Lovesick: How Couples' Relationships Influence Health

Dyadic Analysis of Cumulative Childhood Trauma and Relationship Satisfaction: The Role of Parental Alliance

Cumulative childhood trauma (CCT) increases the risk of relationship difficulties in adulthood. Couples welcoming a new child are particularly prone to relationship distress, and CCT survivors may be especially vulnerable during this period. This study examined the association between CCT and relationship satisfaction and tested the role of parental alliance in this association. A random sample of 1136 different-gender parental couples completed online self-report questionnaires. Path analyses guided by the Actor-Partner Interdependence Model revealed that parents' CCT was associated with their own lower relationship satisfaction through their own and their partner's parental alliance in both mothers and fathers. Results also revealed dyadic associations between one parent's CCT and their partner's relationship satisfaction through their own and their partner's parental alliance. These findings support the relevance of couple interventions focusing on the parental alliance to improve relational well-being in parental couples where one or both partners have experienced CCT.

Daily relationship satisfaction and markers of health: Findings from a smartphone-based assessment

Relationship satisfaction is associated consistently with better physical and mental health. Less is known about these associations in daily life, particularly the association between relationship satisfaction and cognitive health. This study examined the daily, within-person association between relationship satisfaction and subjective health markers, including cognitive health. Participants from the United States (N = 303; Mage = 51.71, SD = 7.32) in the Couples Healthy Aging Project (CHAP) completed assessments of relationship satisfaction and health markers every night for eight days. Multilevel modeling was performed by accounting for personal (sex, age, race, education), relational (relationship duration), and contextual (day in the study, weekend day) factors. Within-person, on days when participants were more satisfied with their relationship, they felt healthier, younger, more satisfied with their life, and more purposeful. They also reported a sharper mind, better memory, and clearer thinking; relationship satisfaction was unrelated to whether participants were bothered and disrupted by forgetting. Results indicated that a satisfying romantic relationship is closely associated with better physical, psychological, and cognitive health markers in daily life.

How the partner's perceived psychological state affects perinatal mental health in Chinese women: multiple mediating effects of couple communication and perceived social support

The association between partner congruence and maternal mental health manifests intricate cultural variations. This study aimed to explore how the perceived psychological state of partners affects perinatal mental health among Chinese women and examine the mediating roles of couple communication and perceived social support. A cross-sectional survey was conducted with 1,654 pregnant women (mean age: 29.7 years; gestational age: 12-41 weeks) from three hospitals in Jiangsu Province. Structural equation modeling (SEM) was applied for data analysis. The results indicated that an unstable partner's perceived psychological state negatively affects perinatal mental health. Couple communication partially mediates the relationship between partner's perceived psychological state and perinatal mental health, and couple communication and perceived social support performed a serial mediation of this relationship. These findings suggest that a partner's psychological state can induce similar emotional responses in pregnant women. However, effective couple communication can alleviate adverse psychological effects by enhancing perceived social support. This study underscores the imperative to incorporate empowerment of primary support companions (particularly spouses) within prenatal social support frameworks. To advocate for the development of a two-way communication model, the enhancement of effective dichotomous communication skills, and the establishment of a supportive communication environment characterized by openness and regularity. This approach ensures that spousal support aligns with women's needs, improving the quality and satisfaction of support while reducing the risk of adverse health outcomes.

Patient-Centered Communication and Cancer Information Overload Among Adults without a History of Cancer in the United States

Patient-centered communication (PCC) plays a pivotal role in improving healthcare quality and health outcomes. A plethora of cancer prevention-related information is publicly available, potentially leading to cancer information overload (CIO). However, little is known about whether experience with PCC can help prevent or reduce CIO among adults without a history of cancer. Pooled data from the Health Information National Trends Survey (HINTS 5, Cycles 1-4, 2017 through 2020) were utilized for 10,636 non-institutionalized U.S. adults (≥18 years) without a history of cancer. The CIO was constructed based on respondents' experiences of difficulties following myriad cancer prevention recommendations. Experience of PCC was measured on a composite score scale of 0 to 100 based on elements of the PCC model for patient-healthcare provider encounters. A multivariable logistic regression model was fitted to investigate associations between PCC and CIO. Approximately 75.0% of the study respondents with a lower mean PCC expressed experiencing CIO (79.1 vs. no-CIO = 82.1, p < .001). With each one-unit score increase on the PCC scale, the odds of experiencing CIO decreased by approximately 1% (adjusted OR = 0.993; 95% CI: 0.988, 0.997; p < .01). The findings highlight that higher levels of PCC are associated with reduced odds of experiencing CIO. Increased PCC could help individuals better navigate cancer prevention-related information, thus reducing stress and improving informed decision-making. Healthcare providers and policy initiatives should promote tailored cancer prevention communication practices that prioritize patient-centeredness.

Partnership and marriage and risk of type 2 diabetes: a narrative review

In this review, we discuss how partnership and marriage influence cardiometabolic risk factors and risk of type 2 diabetes, and how couple-based approaches to type 2 diabetes prevention might complement individual-focused prevention efforts. There is some evidence that being married per se has a small positive effect on type 2 diabetes risk. Moreover, there is spousal concordance for many type 2 diabetes risk factors due to assortative mating and convergence during partnership, with weak to moderate correlations found for anthropometric measures, blood pressure, lipid concentrations, smoking, alcohol consumption and physical activity level. A meta-analysis shows that people have a higher risk of type 2 diabetes if their spouse has diabetes (OR 1.72, 95% CI 1.47, 2.02). However, despite some evidence, there is still a lack of research on similar associations in relation to progression to type 2 diabetes and diabetes complications. Several studies have suggested that behaviour changes, for example smoking cessation or weight loss, in one partner increase the likelihood that the other partner will make the same changes. Subsequent studies of couple-based interventions that focus on both partners have shown that people are more likely to adhere to a diabetes prevention programme if their partners are also involved in the programme. However, the effect of the quality of marriage on the outcome of an intervention is still unclear. Couple-based interventions are promising, but there is a lack of RCTs comparing couple-based interventions with individual-centred interventions.

Risk Factors for Viral Coinfections in Blood Donors in Bahia, Brazil

Human Immunodeficiency Virus (HIV), Human T Lymphotropic Virus (HTLV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) coinfection may lead to disease progression or worsen its clinical presentation. Viral coinfections screening during blood donation is critical. To identify risk factors for coinfection among blood donors, we assessed the blood donations at the Fundação de Hematologia e Hemoterapia da Bahia, from 2008 to 2017. We compared serological/molecular evidence of single infection versus two or more viral blood-borne infections-BBI). A multivariable logistic regression model was performed to evaluate independent associations between characteristics of donors with single infection and multiple infection using "non-infection" category as reference. Among 777,446 collected blood donations, 27 358 (3.5%) were reactive, most (n = 26 677, 97.6%) for a single infection and 681 (2.4%) for coinfection. The most frequent coinfections were HBV-HIV (30.6%), HBV-HCV (30.4%), and HBV-HTLV (24.4%). Male sex, lower education, being single, and being a first-time donor were independently associated with both single and coinfections. Nevertheless, the adjusted odds for risk factors of coinfections were much higher than those for single infection. Donors with single and coinfection for BBI shared identical risks, but they were significantly higher for coinfection. Preventive strategies addressing the identified risks can decrease transmission of viral BBI by blood transfusion.

The association between couple relationships and sleep: A systematic review and meta-analysis

Growing evidence suggests a link between couple relationships and sleep, yet findings are inconsistent. We conducted a systematic review and meta-analysis, searching four databases up to March 2023, and included 62 studies with 43,860 participants. Results indicated a moderate correlation between better couple relationship quality and better overall sleep quality (r = 0.34, 95%CI = 0.09-0.59), as well as longer sleep duration (r = 0.39, 95%CI = 0.04-0.65). Regarding specific couple relationship domains, greater partner responsiveness was linked to improved overall sleep quality (r = 0.19, 95%CI = 0.13-0.25), while partner support showed no significant association (r = 0.03, 95%CI = -0.02-0.09). Increased partner conflict was associated with poorer overall sleep quality (r = 0.17, 95%CI = 0.06-0.27). In the studies that could not be meta-analyzed, greater partner conflict significantly correlated with longer actigraphy-based sleep latency and more wake episodes, but not necessarily with shorter actigraphy-based sleep duration. Increased self-disclosure was related to better overall sleep quality, whereas higher perceived rejection was linked to worse overall sleep quality. Higher closeness was not consistently associated with better overall sleep quality. Our results suggest a significant link between better couple relationships and improved sleep. Improving couple relationships may enhance sleep. However, further long-term cohort studies outside the USA are needed to evaluate these associations, particularly regarding specific couple relationship domains and specific sleep indicators.

Emotional ecosystems: Understanding the relationship between family interactions and anxiety among cancer caregivers

OBJECTIVES

Recent studies have challenged the assumption that families are invariable sources of support for cancer caregivers, noting that relationships with family members can have both positive and negative effects on caregiver well-being. This study expands upon prior literature to examine the relationship between cancer caregivers' perceptions of the quality of their family interactions and their symptoms of anxiety.

METHODS

We employed secondary analysis of baseline data from a multisite randomized clinical trial of an intervention for cancer caregivers conducted at 3 large academic palliative care clinics. We performed linear regression analyses to analyze the relationship between caregivers' perceptions of the quality of their family interactions and their symptoms of anxiety; additional models were estimated to further characterize this relationship with the addition of relevant covariates: race, ethnicity, sex, marital/relationship status, relationship to patient, employment status, household income, and perceived social support received from friends and significant others. We also conducted a sub-analysis of data provided by caregivers who were married or partnered to examine the relationship between their perceptions of the quality of their family interactions and their symptoms of anxiety with relationship satisfaction as a covariate.

RESULTS

Among our analytic sample (n = 244), we identified a significant negative relationship between cancer caregivers' perceptions of the quality of their family interactions and their symptoms of anxiety; this relationship remained statistically significant with the addition of covariates. Relationship satisfaction was not found to be a statistically significant covariate in our sub-analysis of married or partnered caregivers.

SIGNIFICANCE OF RESULTS

Study results provide strong support for the development, testing, and implementation of interventions to improve family interactions as a strategy to reduce caregiver anxiety.

Social Networks, Health Support, and Dietary Intake in Mothers Receiving Home Visiting Services

Home visiting programs (HVPs) provide services to pregnant individuals and parents of young children to improve families' health and well-being. However, little is known about these families' social contexts. This study explores the social networks and dietary intake of mothers enrolled in a HVP, focusing on health support and health undermining. Cross-sectional data from 76 mothers enrolled in a HVP in Los Angeles County were collected by interview, using validated measures. Almost all mothers (95.7%) had one or more health supporters, while 55.1% had one or more health underminers. Some key findings related to health support were that mothers with higher income had more health supporters in their network (b = 1.36, p = 0.03), and network members were more likely to be health supporters if they were a romantic partner (OR = 3.41, p < 0.001), a resource-based connection (OR = 3.46, p < 0.01), or if they lived in the same neighborhood as the mother (OR = 1.68, p < 0.05). Further, having a health supporter who lived in the same neighborhood was associated with consuming more (1 + daily servings) vegetables (OR = 3.0, p < 0.05) and no sugar-sweetened beverages (OR = 0.29, p < 0.05). There were fewer findings related to health undermining: network members more likely to be underminers were romantic partners (OR = 8.93, p < .0001), and those perceived as having overweight or obesity (OR = 3.98, p < 0.001), but health undermining did not predict dietary intake. Overall, a broad set of network features were linked with health support, and given that some types of support were linked with better diet, network-based diet interventions leveraging health support may be effective in this priority population.

In it Together: Relationship Transitions and Couple Concordance in Health and Well-Being

Events that change the family system have the potential to impact couple dynamics such as concordance, that is, partner similarity in health and well-being. This project analyzes longitudinal data (≥ two decades) from both partners of up to 3,501 German and 1,842 Australian couples to investigate how couple concordance in life satisfaction, self-rated health, mental health, and physical health might change with transitioning to parenthood and an empty nest. Results revealed couple concordance in intercepts (averaged r = .52), linear trajectories (averaged r = .55), and wave-specific fluctuations around trajectories (averaged r = .21). Concordance in linear trajectories was stronger after transitions (averaged r = .81) than before transitions (averaged r = .43), whereas no systematic transition-related change in concordance of wave-specific fluctuations was found. Findings emphasize that shared transitions represent windows of change capable of sending couples onto mutual upward or downward trajectories in health and well-being.

Couple depression concordance and adverse health outcomes among middle-aged and older adults: A longitudinal study in China

OBJECTIVES

Little is known about the interactive patterns of depressive symptoms and the consequent joint health burden in couples. This study aimed to evaluate the impacts of couple depression concordance on activities of daily living (ADL) disability, instrumental ADL (IADL) disability, hospitalization, and all-cause mortality among middle-aged and older couples.

STUDY DESIGN

This study used a longitudinal research design.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study. At baseline, 3985 couples aged 45 years and older were included, being categorized into four groups: nondepressed husband-nondepressed wife (NN), depressed husband-nondepressed wife (DHNW), nondepressed husband-depressed wife (NHDW), and depressed husband-depressed wife (DD). Modified Poisson regression models were used to estimate relative risks (RRs) in terms of short-term (2011-2013) and long-term (2011-2018) follow-up.

RESULTS

Compared with participants in the NN group, those in the other three groups were at increased risk of ADL and IADL disability (P < 0.001), with the highest risk in the DD group. Any partner with depressive symptoms in a couple was associated with increased risks of ADL and IADL disability for both members. Depressed middle-aged couples were at a higher long-term risk of ADL disability than the elderly (Pinteraction = 0.031). Additionally, participants in the DD group had a significantly increased risk of hospitalization.

CONCLUSIONS

Depressive symptoms and subsequent health decline are interdependent in couples. Couples where both individuals have depressive symptoms are particularly vulnerable. More consideration should be given to couple-based management and treatment strategies in addressing depression and its detrimental consequences.

Testing the Associations Between Attachment Anxiety, Relational Aggression and Depressive Symptoms in Romantic Relationships: Actor-Partner Interdependence Model and Actor-Partner Interdependence Mediator Model

Emerging adulthood is a pivotal period for romantic relationships, yet the specific mechanisms through which attachment anxiety influences relationship dynamics and psychological outcomes in this phase are poorly understood. Particularly, in the context of romantic dyads, understanding how partners' behaviors and emotional patterns reciprocally influence each other remains underexplored. This study utilizes the Actor-Partner Interdependence Model and Actor-Partner Interdependence Mediator Model to explore the relationship between attachment anxiety,relational aggression (both perpetration and victimization), and depressive symptoms among emerging adults. A sample of 138 mixed-sex emerging adulthood couples from China, was recruited (Mage = 21.40, SD = 2.54; 50% female, 62.6% reporting that this relationship was ongoing for more than a year). Attachment anxiety significantly predicted relational aggression in both partners, with male attachment anxiety also significantly predicted female relational aggression. Significant indirect effects of both partners' relational aggression perpetration and victimization on their own and each other's relationship between attachment anxiety and depressive symptoms. These findings contribute to understanding the intricate dynamics of attachment anxiety and relational aggression in romantic relationships during emerging adulthood, emphasizing the need for targeted interventions to mitigate these risks.

How patients experience discussing couple relationship problems with GPs: an interview study

BACKGROUND

Couple relationship satisfaction is related to good physical health, good mental health, and longevity. Many patients have discussed or wish to discuss their couple relationship with their GP and look for personalised care and support when discussing topics they perceive as sensitive.

AIM

To explore patient experiences of discussing couple relationship problems in GP consultations.

DESIGN & SETTING

Qualitative study employing semi-structured interviews with patients from general practice in Norway.

METHOD

Individual interviews with 18 patients who had discussed their couple relationship with their GP. Participants were recruited through both social media and traditional media, and all interviews were digitally recorded. The purposive sample comprised 13 women and five men, representing diverse age groups, backgrounds, and relationship problems. All participants identified as heterosexual. We analysed interview data thematically using systematic text condensation.

RESULTS

Three main themes emerged: 1) GPs in a facilitating role, not on an assembly line; 2) navigating the 'elephant in the room'; and 3) GPs as biomedically competent life witnesses. GP continuity was vital in fostering the trust required to discuss sensitive topics, such as relationship issues. Participants valued a biopsychosocial approach that incorporated knowledge of close relationships into medical consultations. They appreciated both GP support and constructive challenges that prompted them to take responsibility for relationship improvements.

CONCLUSION

Patients value their GPs' holistic, supportive, and direct approach in addressing couple relationship problems, although they perceive that GPs do not always have sufficient time. They welcome relevant challenges that can drive positive change.

Association of relationship satisfaction with blood pressure: a cross-sectional study of older adults in rural Burkina Faso

OBJECTIVES

The objective of this study is to examine the association between relationship satisfaction and blood pressure (BP) in a low-income setting and to screen for gender moderation in this context. Research conducted in high-income settings suggests that relationship satisfaction is associated with better physical and mental health outcomes.

DESIGN

A cross-sectional study design was employed, using both questionnaire and physical measurement data. Multiple linear regression models were calculated for systolic and diastolic BP and adjusted for age, gender, demographics/socioeconomics and other health-related variables. Gender moderation was tested using interaction terms in multivariable analyses.

SETTING

A household survey was conducted in 2018 in rural northwestern Burkina Faso.

PARTICIPANTS

Final analysis included 2114 participants aged over 40 who were not pregnant, reported being in a partnership and had valid BP readings.

MAIN OUTCOME MEASURES

Systolic and diastolic BP levels.

RESULTS

A significant positive association existed between relationship satisfaction (Couples Satisfaction Index-4 score) and systolic BP (B=0.23, 95% CI (0.02 to 0.45), p=0.03) when controlling for demographics/socioeconomics. Nevertheless, this relationship lost statistical significance when additional adjustments were made for health-related variables (B=0.21, 95% CI (-0.01 to 0.42), p=0.06). There was no significant association of relationship satisfaction and diastolic BP and no evidence of gender moderation.

CONCLUSION

In contrast to many higher-income settings, we found a positive association between relationship satisfaction and systolic BP in very low-income rural Burkina Faso. Our results add to the evidence regarding the contextual nature of the association between relationship satisfaction and health, as high relationship satisfaction may not act as a health promotor in this socioeconomic context.

The prospective impact of extradyadic stress on depressive symptoms and the mediating role of intradyadic stress in parents-an actor-partner interdependence mediation model

BACKGROUND

Stress outside of the couple relationship (extradyadic stress) can spill over into the couple relationship, increasing stress between the partners (intradyadic stress). Extra- and intradyadic stress are furthermore associated with depressive symptoms. Due to the interdependence of romantic partners, this study aimed to investigate the influence of the person's own and their partner's extra- and intradyadic stress on the person's depressive symptoms in parents of toddlers. The second aim was to evaluate whether intradyadic stress mediates the within-person and between-partner association between extradyadic stress and depressive symptoms.

METHODS

Longitudinal data of a community sample of 878 opposite-sex couples, participating in the prospective cohort study DREAM, were collected two and three years after birth. Extra- and intradyadic stress were assessed by the Multidimensional Stress Questionnaire for Couples and depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. An actor-partner interdependence mediation model was applied to the data, while controlling for the confounder academic degree.

RESULTS

The person's own extradyadic stress predicted their depressive symptoms one year later, partially mediated by their intradyadic stress. The partner's extradyadic stress and the person's own depressive symptoms one year later were only indirectly associated through the person's own intradyadic stress. In a sensitivity analysis, between-partner effects were no longer significant after including autoregressive pathways.

CONCLUSION

Our findings highlight the importance of the extradyadic-intradyadic stress spillover for the mental health of women and men with young children. Early targeted interventions could help to prevent later depressive symptoms by reducing stress inside the couple relationship that results from both partners' stress from outside the couple relationship.

Own depression, partner's depression, and childlessness: A nationwide register-based study

Depression and other mental health disorders are increasing while childlessness is increasing. However, this relationship has rarely been studied. We examine how depression, as measured by antidepressant use, is related to childlessness. We add to the previous research by examining both the role of current partnership status and having a partner with depression as a mechanism. We use Finnish total population register data for cohorts born in 1977-1980. We estimate discrete time event history models for the likelihood of having a child with average marginal effects separately for men and women. Depression was measured annually with a time-varying indicator of having at least one purchase of antidepressants in the preceding year. We find a positive association between depression and childlessness; the annual probability of having a child was 2.7 percentage points lower for women with depression and 1.6 percentage points for men with depression in age-controlled models. When controlling for all background variables such as education, the likelihood of having a child was 1.9 percentage points lower for women with depression and 0.3 percentage points lower for men with depression. In total, 41% of men and 26% of women who had used antidepressant medication between ages 18-38 remained childless at age 39, compared to 30% of men and 22% of women who had not used antidepressant medication. We also find that a partner's depression increases the probability of being childless, and the likelihood of being childless is even higher if both an individual and their partner had depression.

Couples in breast cancer survivorship: Daily associations in relationship satisfaction, stress, and health

Romantic relationships are a key health determinant underlying both morbidity and mortality. Dr. Janice Kiecolt-Glaser's prolific research revealed cardiovascular, metabolic, endocrine, and immune pathways connecting marriage to health and longevity. In addition to her empirical work, she developed conceptual models on marriage, the gut microbiome, stress reactivity, and spousal health concordance; these models guide and inspire mechanistic research, serve as essential readings for graduate students and mentees, and provide inspiration for researchers across career stages. This paper highlights Dr. Kiecolt-Glaser's influential work, includes personal reflections and professional growth as past mentees, and provides Dr. Kiecolt-Glaser-inspired evidence linking relationships to health among couples in breast cancer survivorship. Using baseline questionnaires and daily dairies, breast cancer survivors (stage I-IIIB) and their cohabiting partners (60 individuals, 30 couples) rated their relationship satisfaction, stress, and physical health symptoms every day for 7 days. Results suggest that breast cancer survivors and their partners who felt more satisfied with their relationships also felt less stressed, both typically and on a daily basis. Survivors' and partners' lower stress was also associated with fewer physical health problems on average and in daily life. These findings demonstrate the daily stress and health advantages of satisfying relationships for both breast cancer survivors and their partners. We discuss the study's implications and several avenues for Dr. Kiecolt-Glaser-inspired research addressing a relationship's long-term health impact among couples in survivorship.

Prevalence and Risk Factors of HIV Drug Resistance in Zimbabwe: Evidence from Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2020 Survey

(1) Background: HIV drug resistance (HIVDR) poses a significant challenge to the effectiveness of antiretroviral therapy and the overall management of HIVand AIDS. Understanding the predictors of HIVDR is critical for developing strategies to mitigate its impact. The objectives of this study were to identify the predictors of HIVDR among Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA 2020) study participants, a national population-based survey. (2) Methods: Data from people living with HIV who participated in the ZIMPHIA 2020 were used to determine the predictors of HIVDR. (3) Results: The prevalence of HIVDR was 44.9%. Acquired HIVDR was present in 76.1% of people with a virological failure and transmitted resistance is 22.6% in naïve individuals. Factors associated with HIVDR in adjusted analysis were the number of lifetime sexual partners (aOR = 1.03, 95% CI: 1.01-1.06, p = 0.017), each additional year since the first HIV positive result (aOR = 1.17, 95% CI: 1.09-1.25, p < 0.01), each additional year on ART (aOR = 1.14, 95% CI: 1.06-1.23, p = 0.001), initiating ART before 2014 (aOR = 3.08, 95% CI: 1.72-5.49, p = 0.020), ever had switched antiretrovirals (aOR = 2.47, 95% CI: 1.15-5.29, p = 0.020) or had ever had a viral load test (aOR = 2.54, 95% CI: 1.54-4.17, p < 0.001) and a CD4 count < 350 (aOR = 2.04, 95% CI: 1.48-2.83, p < 0.01), while age ≥ 50 (aOR = 0.56, 95% CI: 0.32-0.98, 32 p = 0.04), condom use at last encounter (OR: 0.49, 95%CI: 0.33-0.73, p < 0.001), and not being on ART (aOR = 0.09, 95% CI: 0.06-0.13, p < 0.01) were associated with reduced odds of HIVDR. Conclusions: HIVDR was high among the participants. There is a need to address HIVDR and enhance the mechanisms already in place. This study introduces more information that would help in developing targeted interventions to prevent HIVDR and improve patient outcomes.

The association between dietary carbohydrate intake and the risk of hyperlipidemia among reproductive-aged women in the US: A cross-sectional study

BACKGROUND

The association between dietary carbohydrate intake and hyperlipidemia remained incompletely understood. This study aimed to explore the association between dietary carbohydrate intake and the risk of hyperlipidemia among reproductive-aged women in the US.

METHODS

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2005 to 2020. Dietary intake information was assessed via interviews using 24-hour dietary recall interviews, and hyperlipidemia diagnosis adhered to the National Cholesterol Education Program guidelines. Univariate and multivariate logistic regression analyses, along with restricted cubic splines (RCS) and stratified analyses, were conducted to investigate the association between dietary carbohydrate intake and the risk of hyperlipidemia.

RESULTS

A total of 6,791 women of reproductive age, with a mean age of 34.87 (±8.57) years, were included in the final analysis. In the multivariate logistic regression model adjusting for covariates, a higher percentage of energy from carbohydrate was positively correlated with the risk of hyperlipidemia (adjusted odds ratio (AOR): 1.014, 95% CI: 1.004-1.024). Analyzing the percentage of energy from carbohydrate as a categorical variable, compared to the lowest quartile, the third quartile (AOR: 1.263, 95% CI: 1.031-1.546) and the highest quartile (AOR: 1.411, 95% CI: 1.083-1.839) were associated with increased hyperlipidemia risk. Additionally, a linear relationship (P for nonlinearity = 0.088) existed between the percentage of energy from carbohydrate and the risk of hyperlipidemia, with an inflection point identified at 49.64.

CONCLUSIONS

This study found that elevated dietary carbohydrate intake was associated with an increased the risk of hyperlipidemia in reproductive-aged women. These findings implied that reproductive-aged women should pay closer attention to reducing their carbohydrate intake.

Patterns of dietary quality, physical activity, and sleep duration among cancer survivors and caregivers

Fruit and vegetable intake (FVI), moderate-to-vigorous physical activity (MVPA), and sleep duration are each independently associated with cancer-related and general health outcomes among cancer survivors. Past research suggests that health behaviors cluster among cancer survivors, with caregivers demonstrating similar patterns. This analysis examined co-occurrence of FVI, MVPA, and sleep duration among cancer survivors and informal cancer caregivers and identified sociodemographic and clinical correlates of health behavior engagement. Using data from the Health Information National Trends Survey (HINTS), an exploratory latent profile analysis (LPA) was conducted among those self-reporting a history of cancer or identifying as a cancer caregiver. The LPA model was fit with daily self-reported FVI (cups/d), MPVA (minutes/d) and sleep duration (hours/d). Multinomial logistic regression models were used to predict profile membership based on sociodemographic and clinical characteristics. Four health behavior profiles were identified (Least Engaged-No MVPA, Least Engaged-Low MVPA, Moderately Engaged, and Highly Engaged). The largest profile membership was Least Engaged-No MVPA, capturing 37% of the sample. Profiles were most distinguished by MVPA, with the lowest variance in sleep duration. Participants reporting higher FVI also often reported greater MVPA and longer sleep duration. Profile membership was significantly associated with age, relationship status, education, income, rurality, alcohol use, self-efficacy, psychological distress, BMI, and cancer type. This study identified four health behaviors patterns and sociodemographic correlates that distinguished those patterns among cancer survivors and caregivers drawn from a nationally representative sample. Results may help identify for whom health behavior interventions could be of greatest benefit.

Exploring the differential impacts of social isolation, loneliness, and their combination on the memory of an aging population: A 6-year longitudinal study of the CLSA

Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined effects on memory have been understudied in the literature. This study used three waves of data over six years from the Canadian Longitudinal Study on Aging to examine whether SI and LON are individually and jointly associated with memory in community-dwelling middle-aged and older adults (n = 14,208). LON was assessed with the question: "In the last week, how often did you feel lonely?". SI was measured using an index based on marital/cohabiting status, retirement status, social activity participation, and social network contacts. Memory was evaluated with combined z-scores from two administrations of the Rey Auditory Verbal Learning Test (immediate-recall, delayed-recall). We conducted our analyses using all available data across the three timepoints and retained participants with missing covariate data. Linear mixed models were used to regress combined memory scores onto SI and LON, adjusting for sociodemographic, health, functional ability, and lifestyle variables. Experiencing both SI and LON had the greatest inverse effect on memory (least-squares mean: -0.80 [95 % confidence-interval: -1.22, -0.39]), followed by LON alone (-0.73 [-1.13, -0.34]), then SI alone (-0.69 [-1.09, -0.29]), and lastly by being neither lonely nor isolated (-0.65 [-1.05, -0.25]). Sensitivity analyses confirmed this hierarchy of effects. Policies developed to enhance memory in middle-aged and older adults might achieve greater benefits when targeting the alleviation of both SI and LON rather than one or the other individually.

Deployment and combat experiences and their impact on partner substance use

Despite burgeoning evidence of the negative effects of service experiences on service members' spouses/partners, limited research has examined these effects in the context of substance use. Additionally, a strong literature demonstrates the protective role relationship satisfaction can play for health-related outcomes. The goal of the present research is to examine relations between service experiences (i.e., deployment, combat exposure) and partner substance use, as well as how relationship satisfaction may buffer these effects. Data from 275 civilian partners were drawn from Operation: SAFETY (Soldiers And Families Excelling Through the Years), a longitudinal study examining health among US Army Reserve/National Guard (USAR/NG) soldiers and partners. Analyses examined relations between soldier service history (baseline) and civilian partner alcohol/ drug use (two-year follow-up), as well as interactions with relationship satisfaction. Models controlled for civilian partner sex and age, and soldiers' self-reported PTSD symptoms and substance use. Results revealed interactions between service experiences and partner satisfaction for models predicting alcohol consumption and heavy drinking. Higher relationship satisfaction mitigated overall alcohol consumption and heavy drinking frequency among partners of soldiers with two or more deployments, and among partners of soldiers with higher combat exposure. Soldier service experiences were unrelated to civilian partner drug use. The effects of deployment and combat exposure extend beyond the service member to negatively influence civilian partner alcohol consumption and heavy drinking, with relationship satisfaction buffering these risks. Interventions that assist USAR/NG soldiers and spouses in strengthening their relationships may also help protect against spouse substance use related to soldier service experiences.

Impact of Spousal Mental Illness on Healthcare Utilization Among Patients With Gastrointestinal Cancer

BACKGROUND

Informal caregiving involves increased responsibilities, with financial and emotional challenges, thereby affecting the well-being of the caregiver. We aimed to investigate the effect of spousal mental illness on hospital visits and medical spending among patients with gastrointestinal (GI) cancer.

METHODS

Patients who underwent GI cancer surgery between 2013 and 2020 were identified from the IBM Marketscan database. Multivariable regression analysis was used to examine the association between spousal mental illness and healthcare utilization.

RESULTS

A total of 6,035 patients underwent GI surgery for a malignant indication. Median age was 54 years (IQR: 49-59), most patients were male (n = 3592, 59.5%), and had a CCI score of ≤ 2 (n = 5512, 91.3%). Of note, in the 1 year follow-up period, 19.4% (anxiety: n = 509, 8.4%; depression: n = 301, 5.0%; both anxiety and depression: n = 273, 4.5%; severe mental illness: n = 86, 1.4%) of spouses developed a mental illness. On multivariable analysis, after controlling for competing factors, spousal mental illness remained independently associated with increased odds of emergency department visits (OR 1.20, 95% CI 1.05-1.38) and becoming a super healthcare utilizer (OR 1.37, 95% CI 1.04-1.79), as well as 12.1% (95% CI 10.6-15.3) higher medical spending.

CONCLUSION

Among patients with GI cancer spousal mental illness is associated with higher rates of outpatient visits, emergency department visits, and expenditures during the 1-year postoperative period. These findings underscore the importance of caregiving resources and counseling in alleviating caregiver burden, thereby reducing the overall burden on the healthcare system.

Stigma and the Couple: How Daily Stigma Experiences Influence Relationship Functioning and Alcohol Use in Female Cisgender Couples

Minority stress is the leading explanation for sexual minority women's (SMW) higher rates of, and heavier, alcohol use compared to heterosexual women. Little is known about how both partners' sexual minority stressors impact alcohol consumption in a dyadic context, and even less research has considered these effects at the day-level. This study utilizes dyadic daily diary data to test associations of each partner's sexual minority stress events with drinking outcomes (day-level alcohol use, heavy episodic drinking [HED], and estimated blood alcohol content [eBAC]) among women in same-gender relationships (N = 159 couples). Because high-quality relationships may buffer adverse effects of minority stress on alcohol use outcomes, effect modification was also considered. Results differed across alcohol use outcomes. One's own experience of sexual minority stress was associated with one's own greater odds of drinking that day, OR = 1.33, 95% CI 1.10, 1.61, p = .003, whereas one's partner's experience of sexual minority stress was associated with greater odds of same-day HED, OR = 1.60, 95% CI 1.24, 2.01, p < .001 (no significant effects emerged for eBAC). Relationship functioning was associated with lower eBAC only, B = -0.01, 95% CI -0.01, -0.00, p = .031. No significant effect modification emerged. This initial exploration of how both partners' exposure to sexual minority stressors impact SMW's alcohol use demonstrates nuanced effects across different alcohol outcomes, and is among the first to demonstrate some degree of sexual minority stress contagion on HED.

The relationship between night sleep duration, sleep quality and depressive symptoms in Chinese elderly couples

Although there are many studies analysing the relationship between sleep and depression in individuals, there is currently no bi-directional causal relationship between sleep and depression between older couples analysed from a binary perspective.Thus, this study used the CHARLS database to analyse the relationship between sleep and depression among older couples. A binary cross-lagged model was used to analyse the data.The study found an interaction between nighttime sleep duration and depression among older couples. Wife's depressive symptoms were significant predictors of husband's nocturnal sleep duration. Husband's depression and sleep quality predicted wife's sleep quality and depression, respectively. Therefore, when screening community-dwelling older adults for depressive symptoms, we need to be aware of the impact of different sleep profiles of older adults of different genders on spousal depressive symptoms. In addition, when dealing with patients with depressive symptoms, we need to consider not only the patient but also the impact of their depressive symptoms on their spouse.

The effect of self-rated health on depressive symptoms in Chinese older adults: The mediating role of social participation and spouse health

This study investigates the relationship between self-rated health, social participation, spouse health, and depressive symptoms in older adults. It also analyzed the moderating effects of gender, drinking, visual function, diet, quality of life, and economic level on the model. We analyzed data from 5119 participants aged 60 and above, from the CLHLS. We used a partial least squares structural equation model to explore the correlation between self-rated health, spouse health, social participation, and depressive symptoms. Self-rated health was significantly correlated with spouse health, social participation, and depressive symptoms (P < 0.001). Social participation (β=-0.034) and spouse health (β=-0.029) were mediators of self-rated health to depressive symptoms. In addition, gender, drinking, visual function, diet, quality of life, and economic level were mediated factors. This study provides evidence that self-rated health has direct or indirect associations with depressive symptoms in older people, with social participation and spouse health playing a crucial mediating role.

"What's yours is mine": Partners' everyday emotional experiences and cortisol in older adult couples

The existing literature consistently finds that emotional experiences and cortisol secretion are linked at the within-person level. Further, relationship partners tend to covary in emotional experience, and in cortisol secretion. However, we are only beginning to understand whether and how an individuals' emotions are linked to their relationship partners' cortisol secretion. In this project, we harmonized data from three intensive measurement studies originating from Canada and Germany to investigate the daily dynamics of emotions and cortisol within 321 older adult couples (age range=56-87 years). Three-level multilevel models accounted for the nested structure of the data (repeated assessments within individuals within couples). Actor-Partner Interdependence Models were used to examine the effect of own emotional experiences (actor effects) and partner emotional experiences (partner effects) on momentary and daily cortisol secretion. Adjusting for age, sex, education, comorbidities, assay version, diurnal cortisol rhythm, time spent together, medication, and time-varying behaviors that may increase cortisol secretion, results suggest that higher relationship partner's positive emotions are linked with lower momentary cortisol and total daily cortisol. Further, this association was stronger for older participants and those who reported higher relationship satisfaction. We did not find within-couple links between negative emotions and cortisol. Overall, our results suggest that one's relationship partner's positive emotional experience may be a protective factor for their physiological responding, and that these more fleeting and day-to-day fluctuations may accumulate over time, contributing to overall relationship satisfaction.

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

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

Associations between serum testosterone levels and overactive bladder in women: a cross-sectional research of NHANES 2011 to 2016

PURPOSE

Androgen receptors are expressed in the pelvic floor and lower urinary tract. However, the association between serum testosterone and overactive bladder (OAB) in women remains unclear. This study aimed to investigate their association in a nationally representative population.

METHODS

In this cross-sectional study, we collected data on female participants older than 20 years with serum total testosterone measurements and OAB questionnaires from the 2011-2016 National Health and Nutrition Examination Survey (NHANES). Survey-weighted logistic regression models were used to analyze the relationship between testosterone and OAB in women.

RESULTS

Data on 4991 women was analyzed in this study, of whom 25.9% had OAB symptoms. Women with lower serum testosterone had an increased frequency of urge urinary incontinence and nocturia compared to participants with enough testosterone. The multivariate logistic models showed that those women with a testosterone level less than 18.5 ng/dL had significantly higher odds of OAB compared to those with a testosterone level greater than 18.5 ng/dL [OR 95% CI = 1.271 (1.073-1.505), P = 0.0076]. Separate interaction analyses revealed no significant effect of age, BMI, diabetes, education, alcohol use and menopause on the association between serum testosterone and OAB. Sensitivity analyses demonstrated that additional variables (depression, stroke and stress urinary incontinence) had no significant effect on this relationship.

CONCLUSIONS

Low serum testosterone is associated with an increased likelihood of OAB in women. This supports the potential therapeutic role of testosterone supplementation in women with OAB. Given the direct and indirect effects of testosterone on the pelvic floor and lower urinary tract, a potential mechanism for this relationship can be further explored in translational studies.

Moving toward affective immunology: Legacy and future directions

The term "affective immunology" has recently been used to denote a field focused on the interplay between affective processes (including mood states, specific emotions, and regulatory processes) and various aspects of immune function. The overarching goals of this commentary are a) to provide historical underpinnings of this field with a focus on the profound impact of the work of Janice Kiecolt-Glaser, who is further honored in this special issue, b) to review important off-shoots of her legacy work in this domain, and c) to highlight important future directions for the field. Kiecolt-Glaser's work laid much of the foundation for affective immunology, with groundbreaking research related to depression, hostility and dyadic interactions, loneliness, and other affective patterns, often in the context of holistic models, novel experimental designs, and interventions. Her former mentees (and many of their mentees) have carried on her legacy in these domains, in ways that continue to advance appreciation of how affective processes relate to immune function. There are numerous remaining questions for the field to pursue, including better understanding of the role of emotion regulation, emotional reactivity and recovery, restorative processes, affective variability, and developmental and dynamic social processes. Such work will require greater use of longitudinal and within-person approaches and/or examination of processes in daily life, as well as models that account for interactive and reciprocal processes and which integrate behavior, social context, sociocultural factors, individual differences, and other aspects of health. As more work in these domains continues, building on Kiecolt-Glaser's rich legacy, we move toward the emergence of affective immunology as an important subfield in the domain of psychoneuroimmunology, one which will offer more nuanced understanding of the role of affective processes in immune health.

Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health

Epidemiological studies indicate that better marital quality is associated with less morbidity and premature mortality. A number of interpersonal processes related to marital quality are also associated with health-relevant surrogate biomarkers across different physiological systems. Despite these replicated correlational findings, few interventions have harnessed interpersonal processes as potential interventions to enhance health. Building on Dr. Janice Kiecolt-Glaser's model of relationships and health, we propose that couples-based health behavior change interventions may represent an effective way to decrease dysregulation across autonomic, endocrine and immune systems and, ultimately, improve dyadic health. Given that the cohabiting partner is an essential part of the social context in which the behavior change is being pursued, it is important to consider the relational issues triggered by dyadic interventions. Using a relationship science perspective, this article reviews the literature on couples' concordance in health behaviors and health outcomes, the potential pathways underlying this concordance, theories of the couple as a self-sustaining social system, dyadic adaptation of individual self-regulation strategies, effective and ineffective social support and social control in couple relationships, the integration of relationship-building and health behavior change strategies, and the consideration of key moderators related to the nature of the relationship and the context surrounding the relationship. These findings highlight the importance of adopting a relationship science perspective when designing and testing dyadic interventions to improve health outcomes. The data reviewed provide insights on how to optimize couples-based health behavior change interventions to reduce physiological dysregulation and improve dyadic health.

Overtime work and Chinese workers' physical and mental health: The mediating role of social support and work value awareness

BACKGROUND

China was once called the world's factory. Chinese workers had long weekly working hours. However, the empirical results of the relationship between overtime work and workers' health are mixed and remain inconclusive.

OBJECTIVE

This study aimed to investigate how overtime work influenced workers' physical and mental health and the role of lifestyles, social support, and work value awareness.

METHODS

Data from the China Labor-force Dynamics Survey 2016 (N = 14,205) was used. The instrumental variable approach was employed to overcome the endogeneity problem between overtime work and workers' health. The bootstrapping method was conducted to elicit the role of lifestyles, social support, and work value awareness.

RESULTS

The results indicated that overtime work significantly and negatively influenced Chinese workers' physical and mental health. The results of the bootstrapping suggested that workers' social support and work value awareness partially mediated the relationship between overtime work and their physical and mental health. However, the mediating role of lifestyles was insignificant.

CONCLUSION

Through using big data with national representativeness, this study suggests that overtime work negatively influences Chinese workers' physical and mental health. Our findings provide policy implications for improving workers' health rights and well-being in emerging economies.

Epigenetic aging studies of pair bonding in prairie voles

The quality of romantic relationships can predict health consequences related to aging. DNA methylation-based biomarkers of aging accurately estimate chronological age. We developed several highly accurate epigenetic aging clocks, based on highly conserved mammalian CpGs, for the socially monogamous prairie vole (Microtus ochrogaster). In addition, our dual-species human-vole clock accurately measured relative age and illustrates high species conservation of epigenetic aging effects. Next, we assessed how pair bonding impacts epigenetic aging. We did not find evidence that pair-bonded voles exhibit accelerated or decelerated epigenetic aging effects in blood, ear, liver, or brain tissue. Our epigenome wide association study identified CpGs in five genes strongly associated with pair bonding: Foxp4, Phf2, Mms22l, Foxb1, and Eif1ad. Overall, we present accurate DNA methylation-based estimators of age for a species of great interest to researchers studying monogamy in animals. We did not find any evidence that sex-naive animals age differently from pair-bonded animals.

A tale of two marital stressors: Comparing proinflammatory responses to partner distress and marital conflict

Marital quality shares ties to inflammatory conditions like cardiovascular disease and diabetes. For decades, research has focused on marital conflict as a primary mechanism given its potential to trigger inflammatory responses. However, longitudinal evidence suggests that marital conflict declines over time, and little attention has been paid to the inflammatory aftermath of other types of marital exchanges. A spouse's emotional distress is an important but overlooked marital context, as partners are exposed to each other's upsetting emotions throughout adulthood. To directly compare reactivity in proinflammatory gene expression to these two marital stressors and to examine differences by age and marital satisfaction, 203 community adults ages 25-90 (N = 102 couples) provided blood samples and rated their negative mood before and after they 1) watched their partner relive an upsetting personal memory and, in a separate visit 1-2 weeks later, 2) discussed a conflictual topic in their relationship. Controlling for age, sex, race/ethnicity, BMI, alcohol use, smoking, and comorbidities, increases in proinflammatory gene expression were significantly larger after the partner's upsetting disclosure than after marital conflict (B = 0.073, SE = 0.031, p = .018). This pattern paralleled emotional reactivity to the tasks, wherein negative mood rose more in response to the partner's disclosure than to marital conflict (B = 4.305, SE = 1.468, p = .004). In sum, proinflammatory and mood reactivity to spousal distress exceeded reactivity to marital conflict, a well-established marital stressor. Findings reveal spousal distress as a novel mechanism that may link marriage to inflammation-related diseases, and even pose risks for both happy and unhappy couples across adulthood.

What impact does hearing impairment have on cognitive health in older married couples in China?

Hearing impairment is a common geriatric health problem and chronic stressor, and it is associated with poor cognitive outcomes. However, little is known about the impact of hearing impairment in married couples, particularly its potential spillover effects on the cognitive health among spouses of individuals with impairment. Drawing on a stress-proliferation perspective, we used actor-partner interdependence models to examine (1) whether an individual's hearing impairment influences their spouse's cognitive function; and (2) whether AL, symptoms of depression, and social participation serve as mediators for such an association. We utilized data from the 2015 (baseline) and 2018 (3-year follow-up) waves of the China Health and Retirement Longitudinal Study. 4434 couples were included at baseline, and 2190 couples remained after the 3-year follow-up. Hearing impairment among married women was associated with negative impacts on their spouses' cognitive function. Symptoms of depression and social participation may have served as potential mediators in this relationship. For married men, there was no statistically significant association between hearing impairment and spouses' cognitive function. Our findings suggest that hearing impairment among one spouse can lead to negative impacts on the other, but that this effect may depend on gender. Early diagnosis and couple-based interventions for hearing impairment are important for the cognitive health of both hearing-impaired individuals and their spouses.

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

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

Dual-substance use disorder couples: An integrative review and proposed theoretical model

Committed romantic relationships between two individuals with Substance Use Disorder (or dual-SUD couples) are prevalent. Dual-SUD couples have poor treatment engagement and outcomes. Research has established a reciprocal link between relationship dynamics (e.g., conflict, intimacy) and substance use. Thus, the couple's relationship presents a distinct social context for both partner's substance use. Dual-SUD couples face unique challenges due to substance use being a shared behavior that may serve as a rewarding source of compatibility, closeness, and short-term relationship satisfaction despite it being at the cost of other alternative sources of substance-free reinforcement. Yet, treatment options for these couples are scarce. Dual-maladaptive health behaviors (e.g., dual-substance use) are challenging to treat; however, theory and preliminary research suggests that transformation of couple's joint motivation toward adaptive health behavior change may result in a more satisfying relationship and improved treatment outcomes for both individuals. The current paper reviews the extant literature on dual-SUD couples from theoretical, empirical, and treatment research and proposes an expanded paradigm regarding how we understand dual-SUD couples with the aim of informing basic research and treatment development.

Divorce and risk of suicide attempt: a Swedish national study

BACKGROUND

Prior research has reported an association between divorce and suicide attempt. We aimed to clarify this complex relationship, considering sex differences, temporal factors, and underlying etiologic pathways.

METHODS

We used Swedish longitudinal national registry data for a cohort born 1960-1990 that was registered as married between 1978 and 2018 (N = 1 601 075). We used Cox proportional hazards models to estimate the association between divorce and suicide attempt. To assess whether observed associations were attributable to familial confounders or potentially causal in nature, we conducted co-relative analyses.

RESULTS

In the overall sample and in sex-stratified analyses, divorce was associated with increased risk of suicide attempt (adjusted hazard ratios [HRs] 1.66-1.77). Risk was highest in the year immediately following divorce (HRs 2.20-2.91) and declined thereafter, but remained elevated 5 or more years later (HRs 1.41-1.51). Divorcees from shorter marriages were at higher risk for suicide attempt than those from longer marriages (HRs 3.33-3.40 and 1.20-1.36, respectively). In general, HRs were higher for divorced females than for divorced males. Co-relative analyses suggested that familial confounders and a causal pathway contribute to the observed associations.

CONCLUSIONS

The association between divorce and risk of suicide attempt is complex, varying as a function of sex and time-related variables. Given evidence that the observed association is due in part to a causal pathway from divorce to suicide attempt, intervention or prevention efforts, such as behavioral therapy, could be most effective early in the divorce process, and in particular among females and those whose marriages were of short duration.

"I Love You to Death": Social Networks and the Widowhood Effect on Mortality

Research on "the widowhood effect" shows that mortality rates are greater among people who have recently lost a spouse. There are several medical and psychological explanations for this (e.g., "broken heart syndrome") and sociological explanations that focus on spouses' shared social-environmental exposures. We expand on sociological perspectives by arguing that couples' social connections to others play a role in this phenomenon. Using panel data on 1,169 older adults from the National Social Life, Health, and Aging Project, we find that mortality is associated with how well embedded one's spouse is in one's own social network. The widowhood effect is greater among those whose spouses were not well connected to one's other network members. We speculate that the loss of a less highly embedded spouse signals the loss of unique, valuable, nonredundant social resources from one's network. We discuss theoretical interpretations, alternative explanations, limitations, and directions for future research.

Spousal health, marital satisfaction, and older Chinese adults' sleep: The moderating role of psychological resilience

PURPOSES

This study aims to examine the moderating role of psychological resilience in the association between two common marital relationship stressors (poor spousal health and low marital satisfaction) and sleep (sleep quality and sleep duration) among older adults in China.

METHODS

This study used four waves of data from the Chinese Longitudinal Healthy Longevity Survey (2008-2018) (N = 8769), and mixed-effects logistic models were used.

RESULTS

Poor spousal health and low marital satisfaction were independently associated with increased odds of poor sleep quality and short sleep duration, and decreased odds of long sleep duration. Greater psychological resilience was associated with increased odds of good sleep quality and decreased odds of short sleep duration, but had no significant effect on long sleep duration. In addition, psychological resilience moderated the odds of poor spousal health and low marital satisfaction on the risk of short sleep duration among older Chinese adults.

CONCLUSION

The findings provide novel evidence for the increased importance of marital stress and psychological resilience on sleep health in later life. Policy interventions are needed to support vulnerable older adults who experience poor spousal health and/or low marital satisfaction.

From Organizing Medicine to Cooking With More Leafy Greens: A Dyadic, Qualitative Analysis of How Older African American Couples Take Care of Each Other's Health

Guided by the Dyadic Theory of Illness Management, we explored spousal health management behaviors and their congruence within seventeen older African American married couples participating in a dyadic exercise intervention. Both prior to and after the intervention, spouses reported how they took care of their partner's health as well as what their partner did for them. Data were analyzed using theoretical thematic analysis, and five health management behaviors domains were identified (diet, exercise, self-care, medical compliance, relationship maintenance). Both partners were most likely to encourage healthier diets and exercise. Wives tended to report more behaviors compared to husbands. Couples had little congruence in their appraisals of each other's health management behaviors, and patterns were stable over time. Findings suggest incongruence in couples' health management behaviors represented complementary, collaborative efforts to support each other and that husbands may underestimate how much care they both provide to and receive from their wives.

Let's Enjoy an Evening on the Couch? A Daily Life Investigation of Shared Problematic Behaviors in Three Couple Studies

Symptom-system fit theory proposes that problematic behaviors are maintained by the social system (e.g., the couple relationship) in which they occur because they help promote positive relationship functioning in the short-term. Across three daily life studies, we examined whether mixed-gender couples reported more positive relationship functioning on days in which they engaged in more shared problematic behaviors. In two studies (Study 1: 82 couples who smoke; Study 2: 117 couples who are inactive), days of more shared problematic behavior were accompanied by higher daily closeness and relationship satisfaction. A third study with 79 couples post-stroke investigating unhealthy eating failed to provide evidence for symptom-system fit. In exploratory lagged analyses, we found more support for prior-day problematic behavior being associated with next-day daily relationship functioning than vice-versa. Together, findings point to the importance of a systems perspective when studying interpersonal dynamics that might be involved in the maintenance of problematic behaviors.

Psychological and Physiological Stress and Stressors in Early Childhood Educators: An Observational Pilot Study

While early childhood educators' mental health is important, it may also affect the well-being and education of their students. Yet, little research has described the stress and stressors of early childhood educators (ECEs), particularly as the pandemic wanes. This pilot study aimed to (1) describe ECEs' psychological and physiological stress and (2) examine the association between ECEs' psychological and physiological stress levels with stressors. A convenience sample of 67 ECEs, serving children 0-5 years old from 13 early educational centers completed surveys on psychological stress (perceived stress, anxiety, and depression), stressors (economic hardship, food insecurity, adverse childhood experiences), and demographics in Fall 2021. A subsample of ECEs provided hair samples, analyzed for cortisol, to estimate physiologic stress. Regarding stress, 63% met the criteria for major depressive disorder and 41% for generalized anxiety disorder. Only 26% were taking medications to manage mental health. About 25% experienced the stressors of food insecurity and economic hardship; 80% experienced at least one adverse childhood experience. Only education level significantly predicted perceived stress and depression - above and beyond stressors, household income, race, and age. The results have policy and practice implications for implementing evidence-based solutions to buffer stress and stressors in early childhood educators.

The relationship between Marriage and Body Mass Index in China：Evidence from the China Health and Nutrition Survey

This study investigates the impact of marriage on the body mass index (BMI) of individuals aged 18-45 in China. We used data from ten rounds of the China Health and Nutrition Survey spanning from 1989 to 2015, and applied Difference-in-Differences (DID) model to examine the impact of marriage on BMI. Our findings reveal that marriage has a significant positive effect on BMI, especially among males, with post-marriage elevation of male BMI continuing to increase over time. Moreover, marriage is associated with a 5.2% increase in the prevalence of overweight and a 2.5% rise in the incidence of obesity among males. While energy intake levels for Chinese women did not undergo significant changes after marriage, nor did their energy expenditure levels, men experienced a marked alteration in energy balance, characterized by an increase in caloric intake and a decrease in physical activity. Furthermore, our study confirms significant period differences in the effect of marriage on BMI, with post-marriage elevation of male BMI continuing to rise over time. In contrast, there was no clear trend for female BMI after marriage. Our research highlights the importance of promoting physical fitness and health management within families while fostering intimate relationships through marriage. Public health policies should consider the potential impact of marriage as an intervention window for addressing individuals' weight management needs. Distinct post-marriage body management plans should be designed for both genders.

The association between dual sensory loss and healthcare expenditure: Mediating effect of depression

BACKGROUND

Previous studies have suggested the dual sensory loss (DSL) is linked to depression, and that they are associated with higher healthcare expenditures, respectively. However, the association between DSL, depression and healthcare expenditures remains ambiguous.

OBJECTIVES

The current study aims to examine the association between DSL, depression and healthcare expenditures as well as catastrophic health expenditures (CHE) among Chinese people aged 45 and above.

METHODS

We first utilized the China Health and Retirement Longitudinal Survey (CHARLS) 2018 to obtain data from a total of 13,412 Chinese individuals aged 45 and above to conduct a cross-sectional study. DSL was defined as a combined variable of self-reported vision loss and hearing loss. Depression was measured using The Center for Epidemiologic Studies Depression Scale (CESD-10). The healthcare expenditures, including outpatient out-of-pocket cost and inpatient out-of-pocket cost, were obtained from the Harmonized CHARLS section. CHE were defined as out-of-pocket (OOP) health spending equal to or higher than 40 % of a household's capacity to pay. A Tobit linear regression with three models and a path analysis were conducted to estimate the association between DSL, depression and healthcare expenditures and CHE. Then we utilized 2011CHARLS and 2018CHARLS to present a longitudinal analysis. A path analysis was conducted to estimate the association between 2011DSL, 2018depression and 2018healthcare expenditures and CHE.

RESULTS

Depression has a significant mediating effect between DSL and healthcare expenditures. (For outpatient OOP cost: a = 0.453, b = 23.559, c = 25.257, the proportion of mediating effect in total effect = 29.71 %; for inpatient OOP cost: a = 0.453, b = 13.606, c = 15.463, the proportion of mediating effect in total effect = 28.50 %; all P < 0.05). The mediating effect of depression also exists in the association between DSL and CHE (a = 0.453, b = 0.018, c = 0.043, the proportion of mediating effect in total effect = 15.90 %; P < 0.05). The mediation effect of depression on healthcare expenditures and CHE also exists in the longitudinal analysis using CHARLS 2011 and CHARLS 2018 (all P < 0.05).

LIMITATIONS

The DSL status were based on self-report and we used 2018CHARLS to conduct the study, which may cause some bias.

CONCLUSION

Significant mediating effect of depression exists between DSL and higher healthcare expenditures and CHE. The mental health of elder people with DSL should be focused on, and we should have an overall viewpoint on the topic of healthcare expenditures and CHE.

Development and Empirical Test of the Research-Informed South African Relationship Functioning Assessment (SARFA)

Intimate partners play an important role in chronic diseases. Despite the chronic disease burden increase in sub-Saharan Africa, very few culturally-relevant quantitative measures of intimate relationship functioning are available. We conducted an empirical investigation evaluating the psychometric properties of the South African Relationship Functioning Assessment (SARFA) assessing healthy relationship functioning in N = 150 community members (50% women; M age = 27.2 years) living in the Vulindlela area of KwaZulu-Natal, South Africa. Item development was based on prior qualitative research from two South African communities. All assessments were conducted in isiZulu, participants' primary language. An exploratory factor analysis was conducted on the initial 39-item measure. The best-fitting model consisted of one factor with 22 items. The SARFA's internal consistency was α = .94. Convergent validity was observed via significant positive associations (all rs ≥ .38, p < .001) between the SARFA's total score and measures of trust, emotional intimacy, constructive communication, sexual satisfaction, and relationship control (women only). Divergent validity was observed for women only. Encouraging initial psychometric properties of a culturally-relevant measure of relationship functioning in KwaZulu-Natal may have relevance to other communities and potential to be used in research involving couples and health in chronic disease-burdened communities.

The topology of interpersonal neural network in weak social ties

The strategies for social interaction between strangers differ from those between acquaintances, whereas the differences in neural basis of social interaction have not been fully elucidated. In this study, we examined the geometrical properties of interpersonal neural networks in pairs of strangers and acquaintances during antiphase joint tapping. Dual electroencephalogram (EEG) of 29 channels per participant was measured from 14 strangers and 13 acquaintance pairs.Intra-brain synchronizations were calculated using the weighted phase lag index (wPLI) for intra-brain electrode combinations, and inter-brain synchronizations were calculated using the phase locking value (PLV) for inter-brain electrode combinations in the theta, alpha, and beta frequency bands. For each participant pair, electrode combinations with larger wPLI/PLV than their surrogates were defined as the edges of the neural networks. We calculated global efficiency, local efficiency, and modularity derived from graph theory for the combined intra- and inter-brain networks of each pair. In the theta band networks, stranger pairs showed larger local efficiency than acquaintance pairs, indicating that the two brains of stranger pairs were more densely connected. Hence, weak social ties require extensive social interactions and result in high efficiency of information transfer between neighbors in neural network.

A dyadic analysis of anti-fat attitudes and partners' diet-related influence among gay married men

OBJECTIVES

The focus on physical appearance among gay men has potential implications for anti-fat attitudes, including those directed toward romantic partners. Partners often influence each other's behaviors including those linked to weight, but most research has examined the consequences of these influence strategies versus their antecedents. To address this research gap, we examined how men's own and their partners' anti-fat attitudes were related to both health-promoting (control) and health-compromising (undermining) types of diet-related influence and whether these associations differed by weight status.

METHODS AND RESULTS

Analyzing data from a cross-sectional online survey of 450 U.S. adult gay married men (225 couples), Actor-Partner Interdependence Models revealed that individuals' own anti-fat attitudes (all types) were positively associated with more frequent receipt of spousal control and undermining. Additionally, partner's fears about gaining weight were positively associated with more frequent receipt of spousal control and dislike of higher weight people and fear of gaining weight (among those of higher weight status) were positively associated with more frequent receipt of spousal undermining.

CONCLUSION

Our findings add to the literature on diet-related interactions among gay married men, highlight the value of examining these processes dyadically, and suggest the importance of including both members of couples in health promotion and intervention efforts.

Comparing the Influences of Spouses or Partners With Other Family Members in the Ability of Young Asian Americans to Maintain a Healthy Lifestyle

The relationship between family dynamics and health has been extensively studied, but the specific pathways involved are not yet fully understood. The role of intimate partner relationships in promoting and maintaining healthy lifestyle behaviors remains understudied, particularly in minority populations. This study addressed this gap by examining how frequent spousal and familial interactions affect healthy lifestyle behaviors in young Asian Americans. Survey data from Asian American adults aged 18 to 35, collected in March 2021, is used to compare two groups: one interacting most with an intimate partner and the other interacting most with other non-intimate family members. The results showed that young Asian Americans interact most with their spouses/partners and mothers. Participants who interacted most frequently with their spouses/partners reported a greater influence in maintaining a healthy lifestyle, particularly in the domains of exercise and sleep. Moreover, those who interacted more with their spouses/partners exhibited a greater sense of connectedness, which impacted spousal and personal influence on healthy lifestyle behaviors. The findings suggest that promoting interaction and fostering stronger spousal/partner relationships can positively influence the healthy lifestyle behaviors of young Asian Americans.

"I too have a responsibility for my partner's life": Communal coping among Malawian couples living with HIV and cardiometabolic disorders

RATIONALE

HIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as "our problem" (shared illness appraisal) and are united in shared behavioral efforts.

METHODS

This study qualitatively investigated communal coping of 25 couples living with HIV and hypertension or diabetes in Zomba, Malawi. Partners were interviewed separately regarding relationship quality, shared illness appraisal, communal coping, and dyadic management of illness.

RESULTS

Most participants (80%) were living with HIV, and more than half were also living with hypertension. Most participants expressed high levels of unity and the view that illness was "our problem." In some couples, partners expected but did not extend help and support and reported little collaboration. Communal coping and dyadic management were strongly gendered. Some women reported a one-sided support relationship in which they gave but did not receive support. Women were also more likely to initiate support interactions and offered more varied support than men. In couples with poor relationship quality and weak communal coping, dyadic management of illness was also weak. Partner support was particularly crucial for dietary changes, as women typically prepared meals for the entire family. Other lifestyle changes that could be supported or hindered by a partner included exercise, stress reduction, and medication adherence.

CONCLUSION

We conclude that gendered power imbalances may influence the extent to which couple-level ideals translate into actual communal coping and health behaviors. Given that spouses and families of patients are also at risk due to shared environments, we call for a shift from an illness management paradigm to a paradigm of optimizing health for spouses and families regardless of diabetes or hypertension diagnosis.