Associations of Lifetime Trauma and Chronic Stress With C-reactive Protein in Adults Ages 50 Years and Older: Examining the Moderating Role of Perceived Control

Exploring Resilience Among Midlife and Older Sexual Minority and Heterosexual Adults: A Multidimensional Analysis

Research on resilience in sexual minority midlife and older adults is limited. Using a multidimensional approach, this study examined trait resilience (optimism), resilience as a dynamic process (perceived control), and relational resilience (social support), analyzing their roles in physical and mental health among sexual minority adults. Analyzing data from MIDUS 2 and MIDUS Refresher, we examined a sample of 492 participants, comprising 164 sexual minority and 328 propensity-matched heterosexual individuals. Among sexual minority participants, perceived control was associated with fewer chronic conditions and optimism with lower depressed affect. Among heterosexual participants, perceived control was associated with both outcomes. Subgroup analyses found variations, particularly among lesbian and bisexual women. Resilience measures were not associated with the health outcomes for gay or bisexual men. This study highlighted the complex roles of trait resilience and dynamic resilience processes in association with health outcomes among sexual minority midlife and older adults across diverse subgroups.

Discrimination and Cardiovascular Health in Black Americans: Exploring Inflammation as a Mechanism and Perceived Control as a Protective Factor

OBJECTIVE

Inflammation may be an integral physiological mechanism through which discrimination impacts cardiovascular health and contributes to racial health disparities. Limited research has examined psychosocial factors that protect against the negative effects of discrimination on inflammation. Perceived control is a promising possible protective factor, given that it has been shown to moderate the relationship between other psychosocial stressors and physiological outcomes. This study thus tested whether systemic inflammation mediated the link between discrimination and cardiovascular health and whether perceived control moderated this relationship.

METHODS

Data for this project included 347 non-Hispanic/Latinx Black adults (mean [standard deviation] age = 51.64 [11.24] years; 33% female) taken from the Midlife in the United States study. Perceived control and daily discrimination were assessed via self-report, and inflammation was measured via circulating levels of C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, and tumor necrosis factor α. Cardiovascular health was measured by morbidity of cardiovascular conditions: heart disease, hypertension, and/or stroke.

RESULTS

CRP (indirect effect: b = 0.004, 95% confidence interval [CI] = 0.001-0.007) and fibrinogen (indirect effect: b = 0.002, 95% CI = 0.0003-0.005) mediated the link between discrimination and cardiovascular conditions. Perceived control moderated the relationship between discrimination and CRP ( F (1, 293) = 4.58, Δ R2 = 0.013, b = -0.02, SE = 0.01, p = .033). CRP mediated the link between discrimination and cardiovascular conditions only for those who reported low levels of perceived control (Index = -0.003, 95% CI = -0.007 to -0.0001).

CONCLUSION

Findings provide empirical evidence of inflammation as a mechanism linking discrimination to cardiovascular conditions among Black Americans. Additionally, perceived control may be protective. Findings could suggest beliefs about control as a potential intervention target to help reduce the negative effects of discrimination on cardiovascular health among Black Americans.

Perceived Control and Inflammation: Mediating and Moderating Effects in the Relationship Between Cumulative Trauma and Depression

OBJECTIVE

The effects of trauma exposure on depression risk and severity are well established, but psychosocial and biological factors that impact or explain those relationships remain poorly understood. This study examined the moderating and mediating effects of perceived control and inflammation in the relationship between trauma and depression.

METHODS

Moderation analyses and longitudinal mediation analyses were conducted on data from 945 adults who completed all three waves (spanning around 19 years) of the Midlife Development in the United States (MIDUS) study and the MIDUS Biomarker Study. Data were collected during a phone interview, self-report surveys distributed in the mail, and an in-person blood draw. Two dimensions of perceived control-mastery and constraints-were examined separately in all analyses.

RESULTS

Perceived control did not significantly moderate the relationship between trauma and depression severity at MIDUS 2 ( b = 0.03, SE = .02, p = .091). Constraints significantly mediated the relationship between trauma and MIDUS 3 depression (indirect effect = 0.03, SE = 0.01, p = .016) but not after accounting for MIDUS 2 depression. Perceived control did not have a significant moderating effect in the relationships between trauma and inflammation or inflammation and depression.

CONCLUSIONS

Findings from this study revealed that perceived control may be better characterized as an explanatory factor rather than a buffer in trauma-associated depression. Perceived constraints in particular may be a useful treatment target for trauma-associated depression. Further research is needed to examine whether these results generalize to populations other than among mostly non-Hispanic White adults in the United States.

The role of digital transformation in addressing health inequalities in coastal communities: barriers and enablers

Healthcare systems worldwide are striving for the "quadruple aim" of better population health and well-being, improved experience of care, healthcare team well-being (including that of carers) and lower system costs. By shifting the balance of care from reactive to preventive by facilitating the integration of data between patients and clinicians to support prevention, early diagnosis and care at home, many technological solutions exist to support this ambition. Yet few have been mainstreamed in the NHS. This is particularly the case in English coastal areas which, despite having a substantially higher burden of physical and mental health conditions and poorer health outcomes, also experience inequalities with respect to digital maturity. In this paper, we suggest ways in which digital health technologies (DHTs) can support a greater shift towards prevention; discuss barriers to digital transformation in coastal communities; and highlight ways in which central, regional and local bodes can enable transformation. Given a real risk that variations in digital maturity may be exacerbating coastal health inequalities, we call on health and care policy leaders and service managers to understands the potential benefits of a digital future and the risks of failing to address the digital divide.

The Cumulative Impact of Chronic Stressors on Risks of Myocardial Infarction in US Older Adults

OBJECTIVE

This study aimed to investigate the association between cumulative exposure to chronic stressors and the incidence of myocardial infarction (MI) in US older adults.

METHODS

Nationally representative prospective cohort data of adults 45 years and older (n = 15,109) were used to investigate the association between the cumulative number of chronic stressors and the incidence of MI in US older adults. Proportional hazards models adjusted for confounding risk factors and differences by sex, race/ethnicity, and history of MI were assessed.

RESULTS

The median age of participants was 65 years, 714 (4.7%) had a prior MI, and 557 (3.7%) had an MI during follow-up. Approximately 84% of participants reported at least one chronic stressor at baseline, and more than half reported two or more stressors. Multivariable models showed that risks of MI increased incrementally from one chronic stressor (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.20-1.37) to four or more chronic stressors (HR = 2.71, 95% CI = 2.08-3.53) compared with those who reported no stressors. These risks were only partly reduced after adjustments for multiple demographic, socioeconomic, psychosocial, behavioral, and clinical risk factors. In adults who had a prior MI (p value for interaction = .038), we found that risks of a recurrent event increased substantially from one chronic stressor (HR = 1.30, 95% CI = 1.09-1.54) to four or more chronic stressors (HR = 2.85, 95% CI = 1.43-5.69).

CONCLUSIONS

Chronic life stressors are significant independent risk factors for cardiovascular events in US older adults. The risks associated with multiple chronic stressors were especially high in adults with a previous MI.

Mediators and Moderators of the Association Between Perceived Stress and Episodic Memory in Diverse Older Adults

OBJECTIVE

Stress is a risk factor for numerous negative health outcomes, including cognitive impairment in late-life. The negative association between stress and cognition may be mediated by depressive symptoms, which separate studies have identified as both a consequence of perceived stress and a risk factor for cognitive decline. Pathways linking perceived stress, depressive symptoms, and cognition may be moderated by sociodemographics and psychosocial resources. The goal of this cross-sectional study was to identify modifying factors and enhance understanding of the mechanisms underlying the stress-cognition association in a racially and ethnically diverse sample of older adults.

METHOD

A linear regression estimated the association between perceived stress and episodic memory in 578 older adults (Mage = 74.58) in the Washington Heights-Inwood Columbia Aging Project. Subsequent models tested whether depressive symptoms mediated the stress-memory relationship and whether sociodemographics (gender, race, and ethnicity) or perceived control moderated these pathways.

RESULTS

Independent of sociodemographics and chronic diseases, greater perceived stress was associated with worse episodic memory. This relationship was mediated by more depressive symptoms. Higher perceived control buffered the association between stress and depressive symptoms. There was no significant moderation by gender, race, or ethnicity.

CONCLUSION

Depressive symptoms may play a role in the negative association between perceived stress and cognition among older adults; however, longitudinal analyses and studies using experimental designs are needed. Perceived control is a modifiable psychological resource that may offset the negative impact of stress.

Socioeconomic and psychosocial mechanisms underlying racial/ethnic disparities in cognition among older adults

Objective: Racial/ethnic disparities in cognitive aging are only partly attributable to socioeconomic indicators. Psychosocial factors, such as discrimination and perceived control, also differ across racial/ethnic groups, and emerging literature highlights their potential role in contributing to cognitive disparities in addition to socioeconomic status. Method: 1,463 older adults (51% Hispanic, 27% non-Hispanic Black, and 22% non-Hispanic White) in the Washington Heights-Inwood Columbia Aging Project completed cognitive and psychosocial measures, including a comprehensive neuropsychological battery, Everyday and Major Experiences of Lifetime Discrimination scales, and the Perceived Control scale. Mediation models quantified separate indirect effects of Black race and Hispanic ethnicity on global cognitive composite scores through education, income, discrimination, and external perceived control. Results: Educational attainment, income, and perceived control each mediated racial/ethnic disparities in global cognition. Socioeconomic indicators (i.e., lower education and lower income) explained approximately 50% of the Black-White and Hispanic-White disparities in global cognition, and more external perceived control explained an additional 5%-8%. Hispanics reported the lowest levels of discrimination, while non-Hispanic Blacks reported the highest levels. However, neither everyday nor major lifetime discrimination was associated with global cognition. Significant racial/ethnic disparities in global cognition remained after accounting for the included socioeconomic and psychosocial factors. Conclusions: This study suggests that psychosocial factors may explain racial/ethnic disparities in cognitive aging above and beyond socioeconomic indicators. More external perceived control, which could reflect chronic exposure to interpersonal and institutional marginalization, may be a particularly salient psychosocial risk factor for poorer cognitive aging among non-Hispanic Black and Hispanic older adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Averting a public health crisis in England's coastal communities: a call for public health research and policy

Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level.

Disparities in Chronic Health Outcomes and Health Behaviors Between Lesbian and Heterosexual Adult Women in Pittsburgh: A Longitudinal Study

Background: Compared to heterosexual women, lesbian women experience higher rates of many chronic diseases, including depression, obesity, hypertension, and diabetes. Lesbian women report higher rates of risky health behaviors such as hazardous drinking and cigarette smoking. However, little longitudinal research has been done to examine changes in disparities between lesbian and heterosexual adult women. Methods: A total of 1,084 women were initially recruited from Pittsburgh, PA to participate in the Epidemiologic Study of HEalth Risk in Women (ESTHER) study and completed a baseline survey between 2003 and 2006. In 2015 or 2016, N = 483 women, 270 of whom were lesbian, completed a follow-up survey. Participants completed a questionnaire at both baseline and follow-up and completed a clinic visit for the baseline study to provide biometric data. Results: At baseline, lesbian participants reported higher rates of obesity (p = 0.03), depression (p = 0.02), and smoking (p = 0.04). Lesbian participants had elevated measured C-reactive protein levels (p = 0.05). By the time of the follow-up survey 10 years later, lesbian women continued to have higher rates of smoking (p = 0.04), but the disparity in depression (p = 0.53) and obesity (p = 0.24) rates had resolved. We found no differences in any other outcomes of interest. Conclusions: To our knowledge, this is the first study to report a resolution in obesity or depression disparities between lesbian and heterosexual women. Future research is necessary to determine if other disparities, such as respiratory conditions, appear over time and how lesbian women's health may continue to improve relative to heterosexual women and stem this public health inequity.

A Pilot Randomized Trial Assessing the Effect of a Psychoeducational Intervention on Psychoneuroimmunological Parameters Among Patients With Nonmetastatic Breast Cancer

OBJECTIVE

The aim of this study was to determine a potential benefit of the specific psychoeducational intervention "Learning to Live with Cancer" (LTLWC) for patients with operated nonmetastatic breast cancer, with respect to psychological variables and endocrine and immune parameters.

METHODS

Fifty-two postmenopausal women with operated stage I to III breast cancer were randomized to either a breast cancer intervention group (BCIG, n = 30) who immediately began participating in the LTLWC intervention program or to a breast cancer control group (BCCG, n = 22). Matched healthy women were asked to participate as a noncancer comparison group (n = 26). All participants were evaluated at three different time points (t1-t3) using a set of standardized questionnaires and blood samples were taken to analyze immune cell subsets and stress hormone levels.

RESULTS

A significant reduction in trait anxiety/State Trait Anxiety Inventory score was observed in the BCIG (t1: median = 35.0 [interquartile range = 28.0-38.0] versus t3: median = 26.0 [interquartile range = 18.5-37.0], p = .0001) compared with the BCCG (t1: median = 41.0 [interquartile range =32.75-49.0]; t3: median = 38.5 [interquartile range = 30.75-46.5], p = .01524; p interaction = .001). In parallel, a significant rise of serotonin levels (t1: median = 66.5 ng/ml [interquartile range = 11.50-106.00] versus t3: median = 80.5 ng/ml [interquartile range =59.00-118.00], p = .00008) as well as a significant reduction of the elevated number of Treg cells at baseline (t1: median = 4.45% [interquartile range = 4.00-5.33] versus t3: median = 2.80% [interquartile range = 2.68-3.13], p < .00001) were observed in the BCIG versus no change in the BCCG. A significant statistical association between reduced trait anxiety and decreased Treg cell number could be demonstrated in the BCIG (r = .62, p < .01).

CONCLUSIONS

The observed results of this study provide preliminary support for the efficacy of the LTLWC program in significantly improving psychoneuroimmunological parameters in patients with nonmetastatic breast cancer.

The Biology of Human Resilience: Opportunities for Enhancing Resilience Across the Life Span

Recent scientific and technological advances have brought us closer to being able to apply a true biopsychosocial approach to the study of resilience in humans. Decades of research have identified a range of psychosocial protective factors in the face of stress and trauma. Progress in resilience research is now advancing our understanding of the biology underlying these protective factors at multiple phenotypic levels, including stress response systems, neural circuitry function, and immune responses, in interaction with genetic factors. It is becoming clear that resilience involves active and unique biological processes that buffer the organism against the impact of stress, not simply involve a reversal of pathological mechanisms. Here, we provide an overview of recent progress in the field, highlighting key psychosocial milestones and accompanying biological changes during development, and into adulthood and old age. Continued advances in our understanding of psychological, social, and biological determinants of resilience will contribute to the development of novel interventions and help optimize the type and timing of intervention for those most at risk, resulting in a possible new framework for enhancing resilience across the life span.

Hierarchies of evidence applied to lifestyle Medicine (HEALM): introduction of a strength-of-evidence approach based on a methodological systematic review

BACKGROUND

Current methods for assessing strength of evidence prioritize the contributions of randomized controlled trials (RCTs). The objective of this study was to characterize strength of evidence (SOE) tools in recent use, identify their application to lifestyle interventions for improved longevity, vitality, or successful aging, and to assess implications of the findings.

METHODS

The search strategy was created in PubMed and modified as needed for four additional databases: Embase, AnthropologyPlus, PsycINFO, and Ageline, supplemented by manual searching. Systematic reviews and meta-analyses of intervention trials or observational studies relevant to lifestyle intervention were included if they used a specified SOE tool. Data was collected for each SOE tool. Conditions necessary for assigning the highest SOE grading and treatment of prospective cohort studies within each SOE rating framework were summarized. The expert panel convened to discuss the implications of findings for assessing evidence in the domain of lifestyle medicine.

RESULTS AND CONCLUSIONS

A total of 15 unique tools were identified. Ten were tools developed and used by governmental agencies or other equivalent professional bodies and were applicable in a variety of settings. Of these 10, four require consistent results from RCTs of high quality to award the highest rating of evidence. Most SOE tools include prospective cohort studies only to note their secondary contribution to overall SOE as compared to RCTs. We developed a new construct, Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM), to illustrate the feasibility of a tool based on the specific contributions of diverse research methods to understanding lifetime effects of health behaviors. Assessment of evidence relevant to lifestyle medicine requires a potential adaptation of SOE approaches when outcomes and/or exposures obviate exclusive or preferential reliance on RCTs. This systematic review was registered with the International Prospective Register of Systematic Reviews, PROSPERO [CRD42018082148].

Chronic Ongoing Stressors and C-Reactive Protein: A Within-Person Study

Objectives: Literature suggests C-reactive protein (CRP)-as a marker of low-grade systemic inflammation-may mediate the linkage between chronic stressors and cardiometabolic conditions. Previous population-based reports are based on weak methodologies and may have yielded incorrect inferences. The current study examined linkages of within-person CRP variation with corresponding variation in stressor burdens. Method: Data were from the 2006, 2010, and 2014 waves of the U.S. Health and Retirement Study. Analysis was through unit fixed effects and first-difference estimators. Both gender-combined and gender-specific models were run. Results: In none of the analyses was CRP positively associated with chronic stressors. This was true among both genders, and in models of linear as well as nonlinear change. Results held in a series of separate robustness checks. Discussion: CRP may not mediate the social etiology of degenerative diseases. Population representative evidence of inflammation's role in these processes remains absent.

Longitudinal effects of race, ethnicity, and psychosocial disadvantage on systemic inflammation

Objective

Psychosocial factors likely contribute to racial and ethnic inequalities in cardiovascular diseases (CVDs). However, precise social, psychological, and physiological pathways linking race and ethnicity to the development of CVDs are not well understood. Systemic inflammation, commonly indexed by C-reactive protein (CRP), is a biomarker for CVD risk and progression. The objective of this study was to identify mediating pathways from race and ethnicity to CRP through social, psychological, and behavioral variables.

Methods

Using data from 12,382 participants aged 51 and older in the Health and Retirement Study, structural equation models tested for direct and indirect effects of race and ethnicity on CRP measured over four years through educational disadvantage, everyday discrimination, depressive symptoms, external locus of control, and smoking.

Results

Educational disadvantage mediated Black-White and Hispanic-White disparities in baseline CRP directly, as well as indirectly through elevated depressive symptoms, higher external locus of control, and smoking. Educational disadvantage also mediated Black-White and Hispanic-White disparities in CRP change directly, as well as indirectly through higher external locus of control and smoking. Independent of education, discrimination mediated Black-White differences in baseline CRP via elevated depressive symptoms, higher external locus of control, and smoking. Discrimination also mediated Black-White disparities in CRP change via external locus of control.

Conclusions

Results from this population-based, longitudinal study support the view that racially patterned social disadvantage is prospectively associated with longitudinal inflammatory processes, and some of these effects are independently mediated by psychological and behavioral factors. Biopsychosocial pathways to health disparities also differ between minority groups.

The impact of psychosocial stress and stress management on immune responses in patients with cancer

The range of psychosocial stress factors/processes (eg, chronic stress, distress states, coping, social adversity) were reviewed as they relate to immune variables in cancer along with studies of psychosocial interventions on these stress processes and immune measures in cancer populations. The review includes molecular, cellular, and clinical research specifically examining the effects of stress processes and stress-management interventions on immune variables (eg, cellular immune function, inflammation), which may or may not be changing directly in response to the cancer or its treatment. Basic psychoneuroimmunologic research on stress processes (using animal or cellular/tumor models) provides leads for investigating biobehavioral processes that may underlie the associations reported to date. The development of theoretically driven and empirically supported stress-management interventions may provide important adjuncts to clinical cancer care going forward.

Understanding Resilience and Preventing and Treating PTSD

Resilience is defined as the dynamic ability to adapt successfully in the face of adversity, trauma, or significant threat. Some of the key early studies of resilience were observational studies in children. They were followed by research in adults, studies testing interventions to promote resilience in different populations, and a recent upsurge of studies on the underlying genomic and neurobiological mechanisms. Neural and molecular studies in preclinical models of resilience are also increasingly identifying active stress adaptations in resilient animals. Knowledge gained from animal and human studies of resilience can be harnessed to develop new preventive interventions to enhance resilience in at-risk populations. Further, treatment interventions focused on enhancing potentially modifiable protective factors that are consistently linked to psychological resilience can enrich currently available treatment interventions for individuals with posttraumatic stress disorder (PTSD). Translating our expanding knowledge of the neurobiology of resilience additionally promises to yield novel therapeutic strategies for treating this disabling condition. This review summarizes the vast field of resilience research spanning genomic, psychosocial, and neurobiological levels, and discusses how findings have led and can lead to new preventive and treatment interventions for PTSD.

Resilience and immunity

Resilience is the process that allows individuals to adapt to adverse conditions and recover from them. This process is favored by individual qualities that have been amply studied in the field of stress such as personal control, positive affect, optimism, and social support. Biopsychosocial studies on the individual qualities that promote resilience show that these factors help protect against the deleterious influences of stressors on physiology in general and immunity in particular. The reverse is also true as there is evidence that immune processes influence resilience. Most of the data supporting this relationship comes from animal studies on individual differences in the ability to resist situations of chronic stress. These data build on the knowledge that has accumulated on the influence of immune factors on brain and behavior in both animal and human studies. In general, resilient individuals have a different immunophenotype from that of stress susceptible individuals. It is possible to render susceptible individuals resilient and vice versa by changing their inflammatory phenotype. The adaptive immune phenotype also influences the ability to recover from inflammation-induced symptoms. The modulation of these bidirectional relationships between resilience and immunity by the gut microbiota opens the possibility to influence them by probiotics and prebiotics. However, more focused studies on the reciprocal relationship between resilience and immunity will be necessary before this can be put into practice.

Co-Occurrence of Posttraumatic Stress Disorder and Cardiovascular Disease Among Ethnic/Racial Groups in the United States

OBJECTIVE

Trauma and/or symptoms of posttraumatic stress disorder (PTSD) have been linked to the onset of cardiovascular disease (CVD), but the exact mechanism has not been determined. We examine whether the risk of CVD is different among those who have a history of trauma without PTSD symptoms, those who have experienced trauma and developed any symptoms of PTSD, and those with a PTSD diagnosis. Furthermore, we examine whether this association varies across ethnic/racial groups.

METHODS

We used two data sets that form part of the Collaborative Psychiatric Epidemiology Surveys - the National Latino and Asian American Study and the National Comorbidity Survey Replication.

RESULTS

We found an increased likelihood of cardiovascular events for those with a diagnosis of PTSD (odds ratio [OR] = 2.10, 95% CI = 1.32-3.33) when compared with those who had not experienced trauma. We did not find an increased risk for those who had experienced trauma without symptoms or with subclinical symptoms of PTSD. The higher likelihood of having a cardiovascular event in those with PTSD was significant for non-Latino whites (OR = 1.86, 95% CI = 1.08-3.11), Latinos (OR = 1.94, 95% CI = 1.04-3.62), and non-Latino blacks (OR = 3.73, 95% CI = 1.76-7.91), but not for Asian respondents.

CONCLUSIONS

The constellation of symptoms defining PTSD diagnosis reflect adverse reactions to traumatic events and indicate that complex responses to traumatic events may be a risk factor for CVD.

Coping strategy and social support modify the association between perceived stress and C-reactive protein: a longitudinal study of healthy men and women

Inconsistent associations have been reported between perceived stress and C-reactive protein (CRP), a marker of systemic inflammation. We previously observed a male-specific inverse relationship between perceived stress and CRP in a cross-sectional study. In the present study, we examined the longitudinal association between changes in perceived stress and CRP, and further analyzed whether changes in coping strategies and social support modify this association. This study included 8454 participants in both a baseline survey and a follow-up survey 5 years later. Psychosocial measures (i.e. perceived stress, coping strategies, and social support) and CRP concentrations were measured by identical means in both surveys. Consistent with our previous findings, increased perceived stress was significantly associated with lower CRP in men (p_trend = .037), but not in women. Increased "emotional expression," a coping strategy, was also associated with lower CRP in women (p_trend = .024). Furthermore, interactions between perceived stress and a coping strategy (positive reappraisal) or social support on CRP were found in men (p_interaction = .007 and .038, respectively); the above inverse association between stress and CRP was not detected for participants with diminished positive reappraisal or social support. In conclusion, increases in perceived stress during a 5-year period were associated with decreases in CRP among healthy men, and the observed association was possibly modified by coping strategy or social support.

Lifetime trauma, perceived control, and all-cause mortality: Results from the Midlife in the United States Study

OBJECTIVE

To investigate whether lifetime-trauma exposure predicts all-cause mortality and whether this association is mediated or moderated by perceived control.

METHOD

A sample of middle-aged and older adults (N = 4,961) who participated in the second wave of the Midlife in the United States Study (MIDUS) provided data. Lifetime trauma was operationalized using the reported number of potentially traumatic experiences spanning childhood through adulthood. Both the perceived constraints and mastery dimensions of perceived control were examined. Cox regression models tested main effects and interactions of lifetime trauma with mastery and constraints predicting 10-year mortality risk.

RESULTS

There was a significant main effect of lifetime trauma, b = .06, hazard ratio (HR) = 1.07, p = .032, and an interaction of trauma with mastery, b = -.08, p = .004. A greater number of traumatic experiences was associated with increased mortality risk at below-average levels of mastery, -1 SD; HR = 1.14, p < .001, but not at above-average levels, +1 SD; HR = 0.97, p = .48. This interaction persisted after further adjustment for health status, psychological, and behavioral covariates. An association of constraints with elevated mortality risk, HR = 1.33, p = .008, was attenuated in a fully adjusted model, HR = 1.06, p = .26.

CONCLUSION

A strong sense of mastery may buffer elevated mortality risk associated with exposure to traumatic experiences. Findings extend evidence that mastery may foster resilience to the adverse health effects of traumatic stressors, whereas constraints may show stronger independent associations with health outcomes. (PsycINFO Database Record