF (ICMH) recommends annual screening for mental health problems. We implemented screening according to the recently published guidelines and assessed the results from the first year, as well as the patients' attitude to annual screening METHODS: Adult patients attending Gothenburg CF-center from Feb 2015 to Dec 2016 completed the GAD-7 (anxiety) and PHQ-9 (depression) forms at the time of their annual review. In addition, questions regarding the screening process and instruments used were asked.

RESULTS

All invited patients (n = 100, 52% males, 2% lung transplanted), with a median age of 28 years (range 18-65), agreed to participate. In general (83%), the patients were positive to screening on an annual basis. No significant differences in total GAD-7 and PHQ-9 scores were found when comparing men and women. Patients younger than 30 years of age reported more symptoms of anxiety compared to older patients (p = 0.02). There were 21 (21%) patients with scores > 10 for GAD-7 and/or PHQ-9 indicating at least moderate anxiety or depression. Scores > 10 were reported by 15 patients on GAD-7, 15 patients on PHQ-9, and 9 patients reported scores above 10 on both measures.

CONCLUSION

The patients considered annual check-ups for mental health issues important. Although the screening results are reassuring, the group is heterogenic and younger individuals should be given extra attention. Follow-up over longer time will provide more robust data.

Effects of Social Exclusion on Cardiovascular and Affective Reactivity to a Socially Evaluative Stressor

PURPOSE

Socially disconnected individuals have worse health than those who feel socially connected. The mechanisms through which social disconnection influences physiological and psychological outcomes warrant study. The current study tested whether experimental manipulations of social exclusion, relative to inclusion, influenced subsequent cardiovascular (CV) and affective reactivity to socially evaluative stress.

METHODS

Young adults (N = 81) were assigned through block randomization to experience either social exclusion or inclusion, using a standardized computer-based task (Cyberball). Immediately after exposure to Cyberball, participants either underwent a socially evaluative stressor or an active control task, based on block randomization. Physiological activity (systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)) and state anxiety were assessed throughout the experiment.

RESULTS

Excluded participants evidenced a significant increase in cardiovascular and affective responses to a socially evaluative stressor. Included participants who underwent the stressor evidenced similar increases in anxiety, but systolic blood pressure, diastolic blood pressure, and heart rate did not change significantly in response to the stressor.

CONCLUSIONS

Results contribute to the understanding of physiological consequences of social exclusion. Further investigation is needed to test whether social inclusion can buffer CV stress reactivity, which would carry implications for how positive social factors may protect against the harmful effects of stress.

Association of Race and Ethnicity With Glycemic Control and Hemoglobin A1c Levels in Youth With Type 1 Diabetes

IMPORTANCE

Health disparities in the clinical presentation and outcomes among youth with type 1 diabetes exist. Long-term glycemic control patterns in racially/ethnically diverse youth are not well described.

OBJECTIVES

To model common trajectories of hemoglobin A1c (HbA1c) among youth with type 1 diabetes and test how trajectory group membership varies by race/ethnicity.

DESIGN SETTING AND PARTICIPANTS

Longitudinal cohort study conducted in 5 US locations. The analysis included data from 1313 youths (aged <20 years) newly diagnosed in 2002 through 2005 with type 1 diabetes in the SEARCH for Diabetes in Youth study (mean [SD] age at diabetes onset, 8.9 [4.2] years) who had 3 or more HbA1c study measures during 6.1 to 13.3 years of follow-up. Data were analyzed in 2017.

EXPOSURES

Self-reported race/ethnicity.

MAIN OUTCOMES AND MEASURES

Hemoglobin A1c trajectories identified through group-based trajectory modeling over a mean (SD) of 9.0 (1.4) years of diabetes duration. Multinomial models studied the association of race/ethnicity with HbA1c trajectory group membership, adjusting for demographic characteristics, clinical factors, and socioeconomic position.

RESULTS

The final study sample of 1313 patients was 49.3% female (647 patients) with mean (SD) age 9.7 (4.3) years and mean (SD) disease duration of 9.2 (6.3) months at baseline. The racial/ethnic composition was 77.0% non-Hispanic white (1011 patients), 10.7% Hispanic (140 patients), 9.8% non-Hispanic black (128 patients), and 2.6% other race/ethnicity (34 patients). Three HbA1c trajectories were identified: group 1, low baseline and mild increases (50.7% [666 patients]); group 2, moderate baseline and moderate increases (41.7% [548 patients]); and group 3, moderate baseline and major increases (7.5% [99 patients]). Group 3 was composed of 47.5% nonwhite youths (47 patients). Non-Hispanic black youth had 7.98 higher unadjusted odds (95% CI, 4.42-14.38) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after full adjustment (adjusted odds ratio of non-Hispanic black race in group 3 vs group 1, 4.54; 95% CI, 2.08-9.89). Hispanic youth had 3.29 higher unadjusted odds (95% CI, 1.78-6.08) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after adjustment (adjusted odds ratio of Hispanic ethnicity in group 3 vs group 1, 2.24; 95% CI, 1.02-4.92). In stratified analyses, the adjusted odds of nonwhite membership in the highest HbA1c trajectory remained significant among male patients and youth diagnosed at age 9 years or younger, but not female patients and youth who were older than 9 years when they were diagnosed (P for interaction = .04 [sex] and .02 [age at diagnosis]).

CONCLUSIONS AND RELEVANCE

There are racial/ethnic differences in long-term glycemic control among youth with type 1 diabetes, particularly among nonwhite male patients and nonwhite youth diagnosed earlier in life.

Effects of social adversity and HIV on subcortical shape and neurocognitive function

The purpose of the current study was to examine the independent and interactive effects of social adversity (SA) and HIV infection on subcortical shape alterations and cognitive functions. Participants included HIV+ (n = 70) and HIV- (n = 23) individuals who underwent MRI, neurocognitive and clinical assessment, in addition to completing questionnaires from which responses were used to create an SA score. Bilateral amygdalae and hippocampi were extracted from T1-weighted images. Parametric statistical analyses were used to compare the radial distance of the structure surface to a median curve to determine the presence of localized shape differences as a function of HIV, SA and their interaction. Next, multiple regression was used to examine the interactive association between HIV and SA with cognitive performance data. An HIV*SA interactive effect was found on the shape of the right amygdala and left hippocampus. Specifically, HIV-infected participants (but not HIV-uninfected controls) who evidenced higher levels of SA displayed an inward deformation of the surface consistent with reduced volume of these structures. We found interactive effects of HIV and SA on learning/memory performance. These results suggest that HIV+ individuals may be more vulnerable to neurological and cognitive changes in the hippocampus and amygdala as a function of SA than HIV- individuals, and that SA indicators of childhood SES and perceived racial discrimination are important components of adversity that are associated with cognitive performance.

Review of treatment for late-life depression

Depressive disorder in those over the age of 60 has many clinical similarities to depression in younger adults, but biological changes related to ageing may necessitate a different approach to treatment. We present an evidence-based review of treatment for late-life depression, focusing on pharmacological approaches, including monotherapy, combination and augmentation strategies. Selective serotonin reuptake inhibitors such as sertraline and citalopram are well tolerated, have the advantage of a favourable side-effect profile, and are good options for first-line treatment. Second-line treatment options include combination therapy with a second antidepressant, or treatment augmentation with an antipsychotic or lithium. We also consider evidence for nonpharmacological treatment strategies, including psychological therapy and neurostimulation. Finally, we summarise evidence for treatment of depression in patients in dementia.

Impact of the economic crisis on health-related behaviors in Italy

BACKGROUND

Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population.

AIM

To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy.

METHODS

Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000-2015). Statistics performed by means of linear regression models.

RESULTS

Increased smokers (β = 1.68, p = .03), heavy smokers, that is, people smoking 11-20 cigarettes per day (β = 2.18, p = .04) or more than 20 cigarettes per day (β = 1.04, p < .01) and mean number of smoked cigarettes per day (β = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (β = 0.91, p = .04), while the Italian families' expenditure for alcoholic beverages decreased (β = -812.80, p = .01). Alcohol consumption decreased (β = -0.60, p < .01), especially in men (β = -0.95, p < .01); binge drinking increased in years 2009-2010. No change was noticeable in the diet indicators collected.

CONCLUSION

The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

Differential relationships between social adversity and depressive symptoms by HIV status and racial/ethnic identity

OBJECTIVE

Historically marginalized groups are likely to be exposed to social adversity, which predicts important mental health outcomes (e.g., depression). Despite the well-established relationship between adversity and poor health, few studies have examined how adversity differentially predicts mental health among people living with multiple, co-occurring marginalized identities or statuses. The current study fills this gap by examining whether relationships between social adversity and depressive symptoms differed between those living with or without a stigmatized disease (i.e., HIV) and/or marginalized racial/ethnic identity (i.e., African American).

METHOD

A community sample of men and women (N = 149) completed questionnaires assessing demographics and depressive symptoms. Additionally, a composite index of social adversity was derived from measures of perceived discrimination, socioeconomic status, financial restriction to receiving medical care, and perceived neighborhood characteristics. Multiple regression was used to test whether relationships between adversity and depressive symptoms differed as a function of HIV status and racial/ethnic identity.

RESULTS

A significant 3-way interaction between social adversity, HIV status, and racial/ethnic identity indicated that there was a direct relationship between adversity and depressive symptoms for HIV-positive (HIV+) African Americans but not for HIV-negative (HIV-) African Americans, HIV+ Caucasians, or HIV- Caucasians. Further, HIV+ African Americans evidenced a significantly greater relationship between adversity and depressive symptoms compared with HIV- African Americans, but not compared with other groups.

CONCLUSIONS

The findings suggest that HIV+ African Americans may be at risk for higher depressive symptoms amid adversity, highlighting the importance of evaluating intersectional identities/statuses in the context of mental health. (PsycINFO Database Record

The Association between Educational Level and Cardiovascular and Cerebrovascular Diseases within the EPICOR Study: New Evidence for an Old Inequality Problem

BACKGROUND

A consistent association has been reported between low socioeconomic status (SES) and cardiovascular events (CE), whereas the association between SES and cerebrovascular events (CBVD) is less clear. The aim of this study was to investigate the association between SES (measured using education) and CE/CBVD in a cohort study, as well as to investigate lifestyle and clinical risk factors, to help to clarify the mechanisms by which SES influences CE/CBVD.

MATERIAL AND METHODS

We searched for diagnoses of CE and CBVD in the clinical records of 47,749 members of the EPICOR cohort (average follow-up time: 11 years). SES was determined by the relative index of inequality (RII).

RESULTS

A total of 1,156 CE and 468 CBVD were found in the clinical records. An increased risk of CE was observed in the crude Cox model for the third tertile of RII compared to the first tertile (hazard ratio [HR] = 1.39; 95% confidence interval [CI] 1.21-1.61). The increased risk persisted after adjustment for lifestyle risk factors (HR = 1.19; 95%CI 1.02-1.38), clinical risk factors (HR = 1.35; 95%CI 1.17-1.56), and after full adjustment (HR = 1.17; 95%CI 1.01-1.37). Structural equation model showed that lifestyle rather than clinical risk factors are involved in the mechanisms by which education influences CE. No significant association was found between education and CBVD. A strong relationship was observed between education and diabetes at baseline.

CONCLUSION

The most important burden of inequality in CE incidence in Italy is due to lifestyle risk factors.

The Contribution of Psychosocial Stressors to Sleep among African Americans in the Jackson Heart Study

STUDY OBJECTIVES

Studies have shown that psychosocial stressors are related to poor sleep. However, studies of African Americans, who may be more vulnerable to the impact of psychosocial stressors, are lacking. Using the Jackson Heart Study (JHS) baseline data, we examined associations of psychosocial stressors with sleep in 4,863 African Americans.

METHODS

We examined cross-sectional associations between psychosocial stressors and sleep duration and quality in a large population sample of African Americans. Three measures of psychosocial stress were investigated: the Global Perceived Stress Scale (GPSS); Major Life Events (MLE); and the Weekly Stress Inventory (WSI). Sleep was assessed using self-reported hours of sleep and sleep quality rating (1 = poor; 5 = excellent). Multinomial logistic and linear regression models were used to examine the association of each stress measure (in quartiles) with continuous and categorical sleep duration (< 5 ("very short"), 5-6 h ("short") and > 9 h ("long") versus 7 or 8 h ("normal"); and with sleep quality after adjustment for demographics and risk factors (body mass index, hypertension, diabetes, physical activity).

RESULTS

Mean age of the sample was 54.6 years and 64% were female. Mean sleep duration was 6.4 + 1.5 hours, 54% had a short sleep duration, 5% had a long sleep duration, and 34% reported a "poor" or "fair" sleep quality. Persons in the highest GPSS quartile had higher odds of very short sleep (odds ratio: 2.87, 95% confidence interval [CI]: 2.02, 4.08), higher odds of short sleep (1.72, 95% CI: 1.40, 2.12), shorter average sleep duration (Δ = -33.6 min (95% CI: -41.8, -25.4), and reported poorer sleep quality (Δ = -0.73 (95% CI: -0.83, -0.63) compared to those in the lowest quartile of GPSS after adjustment for covariates. Similar patterns were observed for WSI and MLE. Psychosocial stressors were not associated with long sleep. For WSI, effects of stress on sleep duration were stronger for younger (< 60 y) and college-educated African-Americans.

CONCLUSIONS

Psychosocial stressors are associated with higher odds of short sleep, lower average sleep duration, and lower sleep quality in African Americans. Psychosocial stressors may be a point of intervention among African Americans for the improvement of sleep and downstream health outcomes.

Hostile attitudes and effortful coping in young adulthood predict cognition 25 years later

OBJECTIVE

We studied the relation of early-life (mean age 25 years) and mid-life (mean age 50 years) cognitive function to early measures of hostile attitudes and effortful coping.

METHODS

In 3,126 black and white men and women (born in 1955-1968) from the Coronary Artery Risk Development in Young Adults Study (CARDIA), we used linear regression to examine the association of hostile attitudes (Cook-Medley questionnaire) and effortful coping assessed at baseline (1985-1986) to cognitive ability measured in 1987 and to a composite cognitive Z score of tests of verbal memory, psychomotor speed, and executive function ascertained in midlife (2010-2011).

RESULTS

Baseline hostility and effortful coping were prospectively associated with lower cognitive function 25 years later, controlling for age, sex, race, education, long-term exposure to depression, discrimination, negative life events, and baseline cognitive ability. Compared to the lowest quartile, those in the highest quartile of hostility performed 0.21 SD units lower (95% confidence interval [CI] -0.39, -0.02). Those in the highest quartile of effortful coping performed 0.30 SD units lower (95% CI -0.48, -0.12) compared to those in the lowest quartile. Further adjustment for cumulative exposure to cardiovascular risk factors attenuated the association with the cognitive composite Z score for hostility.

CONCLUSIONS

Worse cognition in midlife was independently associated with 2 psychological characteristics measured in young adulthood. This suggests that interventions that promote positive social interactions may have a role in reducing risk of late-age cognitive impairment.

Vulnerability in perioperative patients: a qualitative study

The study aimed to explore perioperative practitioners' knowledge, awareness and experiences of perioperative vulnerability in clinical practice. A qualitative descriptive design was used; data was obtained by conducting semi-structured interviews with ten perioperative practitioners over a two week period in July 2014. The study found that perioperative practitioners were aware of the concept of perioperative vulnerability and had varied experience of it in practice. Data analysis identified three main themes in relation to vulnerability: labels, recognition and management. We conclude that the concept of perioperative vulnerability exists in practice and that perioperative practitioners manage the concept effectively using strategies that promote positive outcomes.

Childhood Disadvantage and Health Problems in Middle and Later Life: Early Imprints on Physical Health?

Drawing from cumulative inequality theory, we examine the relationship between childhood disadvantage and health problems in adulthood. Using two waves of data from Midlife Development in the United States, we investigate whether childhood disadvantage is associated with adult disadvantage, including fewer social resources, and the effect of lifelong disadvantage on health problems measured at the baseline survey and a 10-year follow-up. Findings reveal that childhood socioeconomic disadvantage and frequent abuse by parents are generally associated with fewer adult social resources and more lifestyle risks. Health problems, in turn, are affected by childhood disadvantage and by lifestyle risks, especially smoking and obesity. Not only was early disadvantage related to health problems at the baseline survey, but childhood socioeconomic disadvantage and frequent abuse also were related to the development of new health problems at the follow-up survey. These findings reveal the imprint of early disadvantage on health decades later and suggest greater attention to resources, even during midlife, can interrupt the chain of risks.

Educational mismatch and mortality among native-born workers in Sweden. A 19-year longitudinal study of 2.5 million over-educated, matched and under-educated individuals, 1990-2008

This study tests the hypothesis that a disjuncture between an individual's attained level of education and that held by average workers in the individual's occupation leads to higher mortality among those with a prolonged mismatched status. Swedish register data are used in a 19-year longitudinal mortality follow-up study of all causes and specific causes of mortality. Participants were all men and women born between 1926 and 1985 who were alive on 1 September 1990, who had concurrent information on their attained level of education and the specific occupation or industry they were employed in during this period for at least a consecutive year. An objective measure of educational and occupational mismatch was constructed from these data. Those with a stable, over-educated matched, or under-educated employment status are included in the final analysis (N = 2,482,696). Independent of social, family, employers' characteristics and prior health problems, the findings from a multivariate, stratified Cox regression analysis suggest there is excessive mortality among the over-educated, and a protective effect of under-education among native-born Swedish men and women.

Factors associated with hopelessness in epileptic patients

AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life (QOL).

METHODS: Sixty-nine participants were administered the following psychometric instruments: Beck Depression Inventory-II, Beck Hopelessness Scale (BHS), and QOL in Epilepsy (QOLIE)-89. Patients were dichotomized into two categories: those affected by epilepsy with generalized tonic-clonic seizures vs those having epilepsy with partial seizures.

RESULTS: The groups differed on the QOLIE Role Limitation/Emotional dimension. Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems than patients with other types of epilepsy (89.57 ± 25.49 vs 72.86 ± 36.38; t₆₃ = -2.16; P < 0.05). All of the respondents reported moderate to severe depression, and 21.7% of patients with generalized seizures and 28.6% of patients with other diagnoses had BHS total scores ≥ 9 indicating a higher suicidal risk. The study did not control for years of the illness.

CONCLUSION: Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems compared to patients with other types of seizures. Patients at increased suicide risk as evaluated by the BHS were older than those who had a lower suicidal risk. Future studies are required to further investigate the impact of hopelessness on the outcome of epileptic patients.

Vulnerability in the perioperative patient: a concept analysis

This study aims to report the analysis of the concept of perioperative vulnerability. Literature searches were conducted in databases CINAHL, Medline, PsychINFO, OVID, InterNurse, as well as a manual library search from article reference lists. Search terms were restricted to 'concept analysis', 'vulnerability', 'perioperative', 'patient' and 'perioperative patient'. Retrieved literature was analysed using the Walker & Advant (2005) concept analysis framework. Based on the concept analysis, vulnerability can be seen as having both physical and psychological elements and can be influenced by personal traits. Vulnerability is affected by previous experiences, perceptions of life, disease and ultimately the level of control an individual has over a given situation. The study concludes that inclusion of the concept of vulnerability within both pre- and post-registration training programmes would facilitate awareness of the issues surrounding perioperative vulnerability and the need to plan individualised care accordingly. It is hoped that this analysis will inspire further research and theoretical underpinning of perioperative practice, facilitating the development of new ways to manage vulnerability that will benefit individual patients, develop practice and promote positive patient outcomes.

Can social support alleviate inflammation associated with childhood adversities?

OBJECTIVE

Childhood adversities have been linked to elevated high-sensitivity C-reactive protein (hsCRP), which has been associated with increased morbidity. Low social support has been reported to worsen the prognosis in heart disease and cancer, and high social support has been linked to lower hsCRP. We hypothesized that social support could be a mediating factor between childhood adversities and hsCRP.

METHODS

The sample was drawn from the data of the nationwide Health and Social Support Study (HeSSup Study) to which 25,898 Finns had responded in 1998. The cohort was stratified into groups of high and low social support, and the study group consisted of 100 women in both groups. Additionally, we invited a randomly drawn group of 50 subjects and a group of 62 women who had reported depressive symptoms. Of the 312 women, 116 participated in the study.

RESULTS

Social support score (Social Support Questionnaire, SSQ) was lower when the number of adverse experiences in childhood was high (r = - 0.251, P = 0.007). hsCRP and SSQ were inversely associated (r = - 0.188, P = 0.046). In the adjusted general linear model, the level of social support was significantly associated with hsCRP and there was a statistically significant interactive effect of small effect size of childhood adversities and the level of social support on hsCRP (ES = 0.123, P = 0.004).

CONCLUSION

This finding suggests that childhood adversity may affect social relationships and that high social support may attenuate the health risks caused by childhood adverse experience.

Perceived stress is associated with subclinical cerebrovascular disease in older adults

OBJECTIVE

To examine the association of perceived stress with magnetic resonance imaging (MRI) markers of subclinical cerebrovascular disease in an elderly cohort.

METHODS

Using a cross-sectional study of a community-based cohort in Chicago, 571 adults (57% women; 58.1% African American; 41.9% non-Hispanic white; mean [SD] age: 79.8 [5.9] years) from the Chicago Health and Aging Project, an epidemiologic study of aging, completed questionnaires on perceived stress, medical history, and demographics as part of an in-home assessment and 5 years later underwent a clinical neurologic examination and MRI of the brain. Outcome measures were volumetric MRI assessments of white matter hyperintensity volume (WMHV), total brain volume (TBV), and cerebral infarction.

RESULTS

Stress was measured with six items from the Perceived Stress Scale (PSS); item responses, ranging from never (0) to often (3), were summed to create an overall stress score (mean [SD]: 4.9 [3.3]; range: 0-18). Most participants had some evidence of vascular disease on MRI, with 153 participants (26.8%) having infarctions. In separate linear and logistic regression models adjusted for age, sex, education, race, and time between stress assessment and MRI, each one-point increase in PSS score was associated with significantly lower TBV (coefficient = -0.111, SE = 0.049, t[563] = -2.28, p = 0.023) and 7% greater odds of infarction (odds ratio: 1.07; 95% confidence interval: 1.01, 1.13; Wald χ(2)[1] = 4.90; p = 0.027). PSS scores were unrelated to WMHV. Results were unchanged with further adjustment for smoking, body mass index, physical activity, history of heart disease, stroke, diabetes, hypertension, depressive symptoms, and dementia.

CONCLUSIONS

Greater perceived stress was significantly and independently associated with cerebral infarction and lower brain volume assessed 5 years later in this elderly cohort.

Social and material adversity from adolescence to adulthood and allostatic load in middle-aged women and men: results from the Northern Swedish Cohort

Background

Little is known about the theoretically assumed association between adversity exposure over the life course and allostatic load in adulthood.

Purpose

This study aims to examine whether social and material adversity over the life course is related to allostatic load in mid-adulthood.

Methods

A 27-year prospective Swedish cohort (N = 822; 77% response rate) reported exposure to social and material adversities at age 16, 21, 30 and 43 years. At age 43, allostatic load was operationalized based on 12 biological parameters.

Results

Social adversity accumulated over the life course was related to allostatic load in both women and men, independently of cumulative socioeconomic disadvantage. Moreover, social adversity in adolescence (in women) and young adulthood (in men) was related to allostatic load, independently of cumulative socioeconomic disadvantage and also of later adversity exposure during adulthood.

Conclusion

Exposure to adversities involving relational threats impacts on allostatic load in adulthood and operates according to life course models of cumulative risk and a sensitive period around the transition into adulthood.

Electronic supplementary material

The online version of this article (doi:10.1007/s12160-011-9309-6) contains supplementary material, which is available to authorized users.

Depression and affective temperaments are associated with poor health-related quality of life in patients with HIV infection

INTRODUCTION

Human immunodeficiency virus (HIV) represents one of the most chronic and debilitating infections worldwide. Hopelessness and affective temperaments (mood that is characteristic of an individual's habitual functioning) may play important roles in the health-related quality of life (HRQoL) of patients with HIV. The purpose of this study was to examine affective temperaments in a sample of patients with HIV, the impact of hopelessness on HRQoL, and associations among HRQoL, hopelessness, and affective temperaments.

METHODS

The study involved 88 participants who were administered the short- form health survey (SF-36), the Beck hopelessness scale (BHS), the suicidal history self-rating screening scale (SHSS), the Gotland male depression scale (GMDS), and the temperament evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A).

RESULTS

Patients with a poorer HRQoL reported more severe depression and hopelessness than patients with a higher HRQoL. Patients with a poorer HRQoL also had higher scores on all dimensions of the TEMPS-A with a depressive component compared to patients with a higher HRQoL. The small sample size in this study limits the generalizability of the findings.

CONCLUSION

Patients with a poorer HRQoL were more depressed and also at an increased risk of suicide as indicated by the more severe hopelessness they reported compared to patients with higher HRQoL. These patients were also more likely to have depressive affective temperaments than those with a higher HRQoL.

Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis

OBJECTIVES

This study examines (a) the heterogeneity in individual multidimensional health trajectories and (b) the socioeconomic stratification of individual multidimensional health trajectories during the late older years.

METHOD

This study used prospective data from 1,945 adults, 75 to 85 years old, collected over an 8-year period from the Health and Retirement Study. To examine inconsistent findings in the research literature, a latent trajectory class analysis was performed.

RESULTS

Multidimensional overall health trajectories showed three heterogeneous latent classes (maintaining, persistently high, and deteriorating), and profiles of ascribed and achieved socioeconomic characteristics of multidimensional health trajectory classes showed a significant social and racial/ethnic stratification in late older years.

DISCUSSION

Past adverse socioeconomic circumstances, including childhood and adulthood adversity, are potential sources of unobserved heterogeneity of multidimensional health trajectories even in late older years. The identification of members of latent trajectory health classes and the associated antecedents linked to health class membership are consistent with a life-course conceptual framework. Thus, multidimensional health capturing the full range of health problems needs to be investigated for proper examination of socioeconomic correlates of health. This facilitates the understanding of the associations between life-course experiences and health in late old age that ultimately have implications for prevention and intervention.

Social adversity in adolescence increases the physiological vulnerability to job strain in adulthood: a prospective population-based study

Background

It has been argued that the association between job strain and health could be confounded by early life exposures, and studies have shown early adversity to increase individual vulnerability to later stress. We therefore investigated if early life exposure to adversity increases the individual's physiological vulnerability job strain in adulthood.

Methodology/Principal Findings

In a population-based cohort (343 women and 330 men, 83% of the eligible participants), we examined the association between on the one hand exposure to adversity in adolescence, measured at age 16, and job strain measured at age 43, and on the other hand allostatic load at age 43. Adversity was operationalised as an index comprising residential mobility and crowding, parental loss, parental unemployment, and parental physical and mental illness (including substance abuse). Allostatic load summarised body fat, blood pressure, inflammatory markers, glucose, blood lipids, and cortisol regulation. There was an interaction between adversity in adolescence and job strain (B = 0.09, 95% CI 0.02 to 0.16 after adjustment for socioeconomic status), particularly psychological demands, indicating that job strain was associated with increased allostatic load only among participants with adversity in adolescence. Job strain was associated with lower allostatic load in men (β = −0.20, 95% CI −0.35 to −0.06).

Conclusions/Significance

Exposure to adversity in adolescence was associated with increased levels of biological stress among those reporting job strain in mid-life, indicating increased vulnerability to environmental stressors.

Restorative biological processes and health

Research on psychological influences on physiology primarily focuses on biological responses during stressful challenges, and how those responses can become dysregulated with prolonged or repeated exposure to stressful circumstances. At the same time, humans spend considerable time recovering from those challenges, and a host of biological processes involved in restoration and repair take place during normal, non-stressed activities. We review restorative biological processes and evidence for links between psychosocial factors and several restorative processes including sleep, wound healing, antioxidant production, DNA repair, and telomerase function. Across these biological processes, a growing body of evidence suggests that experiencing negative emotional states, including acute and chronic stress, depressive symptoms, and individual differences in negative affectivity and hostility, can influence these restorative processes. This review calls attention to restorative processes as fruitful mechanisms and outcomes for future biobehavioral research.

Protective Factors in Midlife

The detection of psychological variables with a positive impact on health during middle age is of great interest. The data of 393 middle-aged participants (aged 35–45 at T1 and 45–55 at T2) of the National Survey of Midlife Development in the United States (MIDUS) were analyzed to investigate the associations between health, optimism, positive affect, social support, and a cumulative burden score. Results show a positive association of the protective factors and a predictive value of positive emotions on health over time. The burden score showed no unique association with health. Overall, the predictors explained 17% of the variance of physical health and 33% of the variance of mental health. These findings emphasize the importance of investigating protective pathways.

Early life adversity and inflammation in African Americans and whites in the midlife in the United States survey

OBJECTIVES

To determine whether early life adversity (ELA) was predictive of inflammatory markers and to determine the consistency of these associations across racial groups.

METHODS

We analyzed data from 177 African Americans and 822 whites aged 35 to 86 years from two preliminary subsamples of the Midlife in the United States biomarker study. ELA was measured via retrospective self-report. We used multivariate linear regression models to examine the associations between ELA and C-reactive protein, interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1, independent of age, gender, and medications. We extended race-stratified models to test three potential mechanisms for the observed associations.

RESULTS

Significant interactions between ELA and race were observed for all five biomarkers. Models stratified by race revealed that ELA predicted higher levels of log interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1 among African Americans (p < .05), but not among whites. Some, but not all, of these associations were attenuated after adjustment for health behaviors and body mass index, adult stressors, and depressive symptoms.

CONCLUSIONS

ELA was predictive of high concentrations of inflammatory markers at midlife for African Americans, but not whites. This pattern may be explained by an accelerated course of age-related disease development for African Americans.

Fetal and life course origins of serum lipids in mid-adulthood: results from a prospective cohort study

Background

During the past two decades, the hypothesis of fetal origins of adult disease has received considerable attention. However, critique has also been raised regarding the failure to take the explanatory role of accumulation of other exposures into consideration, despite the wealth of evidence that social circumstances during the life course impact on health in adulthood. The aim of the present prospective cohort study was to examine the contributions of birth weight and life course exposures (cumulative socioeconomic disadvantage and adversity) to dyslipidemia and serum lipids in mid-adulthood.

Methods

A cohort (effective n = 824, 77%) was prospectively examined with respect to self-reported socioeconomic status as well as stressors (e.g., financial strain, low decision latitude, separation, death or illness of a close one, unemployment) at the ages of 16, 21, 30 and 43 years; summarized in cumulative socioeconomic disadvantage and cumulative adversity. Information on birth weight was collected from birth records. Participants were assessed for serum lipids (total cholesterol, low- and high-density lipoprotein cholesterol and triglycerides), apolipoproteins (A1 and B) and height and weight (for the calculation of body mass index, BMI) at age 43. Current health behavior (alcohol consumption, smoking and snuff use) was reported at age 43.

Results

Cumulative life course exposures were related to several outcomes; mainly explained by cumulative socioeconomic disadvantage in the total sample (independently of current health behaviors but attenuated by current BMI) and also by cumulative adversity in women (partly explained by current health behavior but not by BMI). Birth weight was related only to triglycerides in women, independently of life course exposures, health behaviors and BMI. No significant association of either exposure was observed in men.

Conclusions

Social circumstances during the life course seem to be of greater importance than birth weight for dyslipidemia and serum lipid levels in adulthood.

Dynamics of family economic hardship and the progression of health problems of husbands and wives during the middle years: a perspective from rural Mid-West

OBJECTIVE

The objective of this study was to investigate the influence of theoretically important dimensions of stability and change in economic hardship during early middle years on decade-long health problems of husbands and wives.

METHOD

The study used prospective data collected from 360 middle-aged husbands and wives during a 12-year period. The variables included self-reported economic hardship (22 items), mental and physical health, and physical impairment.

RESULTS

The results supported the hypothesis that the dynamics of family economic hardship (in terms of stability and change) during the early middle years contribute to subsequent onset of health problems of middle-aged husbands and wives. These health problems in turn progress as an interrelated process through intrahealth-domain continuities, cross-health domain proliferations, and dyadic associations as they pass through midlife.

DISCUSSION

A better understanding of these processes may aid in the formation and effective implementation of health promotion programs for middle-aged husbands and wives.

Is there a link between components of health-related functioning and incident impaired glucose metabolism and type 2 diabetes? The Australian Diabetes Obesity and Lifestyle (AusDiab) study

OBJECTIVE

To determine the longitudinal association of components of health-related functioning (HRF) with incident impaired glucose metabolism and type 2 diabetes.

RESEARCH DESIGN AND METHODS

The Australian Diabetes Obesity and Lifestyle (AusDiab) study is a national, longitudinal study of adults aged > or =25 years from 42 randomly selected areas of Australia. Diabetes status was defined using the World Health Organization criteria, and HRF was assessed using the SF-36 questionnaire in 1999-2000 and 2004-2005.

RESULTS

Incident impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and newly diagnosed type 2 diabetes were associated with increased bodily pain at baseline compared with those with normal glucose tolerance (NGT) (IFG P = 0.005, IGT P < 0.004, and newly diagnosed type 2 diabetes P = 0.005), after adjustment. In addition, those with incident IGT and newly diagnosed type 2 diabetes had significantly reduced physical functioning, general health, mental health, and vitality at baseline compared with those with NGT. After we controlled for factors associated with incident diabetes, those in the lowest quartile of the physical component summary scale at baseline had at least a 50% higher risk of progression to impaired glucose metabolism and diabetes 5 years later.

CONCLUSIONS

These findings show that incident IFG, IGT, and newly diagnosed type 2 diabetes are associated with reduced HRF independent of cardiovascular disease and that this is evident before the onset of these conditions. If future health promotion campaigns are to effectively target those at high risk of developing diabetes, an understanding of the process of declining health before onset of the disease is essential.

Hostility and change in cognitive function over time in older blacks and whites

OBJECTIVE

To test whether the level of hostility predicted the rate of cognitive decline in a community of older blacks and whites and whether the association varied as a function of race.

METHODS

Over 4800 persons from a defined community in Chicago completed up to three structured interviews at approximately 3 year intervals over a period of up to 8.8 years (mean = 4.4 years). At the baseline interview, hostility was assessed with 8-items from the Cook-Medley Hostility Scale. Cognitive function was assessed at each interview with four cognitive function tests from which a composite measure of cognition was formed. Mixed effects models were used to assess change in cognition and its relation to hostility, controlling for age, sex, education, and race.

RESULTS

The average score on the hostility scale at baseline was 3.0 (SD = 2.1). Higher levels of hostility were associated with lower cognitive scores (estimate = -0.028, SE = 0.004, p < .001). Cognition declined at a rate of 0.051 U per year on average, but hostility was not related to the rate of decline. Results were unchanged after controlling for depressive symptoms, chronic health, neuroticism, and social and cognitive activity patterns, or when persons with cognitive impairment at baseline were excluded. The association was similar in blacks and whites.

CONCLUSION

The results suggest that hostility is associated with level of cognitive function in older persons but not related to cognitive decline.

Multiple roles, multiple lives: the protective effects of role responsibilities on the health functioning of African American mothers

Using data from 747 rural African American mothers, this study incorporated role accumulation theory to test direct and indirect effects of stressors, coping behaviors, and role responsibilities on health functioning. Results indicated that demands emerging from financial strain were related to compromised mental health and decreases in mothers' use of effective coping strategies and role responsibility engagement. Conversely, mothers who effectively responded to stressors and fulfilled responsibilities to their children and communities experienced enhanced mental health, which in turn promoted optimal physical health. The results can inform research and intervention with African American women.

Chronic and acute stress and the prediction of major depression in women

BACKGROUND

This study explored the relatively neglected role of chronic stress in major depression, examining the independent contributions of co-occurring chronic and acute stress to depression, whether chronic stress predicts acute life events, and whether the two types of stress interact such that greater chronic stress confers greater sensitivity-or resistance-to the depressive effects of acute stressors.

METHODS

From a sample of 816 community women, those who had a major depression onset in the past 9 months and those without major depressive episodes (MDE) onset and with no history of current or recent dysthymic disorder were compared on interview-based measures of antecedent acute and chronic stress. Chronic stress interviews rated objective stress in multiple everyday role domains, and acute stress was evaluated with contextual threat interviews.

RESULTS

MDE onset was significantly associated with both chronic and acute stress; chronic stress was also associated with the occurrence of acute events, and there was a trend suggesting that increased acute stress is more strongly associated with depression in those with high versus low chronic stress.

CONCLUSIONS

Results suggest the importance of including assessment of chronic stress in fully understanding the extent and mechanisms of stress-depression relationships.

Positive affect, psychological well-being, and good sleep

OBJECTIVE

To discover whether positive affect and purpose in life (eudaimonic well-being) are associated with good sleep independently of health problems and socioeconomic status, and to evaluate their role in mediating the influence of psychosocial risk factors on poor sleep.

METHODS

A cross-sectional study was carried out with 736 men and women aged 58-72 years, with positive affect assessed by aggregating ecological momentary samples. Sleep problems were assessed with the Jenkins Sleep Problems Scale, and psychosocial risk factors were measured by standardized questionnaires.

RESULTS

Both positive affect and eudaimonic well-being were inversely associated with sleep problems after adjustment for age, gender, household income, and self-rated health (P<.001). Negative psychosocial factors including financial strain, social isolation, low emotional support, negative social interactions, and psychological distress were also related to reported sleep problems. The strength of these associations was reduced by 20-73% when positive affect and eudaimonic well-being were taken into account, suggesting that effects were partly mediated by positive psychological states.

CONCLUSIONS

These results suggest that both positive affect and eudaimonic well-being are directly associated with good sleep and may buffer the impact of psychosocial risk factors. The relationships are likely to be bidirectional, with disturbed sleep engendering lower positive affect and reduced psychological well-being, and positive psychological states promoting better sleep.

Socioeconomic status and psychological well-being predict cross-time change in glycosylated hemoglobin in older women without diabetes

OBJECTIVE

To investigate whether socioeconomic status and psychological well-being (eudaimonic and hedonic aspects) predicted nondiabetic levels of glycosylated hemoglobin (HbA1c) over time, after adjusting for covariates and baseline level of HbA1c.

METHODS

These questions were investigated with a longitudinal sample (n = 97; age = 61-91 years) of older women without diabetes. Socioeconomic status, well-being, and health behaviors were assessed using self-administered questionnaires. Fasting blood samples for assays of HbA1c were obtained before 7 AM during the respondents' overnight stay at the General Clinical Research Center at the University of Wisconsin-Madison. All measurements were obtained at baseline and 2-year follow-up.

RESULTS

Regression analyses showed that higher income and positive affect predicted lower levels of HbA1c, after controlling for baseline HbA1c and health factors. Additionally, three well-being measures (purpose in life, personal growth, and positive affect) moderated the relationship between income and HbA1c.

CONCLUSION

These results suggest that psychological well-being and socioeconomic status interact in important ways in influencing nondiabetic glucose metabolism.

Financial stress and strain associated with terminal cancer--a review of the evidence

Financial circumstances are a significant influence on the quality of life for older people and may be important to health and wellbeing at the end of life. The aim of this study is to review the evidence for the existence and consequences of financial stress and strain at the end of life for people dying with cancer. We conducted a systematic search of four electronic databases for studies, providing data on illness-related financial burden (stress), or perception of financial hardship (strain), from patients with terminal cancer or their caregivers. Twenty-four papers were identified from 21 studies published in English between 1980 and 2006, the majority (14) of cross-sectional design. Financial stress was reported in all 13 studies from the USA (median 33%, range 10-66%), but only four sought measures of financial strain. In the USA, specific social consequences, such as moving house or change in employment to cope with caregiving, were reported in four of these studies; one of these also noted changes in treatment choices and avoidance of care for other family members. In studies from outside the USA, there is a dearth of data on financial stresses and the consequences of this for the household, despite widespread reporting of financial strain. To fill a gap in our understanding and improve holistic palliative care, researchers need to ask the questions about the consequences of financial stresses and strain for the health and wellbeing of the household.

Socioeconomic status predicts objective and subjective sleep quality in aging women

OBJECTIVE

To test the hypothesis that socioeconomic status (SES) would be associated with sleep quality measured objectively, even after controlling for related covariates (health status, psychosocial characteristics). Epidemiological studies linking SES and sleep quality have traditionally relied on self-reported assessments of sleep.

METHODS

Ninety-four women, 61 to 90 years of age, participated in this study. SES was determined by pretax household income and years of education. Objective and subjective assessments of sleep quality were obtained using the NightCap sleep system and the Pittsburgh Sleep Quality Index (PSQI), respectively. Health status was determined by subjective health ratings and objective measures of recent and chronic illnesses. Depressive symptoms and neuroticism were quantified using the Center for Epidemiological Studies Depression Scale and the Neuroticism subscale of the NEO Personality Inventory, respectively.

RESULTS

Household income significantly predicted sleep latency and sleep efficiency even after adjusting for demographic factors, health status, and psychosocial characteristics. Income also predicted PSQI scores, although this association was significantly attenuated by inclusion of neuroticism in multivariate analyses. Education predicted both sleep latency and sleep efficiency, but the latter association was partially reduced after health status and psychosocial measures were included in analyses. Education predicted PSQI sleep efficiency component scores, but not global scores.

CONCLUSIONS

These results suggest that SES is robustly linked to both subjective and objective sleep quality, and that health status and psychosocial characteristics partially explain these associations.

PTSD in urban primary care: high prevalence and low physician recognition

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with medical and psychological morbidity. The prevalence of PTSD in urban primary care has not been well described.

OBJECTIVE

To measure the prevalence of PTSD in primary care patients overall and among those with selected conditions (chronic pain, depression, anxiety, heavy drinking, substance dependence (SD), irritable bowel syndrome (IBS), and immigrant status).

DESIGN

Cross-sectional study.

PARTICIPANTS

English-speaking patients aged 18-65 years old, awaiting primary care appointments in an urban academic medical center, were eligible for enrollment to determine PTSD prevalence (N = 509). Additional eligible participants (n = 98) with IBS or SD were subsequently enrolled.

MEASUREMENTS

PTSD (past year) and trauma exposure were measured with Composite International Diagnostic Interview. We calculated the prevalence of PTSD associated with depression, anxiety, heavy drinking, SD, IBS, and chronic pain. Only the analyses on heavy drinking, SD, and IBS used all 607 participants.

RESULTS

Among the 509 adults in primary care, 23% (95% CI, 19-26%) had PTSD, of whom 11% had it noted in the medical record. The prevalence of PTSD, adjusted for age, gender, race, and marital and socioeconomic statuses, was higher in participants with, compared to those without, the following conditions: chronic pain (23 vs 12%, p = .003), major depression (35 vs 11%, p < .0001), anxiety disorders (42 vs 14%, p < .0001), and IBS (34 vs 18%, p = .01) and lower in immigrants (13 vs 21%, p = .05).

CONCLUSIONS

The prevalence of PTSD in the urban primary care setting, and particularly among certain high-risk conditions, compels a critical examination of optimal approaches for screening, intervention, and referral to PTSD treatment.

Psychological underpinnings of metabolic syndrome

Metabolic syndrome (MS) is more common among socio-economically disadvantaged individuals and is associated with certain risky lifestyle practices. MS also appears to be triggered by adverse social circumstances and chronic stress. The present paper reviews accumulating evidence to imply that individuals who have certain personality and behaviour traits are particularly predisposed to develop MS, and brings together theories that relate to possible psychological mechanisms underlying MS. It considers how such factors might interact causally to encourage the development of MS. As part of the EU-funded LIPGENE Integrated Project, multi-level modelling will be undertaken to explore potential pathways to MS, taking into consideration the interplay between a range of psycho-social, demographic, cultural and lifestyle factors thought to contribute to the development of MS. Data will be gathered for this purpose from a representative sample of >50-year-olds living in Britain (n 1000) and Portugal (n 500). It is anticipated that this information will assist in the development and targetting of future intervention to prevent and treat MS in the normal population.