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

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

Predictors of Complicated Grief During the COVID-19 Pandemic: A Cross-Classified Analysis

The COVID-19 pandemic left many people grieving multiple deaths and at risk for developing symptoms of complicated grief (CG). The present study is a prospective examination of the role of neuroticism and social support in the development of CG symptoms. Findings from cross-classified multilevel models pointed to neuroticism as a risk factor for subsequent CG symptoms. Social support had a stress-buffering effect, emerging as a protective factor following the loss of a first degree relative. More recent loss and younger age of the deceased were both independently associated with heightened CG symptoms. Results from the present study provide insight into heterogeneity in CG symptom development at the between-person level, and variability in CG symptoms within individuals in response to different deaths. Findings could therefore aid in the identification of those at risk for the development of CG symptoms.

Nightly Sleep Predicts Next-Morning Expectations for Stress and Positive Experiences

OBJECTIVE

Abundant research has linked nightly sleep as an antecedent of daily psychosocial experiences; however, less is known about sleep's influence on daily expectations of these experiences. Therefore, this research examined the day-to-day associations of sleep quality, duration, and efficiency with next-day expectations for stress(ors) and positive experiences, as well as whether these expectations were related to end-of-day reports of physical symptoms.

METHODS

In Study 1, U.S. adults ( n = 354; ages 19 to 74) completed twice-daily diaries for 10 weekdays about sleep, expectations for encountering daily stressors and positive events, and physical symptoms. In Study 2, adults in Canada ( n = 246; ages 25 to 87) wore a sleep watch for 14 consecutive days and completed mobile surveys 5×/day about sleep, stressfulness and pleasantness expectations, and physical symptoms.

RESULTS

Multilevel models indicated that self-reported sleep quality and duration, but not efficiency, were associated with lower next-day expectations for stressors (Study 1) and stressfulness (Study 2). Self-reported sleep quality (Study 1) and all sleep indices (Study 2) predicted greater next-day expectations for positive events and pleasantness, respectively. For actigraphy-assessed sleep (Study 2), only longer-than-usual actigraphic sleep duration was associated with lower stressfulness expectations, whereas both sleep duration and efficiency were positively linked with daily pleasantness expectations. Only pleasantness expectations (Study 2)-but not daily stressfulness and event expectations (Study 1)-predicted end-of-day physical symptoms.

CONCLUSION

Findings suggest the importance of sleep on expectations of next-day stress and positive experiences, of which may have implications for daily physical health.

Examining changes in sense of purpose before, during, and after COVID-19 vaccination

Multiple studies have focused on the role of psychosocial factors as predictors of COVID-19 vaccination willingness and uptake, with less attention paid to whether vaccination itself could influence wellbeing. The current study evaluated this possibility with respect to sense of purpose, the perception one has goals and a direction in life, building on previous evidence this factor may influence vaccination willingness and decision-making. Across seven waves of monthly data from February to August 2021, participants (n = 2169, mage = 48.0 years) across Canada and the United States reported on their sense of purpose and vaccination status. Using piecewise regression models, results indicated that sense of purpose did not appear to fluctuate in the month prior to, during, or following COVID-19 vaccination. However, across most months of the survey, vaccinated participants did report greater sense of purpose relative to unvaccinated participants. These findings are discussed with respect to whether health behaviors, such as vaccination, should be viewed as behaviors indicative of leading a purposeful life.

Positive event diversity: Relationship with personality and well-being

OBJECTIVE

Examining the personality and well-being correlates of positive event diversity.

BACKGROUND

Past research has highlighted that personality traits are linked to the frequency of daily positive events. This study is the first to examine positive event diversity, the extent to which positive events are spread across multiple types of positive life domains, as well as its personality and well-being correlates.

METHOD

We conducted parallel analyses of three daily diary datasets (Ns = 1919, 744, and 1392) that included evening assessment of daily positive events and affective well-being. The Big Five personality traits were assessed in baseline surveys.

RESULTS

Positive Event Diversity was related to higher person-mean daily positive affect but not negative affect. Higher Extraversion, Agreeableness, Openness, and lower Neuroticism were correlated with more positive event diversity. These associations became nonsignificant when controlling for positive event frequency. Positive event frequency moderated the link between positive event diversity and person-mean affect, such that higher positive event diversity was associated with higher negative and lower positive affect for people who experienced more frequent positive events.

CONCLUSIONS

No consistent evidence was found for personality as a moderator of the positive event diversity-well-being link across the three studies. Further, the well-being implications of positive event diversity may be better understood when interpreting them alongside indexes of positive event frequency.

The American Psychosomatic Society Antiracism Task Force: Implementation, Activities, and Lessons Learned

ABSTRACT

The American Psychosomatic Society (APS) is an international professional society that aims to advance the scientific study of biological, behavioral, and social factors in health among educators, clinicians, and researchers. In pledging to be an antiracist organization in 2020, APS formed the Antiracism Task Force (ARTF) to identify different manifestations of systemic racism within the society and to make recommendations for building a more inclusive and equitable professional organization. The goal of this paper is to be maximally transparent to membership about our activities and lessons learned, as well as offer a case study to other organizations striving toward antiracism. We describe the inaugural year of activities of the APS ARTF, which included proposing amendments to the society's bylaws, collecting data on member attitudes toward diversity, and consulting on other member efforts to implement antiracism activities (e.g., increasing access to early career awards). In addition to reflecting on task force and society-specific factors that were facilitative in our first year, we describe future plans and potential challenges we may face as we support sustained commitment to APS's antiracism efforts.

Chronic Pain and Affective Experiences Associated with Daily Stressors and Uplifts

People with chronic pain often report greater reactivity to stress than those without pain. This finding is consistent with the kindling hypothesis, which states that continued exposure to stressors only heightens negative affect and dampens positive affect. Yet, people with chronic pain may also respond more positively to enjoyable activities, or uplifts, as well. Chronic pain is related to lower levels of well-being, and the fragility of positive affect model explains how individuals with lower levels of well-being often exhibit stronger, more positive responses to daily uplifts than their less distressed peers. Our study used the National Study of Daily Experiences to assess daily stressors, positive uplifts, and positive and negative affect across eight days among those with and without chronic pain. Participants (nChronicPain=658, nNoPain=1,075) were predominately Non-Hispanic White (91%), 56% female, and averaged 56 years old. Results revealed that people with chronic pain had lower levels of daily positive affect and higher levels of negative affect, yet the two groups did not vary in their stressor-related negative and positive affect. In contrast, having chronic pain was related to a greater increase in positive affect and greater decreases in negative affect on days with positive uplifts. Findings suggest that intervention efforts focusing on uplifts may be particularly helpful for people who report chronic pain.

Considerations for Advancing the Conceptualization of Well-being

In this commentary, we raise several points regarding Park and colleagues' emotional well-being framework. First, we question whether the term emotional well-being is appropriate and whether a new framework is necessary, and we argue that the field may be better served through other efforts, such as clarifying the distinctions between different well-being constructs and providing guidance on best practices for measurement and intervention. In addition, we note that by placing well-being on the opposite end of the spectrum from despair and depression, Park and colleagues have overlooked the influences of stress, distress, and life challenges on shaping positive aspects of well-being, and vice versa. Furthermore, we challenge the conceptualization of well-being as encompassing how positive an individual feels generally and about life overall. In its current form, this definition of well-being is overly static and trait-like, whereas a process-oriented conceptualization would more closely align with how well-being unfolds in real-life contexts and would be more suitable for identifying mechanistic targets for intervention. Finally, we raise the concern that the process for developing this definition of well-being did not actively involve input from diverse communities that have historically been disserved and underrepresented in research, practice, and policy. The cultural differences in constituents of well-being as well as evidence demonstrating that key positive psychological constructs (e.g., positive affect, sense of control) are less health-protective in racial/ethnic minorities than in whites necessitate greater integration of perspectives from underrepresented communities to build a more inclusive and accurate understanding of well-being.

Perceived threat and coping responses during the COVID-19 pandemic: Prospective associations with vaccine hesitancy

BACKGROUND

The COVID-19 pandemic has brought to light the importance of identifying factors associated with vaccine hesitancy. Disease threat and coping responses are central to health behavior engagement and present potential alterable targets for intervention.

PURPOSE

To examine the roles of perceived threat of COVID-19 and coping in vaccine hesitancy, we examined how coping strategies involving approach and avoidance interact with perceived threat of COVID-19 to predict vaccine hesitancy.

METHODS

We used data from 1570 North American participants who reported their vaccine hesitancy as part of a longitudinal study assessing psychosocial responses to the pandemic. We used logistic regression models and mean scores of perceived threat of COVID-19, approach coping, and avoidance coping from prior timepoints to predict vaccine hesitancy in December 2020, when COVID-19 vaccines were first being approved for use in North America.

RESULTS

Low perceived threat of COVID-19 was associated with greater likelihood of being vaccine hesitant. However, approach coping moderated this association, such that people who engaged in more approach coping were less likely to be vaccine hesitant even when they did not feel personally threatened by COVID-19. In contrast, avoidance coping was associated with greater likelihood of vaccine hesitancy regardless of perceived threat of COVID-19.

CONCLUSIONS

Our results illustrate the contributions of approach and avoidance coping to vaccine hesitancy and in doing so, provide preliminary evidence for coping behavior to serve as a target for intervention to reduce vaccine hesitancy.

Everyday discrimination, daily affect, and physical symptoms during the COVID-19 pandemic

OBJECTIVE

Abundant evidence has linked everyday discrimination with health risks. Because the COVID-19 pandemic has increased exposure to discrimination (e.g., based on age and race), it is important to understand the day-to-day implications of discrimination experiences for well-being. Furthermore, daily positive events were examined as a moderator due to their potential for mitigating the associations between everyday discrimination and well-being.

METHOD

From March to August 2020, 1,212 participants aged 18-91 in the United States and Canada (84% women, 75% White) completed surveys for seven consecutive evenings about everyday discrimination, positive events, physical health symptoms, and positive and negative affect. Data were analyzed using multilevel models and controlled for sociodemographic factors.

RESULTS

Everyday discrimination was reported on 9.3% of days when in-person or remote social interactions occurred. Within-persons, positive affect was lower and negative affect and physical symptoms were higher on days when discrimination occurred versus on days without discrimination. Positive events mitigated the within-person association between everyday discrimination and same-day negative affect, but not for positive affect or physical symptoms. Discrimination perceived to be due to age was associated with higher negative affect and lower positive affect within-persons. Positive events did not moderate the associations between age-based discrimination and same-day outcomes.

CONCLUSIONS

Everyday discrimination was related to lower daily positive affect and higher negative affect and physical symptoms during the COVID-19 pandemic. This study provides initial evidence that daily positive events partially offset the increased negative affect associated with same-day discrimination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pandemic stressors and depressive symptoms: Examining within- and between-person effects of neuroticism

Experiencing stressors related to the COVID-19 pandemic such as health-related concern, social isolation, occupational disruption, financial insecurity, and resource scarcity can adversely impact mental health; however, the extent of the impact varies greatly between individuals. In this study, we examined the role of neuroticism as an individual-level risk factor that exacerbates the association between pandemic stressors and depressive symptoms. With repeated assessments of pandemic stressors and depressive symptoms collected from 3181 participants over the course of the pandemic, we used multilevel modeling to test if neuroticism moderated the association between pandemic stressors and depressive symptoms at both between- and within-person levels. At the between-person level, we found that participants who reported more pandemic stressors on average had higher levels of depressive symptoms and that this association was stronger among those high in neuroticism. At the within-person level, reporting more pandemic stressors relative to one's average on any given occasion was also associated with heightened depressive symptoms and this effect was similarly exacerbated by neuroticism. The findings point to pandemic stressor exposure and neuroticism as risk factors for depressive symptoms and, in demonstrating their synergistic impact, may help identify individuals at greatest risk for adverse psychological responses to the COVID-19 pandemic.

Pet ownership is associated with greater cognitive and brain health in a cross-sectional sample across the adult lifespan

Human-animal interactions that stem from pet ownership have a wide range of benefits for social, emotional, and physical health. These factors also tend to improve cognition. Following this logic, owning a pet could indirectly enhance cognitive and brain health through mechanisms like improvements in well-being, socialization, and decreased stress. In the present study, cross-sectional data were drawn from the Alabama Brain Study on Risk for Dementia in which 95 participants aged 20–74 were recruited. Specifically, 56 adults were pet-owners and 39 adults were not pet-owners. Multivariate analyses revealed that pet ownership was related to higher levels of cognition and larger brain structures, and these effects were largest in dog owners. The most consistent cognitive relationships were found with better processing speed, attentional orienting, and episodic memory for stories, and with dorsal attention, limbic, and default mode networks. Moreover, we show that owning a pet can reduce one’s brain age by up to 15 years. Pet ownership was not related to indirect factors including social, emotional, and physical health. We found also that older adults’ brain health benefited from owning more than one pet versus owning one or fewer pets. These findings indicate that pet ownership, especially dog ownership, may play a role in enhancing cognitive performance across the adult lifespan, which could in turn influence protection against age-related cognitive decline.

Perceived control and reactivity to acute stressors: Variations by age, race and facets of control

Greater perceived control is associated with better health and well-being outcomes, possibly through more adaptive stress processes. Yet little research has examined whether facets of perceived control (personal mastery and perceived constraints) predict psychological and physiological stress reactivity. The present study evaluated the associations of personal mastery and perceived constraints with changes in subjective stress and cortisol in response to acute laboratory stressors, with age and race as potential moderators. In the Midlife in the United States Refresher Study (N = 633 adults aged 25-75), participants completed a baseline perceived control measure and were subsequently recruited to participate in the laboratory stress protocol. The protocol consisted of completing two mental stress tasks (mental arithmetic and Stroop) as well as providing saliva samples and subjective stress ratings. Race moderated the association between perceived constraints and subjective stress reactivity, such that higher constraints predicted greater subjective stress responses in White participants, but no association was observed in Black participants. Higher personal mastery and perceived constraints each predicted greater increases in cortisol in response to the stress tasks (AUC_i ) among younger but not older adults. These findings suggest that older adults were buffered against the association between facets of control and cortisol stress reactivity. Discussion on potential racial differences in the link between constraints and stress reactivity are elaborated further, as well as considerations for future work to distinguish between facets of control and examine age and racial differences.

Sense of purpose predicts daily positive events and attenuates their influence on positive affect

Sense of purpose has proven a consistent predictor of positive outcomes during adulthood. However, it remains unclear how purposeful adults respond to positive events in their daily lives. The current study examined whether sense of purpose predicted the frequency of daily positive events, as well as participants' affect on days with a positive event, across 8 days in an adult sample (n = 1959; mean age: 56 years). Sense of purpose predicted a greater frequency of daily positive events. Moreover, sense of purpose moderated the associations between daily positive events and daily positive affect; purposeful adults experienced less of an increase in positive affect both on the current day and the day following the positive event. Findings are discussed with respect to how purpose in life may serve homeostatic functions, insofar that having a life direction reduces responsivity to daily events and promote affect stability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adherence to Recommended Preventive Behaviors During the COVID-19 Pandemic: The Role of Empathy and Perceived Health Threat

Background

Coping via empathic responding may play a role in preventive behavior engagement during the COVID-19 pandemic, and unlike trait empathy, is a potentially alterable target for changing health behavior.

Purpose

Our goal was to examine the role of empathic responding in preventive behavior engagement during the COVID-19 pandemic, independent of trait empathy and perceived threat of COVID-19.

Methods

Participants (N = 2,841) completed a baseline survey early in the pandemic, and a follow-up survey approximately 2 weeks later (M = 13.50 days, SD = 5.61). Preventive health behaviors, including physical distancing and hygiene practices, were assessed at both timepoints. Hierarchical linear regression examined the contributions of trait empathy, perceived threat of COVID-19, and empathic responding at baseline to preventive behaviors at follow-up.

Results

Controlling for baseline levels of preventive behaviors and demographic covariates, trait empathy and threat of COVID-19 at baseline were each independently associated with preventive behaviors at follow-up. An interaction between perceived threat and empathic responding indicated that those perceiving high threat of COVID-19 at baseline tended to report engaging in preventive behaviors at follow-up regardless of their levels of empathic responding, whereas for those reporting low levels of perceived threat, higher levels of empathic responding were associated with higher engagement in preventive behavior.

Conclusions

When perceived threat of COVID-19 was low, higher empathic responding was associated with increased engagement in preventive behaviors regardless of trait empathy, suggesting that empathic responding can serve as an actionable target for intervention to promote preventive behavior during the pandemic.

Associations Between Everyday Discrimination and Sleep: Tests of Moderation by Ethnicity and Sense of Purpose

BACKGROUND

Everyday discrimination holds pernicious effects across most aspects of health, including a pronounced stress response. However, work is needed on when discrimination predicts sleep outcomes, with respect to potential moderators of these associations.

PURPOSE

The current study sought to advance the past literature by examining the associations between everyday discrimination and sleep outcomes in an ethnically diverse sample, allowing tests of moderation by ethnic group. We also examined the role of sense of purpose, a potential resilience factor, as another moderator.

METHODS

Participants in the Hawaii Longitudinal Study of Personality and Health (n = 758; 52.8% female; mage: 60 years, sd = 2.03) completed assessments for everyday discrimination, sleep duration, daytime dysfunction due to sleep, sleep quality, and sense of purpose.

RESULTS

In the full sample, everyday discrimination was negatively associated with sleep duration, sleep quality, and sense of purpose, while positively associated with daytime dysfunction due to sleep. The associations were similar in magnitude across ethnic groups (Native Hawaiian, White/Caucasian, Japanese/Japanese-American), and were not moderated by sense of purpose, a potential resilience factor.

CONCLUSIONS

The ill-effects on health due to everyday discrimination may operate in part on its role in disrupting sleep, an issue that appears to similarly impact several groups. The current research extends these findings to underrepresented groups in the discrimination and sleep literature. Future research is needed to better disentangle the day-to-day associations between sleep and discrimination, and identify which sources of discrimination may be most problematic.

Associations Between Intraindividual Variability in Sleep and Daily Positive Affect

Recent research highlights a variety of negative outcomes associated with intraindividual variability in positive affect (PA) and in sleep. Thus, this study examined the associations of variability in multiple dimensions of sleep (quality, duration, wake after sleep onset, bedtime, rise-time) with mean and variability in PA. For 7 days, morning and evening surveys were collected online from two separate samples: community-based adults (N = 911) and university students (N = 322). Regression analyses revealed that across both samples, people with more variable sleep quality exhibited greater fluctuations in PA throughout the week and, surprisingly, higher levels of PA on average. In the community sample only, individuals with more variable sleep duration had lower and more variable PA. Findings suggest that fluctuations in sleep quality and duration are linked with daily PA outcomes, which is important to consider as technological advances and modern demands make inadequate and irregular sleep increasingly common.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-021-00082-6.

Day-to-day associations between nightly sleep and next-day well-being amid the COVID-19 pandemic in North America

OBJECTIVE

Sleep may be especially important for maintaining health and well-being in daily life amid the stress of the coronavirus disease 2019 (COVID-19) pandemic. This preregistered study examined the associations of sleep quality, duration, and efficiency with next-day physical symptoms, affect, and stressors during the COVID-19 pandemic in North America, in addition to evaluating individual differences in COVID-19 threat as a moderator.

METHOD

From mid-March to early August 2020, 1025 adults from Canada and the United States aged 18-91 reported COVID-19 threat at baseline and subsequently completed twice-daily diaries for one week about their sleep, negative affect, stressors, and physical symptoms.

RESULTS

Within-persons, nights with better-than-usual sleep quality predicted lower next-day negative affect, physical symptoms, and stressor occurrence. Better-than-usual sleep efficiency and longer-than-usual sleep duration also predicted lower next-day physical symptoms. COVID-19 threat ratings moderated several of these associations, such that individuals with higher COVID-19 threat showed weaker within-person associations of sleep duration and efficiency with next-day well-being, compared to individuals with lower-to-moderate levels of COVID-19 threat. For the reversed direction of association, stressor occurrence predicted shorter-than-usual sleep that night, but no other links between daily well-being and subsequent sleep were observed.

DISCUSSION

Sleep quality, efficiency, and duration were important predictors of daily health and well-being during the COVID-19 pandemic, but the protective associations between sleep and next-day well-being were attenuated among people with higher COVID-19 threat. These findings highlight the role of heightened stress contexts when considering the benefits of sleep on daily health and well-being.

Personality differences in the occurrence and affective correlates of daily positive events

OBJECTIVE

Previous research shows that Neuroticism predicts exposure and affective reactivity to daily stressors. Zautra and colleagues extended this work to daily positive events. Building on these frameworks, we examined the Big Five personality traits as predictors of the occurrence and affective correlates of daily positive events.

METHOD

Participants in two national U.S. daily diary studies (NSDE 2: N = 1,919 and NSDE Refresher: N = 778; aged 25-84) reported daily positive events, emotions specific to the events, and daily affect for 8 consecutive days.

RESULTS

In parallel analyses in both samples, Extraversion and in the NSDE Refresher sample only Openness (but not Neuroticism, Conscientiousness, or Agreeableness) predicted more frequent positive event occurrence. All Big Five traits were associated with one or more emotional experiences (e.g., calm, proud) during positive events. Neuroticism predicted greater event-related positive affect in the NSDE 2 sample, whereas Agreeableness was related to more event-related negative affect in the NSDE Refresher sample.

CONCLUSIONS

The Big Five personality traits each provided unique information for predicting positive events in daily life. The discussion centers on potential explanations and implications for advancing the understanding of individual differences that contribute to engagement in positive experiences.

Purposefulness and daily life in a pandemic: Predicting daily affect and physical symptoms during the first weeks of the COVID-19 response

OBJECTIVE

Sense of purpose has been associated with greater health and well-being, even in daily contexts. However, it is unclear whether effects would hold in daily life during COVID-19, when people may have difficulty seeing a path towards their life goals.

DESIGN

The current study investigated whether purposefulness predicted daily positive affect, negative affect, and physical symptoms. Participants (n = 831) reported on these variables during the first weeks of the COVID-19 response in North America.

MAIN OUTCOME MEASURES

Participants completed daily surveys asking them for daily positive events, stressors, positive affect, negative affect, physical symptoms, and purposefulness.

RESULTS

Purposefulness at between- and within-person levels predicted less negative affect and physical symptoms, but more positive affect at the daily level. Between-person purposefulness interacted with positive events when predicting negative and positive affect, suggesting that purposeful people may be less reactive to positive events. However, between-person purposefulness also interacted with daily stressors, insofar that stressors predicted greater declines in positive affect for purposeful people.

CONCLUSION

Being a purposeful person holds positive implications for daily health and well-being, even during the pandemic context. However, purposefulness may hold some consequences unique to the COVID-19 context, which merit attention in future research.

Emotional Vulnerability to Short Sleep Predicts Increases in Chronic Health Conditions Across 8 Years

BACKGROUND

Sleep is a robust determinant of next-day emotions, but people vary in the extent that their emotions fluctuate on days following short sleep duration. These individual differences in day-to-day sleep and emotion dynamics may have long-term health implications.

PURPOSE

To evaluate emotional vulnerability to short sleep (within-person associations between sleep duration and next-day emotions) as a risk factor for future chronic conditions.

METHODS

Adults aged 33-84 (N = 1,426; 57% female) in the Midlife in the United States Study reported sleep duration and emotions by telephone for eight consecutive days. Chronic conditions were assessed via checklist at baseline and at a median follow-up of eight years (range: 5-10 years). Short sleep was examined in three ways: person-centered continuous variable, ≤6 hr, and <7 hr; long sleep was defined as ≥9 hr.

RESULTS

Multilevel structural equation models revealed that people with greater negative emotions following nights of sleep ≤6 hr (vs. their negative emotions after longer sleep) had increased chronic conditions at follow-up, compared to people who were less emotionally vulnerable to short sleep (Est. = 1.04, SE = .51, p < .028). Smaller declines in positive emotions following ≤6 hr of sleep were marginally predictive of lower risk for chronic conditions (Est. = -.77, SE = .44, p = .054). Emotional vulnerability to <7, ≥9, and continuous sleep hours were not associated with subsequent chronic conditions.

CONCLUSIONS

Emotional vulnerability to short sleep is a unique risk factor for the development of chronic conditions, independent of mean-level sleep duration and emotions.

Daily prosocial activities and well-being: Age moderation in two national studies

Prosocial activities, such as volunteering, predict better mental and physical health in late adulthood, but their proximal links to well-being in daily life are largely unknown. The current study examined day-to-day associations of prosocial activities with emotional and physical well-being, and whether these associations differ with age. We used daily diary data from the National Study of Daily Experiences (NSDE) II (n = 2,016; ages 33-84) and NSDE Refresher Study (n = 774; ages 25-75). Participants completed telephone interviews on 8 consecutive evenings regarding their prosocial activities (formal volunteering, providing unpaid assistance, providing emotional support), well-being (negative affect, stressors, positive events), and physical symptoms. On days when individuals participated in more formal volunteering or provided more unpaid assistance than usual, they experienced more stressors and positive events but no difference in the number of physical symptoms. Negative affect was reduced on volunteering days for older adults but increased for younger adults (NSDE Refresher). Providing emotional support was associated with higher same-day negative affect, more stressors, more positive events, and elevated physical symptoms. Compared to younger and middle-aged adults, older adults experienced less of an increase in stressors and positive events (NSDE II) and negative affect (NSDE Refresher) on days when they provided more emotional support than usual. These findings demonstrate that prosocial activities are associated with both costs (negative affect, stressors, physical symptoms) and benefits (positive events) for same-day well-being. Older age may protect against negative ramifications associated with prosocial activities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Ups and Downs of Daily Life During COVID-19: Age Differences in Affect, Stress, and Positive Events

Objective

Past research has linked older age with greater emotional well-being and decreased reactivity to stressors, but it is unknown whether age-related advantages in emotional well-being are maintained in the wake of COVID-19. We examined age differences in exposure and affective reactivity to daily stressors and positive events in the first several weeks of the COVID-19 outbreak.

Method

In March and April 2020, 776 adults from Canada and the U.S. ages 18-91 (mean age 45) reported COVID-19 threats at baseline, then completed nightly surveys for one week about their daily stressors, positive events, and affect.

Results

Younger age predicted more concerns about the threat of COVID-19 across multiple domains, in addition to lower positive affect, higher negative affect, and less frequent positive events. Younger adults had more non-COVID-19 daily stressors and higher perceived control over stressors, but lower perceived coping efficacy than older adults. There were no age differences in the frequency of COVID-19 daily stressors nor perceived stressor severity. Younger adults had greater reductions in negative affect on days when more positive events occurred and greater increases in negative affect on days when non-COVID-19 stressors occurred. Age moderation was attenuated for negative affective reactivity to COVID-19 stressors. Age did not moderate positive affective reactivity to daily events.

Discussion

In the early weeks of the pandemic, older adults showed better emotional well-being and less reactivity to stressors but did not differ from younger adults in their exposure to COVID-19 stressors. Additionally, younger adults benefited more from positive events.

Helping Amid the Pandemic: Daily Affective and Social Implications of COVID-19-Related Prosocial Activities

BACKGROUND AND OBJECTIVES

The novel coronavirus disease 2019 (COVID-19) pandemic may have prompted more engagement in prosocial activities, such as volunteering and support transactions. The day-to-day affective and social implications of these activities for adults of different ages are unknown. The current study examined associations of daily prosocial activities with affective and social well-being, and whether these associations varied by age.

RESEARCH DESIGN AND METHODS

Participants ages 18-91 in Canada and the United States (N = 1,028) completed surveys for 7 consecutive evenings about their daily experiences of COVID-19-related prosocial activities (formal volunteering, support provision, support receipt), positive and negative affect, and satisfaction with social activities and relationships. Analyses were conducted using multilevel modeling and accounted for a range of potential confounding factors (e.g., sociodemographics, work, family, caregiving, daily stressors).

RESULTS

Older age predicted more frequent formal volunteering, as well as more support provision and support receipt due to COVID-19. In particular, middle-aged and older adults provided more emotional support than younger adults, middle-aged adults provided the most tangible support, and older adults received the most emotional support. All three types of prosocial activities were associated with higher positive affect and greater social satisfaction on days when they occurred. Providing COVID-19-related support further predicted lower same-day negative affect. Age did not significantly moderate these associations.

DISCUSSION AND IMPLICATIONS

Older age was related to more frequent engagement in prosocial activities during the COVID-19 crisis. These activities were associated with improved daily affective and social well-being for adults of all ages.

Sleep duration and affective reactivity to stressors and positive events in daily life

OBJECTIVE

Experimental evidence suggests that inadequate sleep disrupts next-day affective processing and evokes greater stress reactivity. However, less research has focused on whether sleep predicts next-day affective reactivity to naturally occurring stressors and positive events in daily life, as well as the reversed direction of association (i.e., affective reactivity to daily events as predictors of subsequent sleep). The purpose of this study was to evaluate the within-person, bidirectional associations between nightly sleep duration and day-to-day fluctuations in affect related to stressors and positive events.

METHOD

Adults ages 33-84 (N = 1,982, 57% female) in the U.S. National Study of Daily Experiences II reported sociodemographics and chronic conditions at baseline, then completed telephone interviews for 8 consecutive days about their sleep duration, daily stressors, positive events, and affect.

RESULTS

Prior-night sleep duration moderated the link between current-day events and positive affect, but not negative affect. Specifically, nights of shorter-than-usual sleep duration predicted more pronounced decreases in positive affect in response to daily stressors, as well as smaller increases in positive affect in response to daily positive events. Results for the reversed direction of association showed no evidence for affective reactivity to daily events as predictors of subsequent sleep duration. People with more chronic conditions were more reactive to positive events, particularly after nights of longer sleep.

CONCLUSION

Affective reactivity to daily stressors and positive events vary based upon sleep duration, such that sleep loss may amplify loss of positive affect on days with stressors, as well as reduce positive affective responsiveness to positive events. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Cycle of Daily Stress and Sleep: Sleep Measurement Matters

BACKGROUND

Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress.

PURPOSE

We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG).

METHODS

Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]).

RESULTS

Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (β = -0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (β = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity.

CONCLUSIONS

Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary-not redundant-sleep measurement approaches.

0178 The Cycle of Daily Stress and Sleep: Sleep Measurement Matters

Introduction

Disturbed sleep can be both a cause and a consequence of increased stress. Yet intensive longitudinal studies have demonstrated that sleep assessed via sleep diaries and actigraphy is inconsistently associated with daily stress. We expanded this research by examining daily associations between sleep and stress using a three-fold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography [EEG].

Methods

Participants were 80 adults (M age = 32.65 years, 63% female) who completed 7 days of sleep and perceived stress assessments in a naturalistic setting (resulting in 560 possible measurement occasions). Multilevel models were used to examine bidirectional associations between daily stressor occurrence (0 = stressor did not occur, 1 = stressor occurred) and stressor severity (0 = not at all severe to 3 = very severe) and sleep parameters assessed via diary, actigraphy, and EEG (e.g. total sleep time [TST], sleep efficiency [SE], and sleep onset latency [SOL], wake after sleep onset [WASO]).

Results

Participants reported at least one stressor on 37% of days. Compared to days without a stressor experienced, days with a stressor were associated with a 14.4-minute reduction in actigraphy-determined TST the subsequent night (β = -0.24, p = 0.030). Nights with greater sleep-diary determined WASO were associated with greater next-day stressor severity (β = 0.01, p = .026). No EEG-determined sleep parameters were associated with next-day stressor occurrence or severity, or vice versa.

Conclusion

Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary — not redundant — sleep measurement approaches.

Support

Funding for this study included NIH/NIAID R01AI128359-01; DoD-VA 1I01CU000144-01; the Foundation for Rehabilitation Psychology; and General Sleep Corporation.

Affect variability and inflammatory markers in midlife adults

OBJECTIVE

Higher affect variability (the extent to which individuals vary in their affect over time) has been associated with poorer health indicators, but associations with inflammation are less well understood. The purpose of the present study was to examine whether affect variability was associated with inflammation in ways consistent with the stability theory or the fragile positive affect theory, and whether associations were linear or nonlinear.

METHOD

In a racially diverse sample (N = 231; Aged 25-65; 65% female; 62% Black; 25% Hispanic), we examined whether positive affect (PA) and negative affect (NA) variability exhibited linear or quadratic associations with circulating inflammatory cytokines (a composite measure comprised of IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ), and C-reactive protein (CRP) and whether person-mean affect moderated these associations. Affective states were assessed using ecological momentary assessments (EMAs) 5 times per day for 2 weeks, with a blood draw at the end of the EMA period. Individual standard deviations of affective states indexed affect variability.

RESULTS

A quadratic association indicated that moderate NA variability was associated with lower CRP. There was evidence of significant moderation by linear associations with PA only: For those with higher person-mean PA, PA variability was positively associated with the cytokine composite. Both person-mean PA and person-mean NA moderated quadratic associations, such that for those with high person-mean affect, both high and low affect variability was associated with systemic inflammation.

CONCLUSION

Results are in line with fragile affect theory suggesting that associations between affect variability and health indicators may vary by person-mean affect. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

PERCEIVED CONTROL AND CORTISOL STRESS REACTIVITY: VARIATIONS BY AGE, RACE, AND FACETS OF CONTROL

Greater perceived control is associated with better aging-related health outcomes, and these associations have previously been shown to differ based on sociodemographics. Physiological stress responses—including cortisol reactivity to stressors—may underlie the link between perceived control and health. The goal of this study was to evaluate the associations of perceived control and its facets (personal mastery and perceived constraints) with cortisol reactivity to acute laboratory stressors, in addition to the moderating roles of age and race. Participants (N = 737) ages 25-75 completed a perceived control questionnaire and two lab-based stress tasks. Salivary cortisol was collected pre- and post-stressor exposure. The results showed no main effects of perceived control, personal mastery, nor perceived constraints on salivary cortisol reactivity to stressors. However, age and race moderated the association between perceived constraints and post-stressor cortisol level, adjusting for baseline cortisol, sociodemographics, and health covariates. Among white participants, younger adults who reported higher constraints had elevated cortisol responses compared to those who reported lower constraints, whereas constraints were unrelated to cortisol reactivity among midlife and older adults. Among black participants, perceived control and its subscales were unrelated to cortisol, regardless of age. These findings suggest that older age buffers against the association between constraints and stress reactivity, but this buffering effect is only evident for white participants. Future research on the role of perceived control in stress and health should consider the importance of racial differences, facets of control, and age variations.

Sense of Purpose Moderates the Associations Between Daily Stressors and Daily Well-being

Background

Having a sense of purpose in life has been consistently demonstrated as a predictor of positive health outcomes, including less perceived stress, yet, little is known about the role of sense of purpose on stressful days.

Purpose

The current study investigated the sense of purpose as a moderator of stressor-related changes in daily physical symptoms, positive affect, and negative affect.

Methods

A subset of the Midlife in the United States study (n = 1949, mage: 56.4 years) reported their sense of purpose, along with up to eight daily assessments of stressors, affect, and physical symptoms. Multilevel models evaluated whether sense of purpose was associated with deviations in affect or physical symptom reporting on days when participants reported a stressor versus days when stressors did not occur.

Results

Sense of purpose was associated with higher daily positive affect, lower daily negative affect, and fewer daily physical symptoms. Compared with individuals who reported lower levels of purpose, those reporting higher levels encountered the same number of daily stressors, yet showed less of an increase in negative affect and physical symptoms on stressor days than on stressor-free days. Purpose did not predict changes in positive affect in response to daily stressors.

Conclusions

Findings provide evidence that a purposeful life may be characterized by lower negative affect and physical symptom reporting on stressful days.

Bidirectional, Temporal Associations of Sleep with Positive Events, Affect, and Stressors in Daily Life Across a Week

BACKGROUND

Sleep is intricately tied to emotional well-being, yet little is known about the reciprocal links between sleep and psychosocial experiences in the context of daily life.

PURPOSE

The aim of this study is to evaluate daily psychosocial experiences (positive and negative affect, positive events, and stressors) as predictors of same-night sleep quality and duration, in addition to the reversed associations of nightly sleep predicting next-day experiences.

METHODS

Daily experiences and self-reported sleep were assessed via telephone interviews for eight consecutive evenings in two replicate samples of US employees (131 higher-income professionals and 181 lower-income hourly workers). Multilevel models evaluated within-person associations of daily experiences with sleep quality and duration. Analyses controlled for demographics, insomnia symptoms, the previous day's experiences and sleep measures, and additional day-level covariates.

RESULTS

Daily positive experiences were associated with improved as well as disrupted subsequent sleep. Specifically, positive events at home predicted better sleep quality in both samples, whereas greater positive affect was associated with shorter sleep duration among the higher-income professionals. Negative affect and stressors were unrelated to subsequent sleep. Results for the reversed direction revealed that better sleep quality (and, to a lesser degree, longer sleep duration) predicted emotional well-being and lower odds of encountering stressors on the following day.

CONCLUSIONS

Given the reciprocal relationships between sleep and daily experiences, efforts to improve well-being in daily life should reflect the importance of sleep.

Trait emotion regulation strategies and diurnal cortisol profiles in healthy adults

OBJECTIVE

Experimental studies have shown that 2 emotion regulation strategies-suppression and reappraisal-are associated with differential profiles of physiological activation in response to a stress test. The present study aims to add to those findings by investigating whether individual differences in trait emotion regulation strategies are associated with diurnal cortisol patterns in a naturalistic context.

METHOD

A sample of 46 men and women from the Midlife in the United States II (MIDUS II) study completed the Emotion Regulation Questionnaire (ERQ) and provided 4 salivary cortisol samples per day over 4 consecutive days. Trait reappraisal and suppression were tested as predictors of 3 cortisol parameters averaged across days: cortisol awakening response (CAR), diurnal cortisol slope (DCS), and area under the curve with respect to ground (AUCg).

RESULTS

Higher scores on the suppression scale were associated with more physiological activation, as indicated by steeper CAR and flatter DCS. Suppression was not associated with AUCg, and reappraisal was not predictive of any cortisol parameter.

CONCLUSIONS

Individual differences in suppression, but not reappraisal, were linked to greater cortisol activation in this naturalistic study. These preliminary results add to a growing body of findings that link suppression to adverse psychological and physiological profiles. (PsycINFO Database Record

The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications

Positive psychological aspects of well-being-including positive emotions, optimism, and life satisfaction-are increasingly considered to have protective roles for cardiovascular disease (CVD) and longevity. A rapidly-growing body of literature has linked positive well-being with better cardiovascular health, lower incidence of CVD in healthy populations, and reduced risk of adverse outcomes in patients with existing CVD. This review first examines evidence on the associations of positive well-being with CVD and mortality, focusing on recent epidemiological research as well as inconsistent findings. Next, an overview is provided of putative biological, behavioral, and stress-buffering mechanisms that may underlie the relationship between positive well-being and cardiovascular health. Key areas for future inquiry are discussed, in addition to emerging developments that capitalize on technological and methodological advancements. Promising initial results from randomized controlled trials suggest that efforts to target positive well-being may serve as valuable components of broader CVD management programs.

Daily positive events and diurnal cortisol rhythms: Examination of between-person differences and within-person variation

Growing evidence from field studies has linked daily stressors to dysregulated patterns of diurnal cortisol. Less is known about whether naturally-occurring positive events in everyday life are associated with diurnal cortisol. The objectives of this study were to evaluate daily positive events as predictors of between-person differences and within-person (day-to-day) variations in diurnal cortisol parameters, in addition to daily positive events as buffers against the associations between daily stressors and cortisol. In the National Study of Daily Experiences, 1657 adults ages 33-84 (57% female) reported daily experiences during telephone interviews on 8 consecutive evenings. Saliva samples were collected 4 times per day on 4 interview days and assayed for cortisol. Multilevel models were used to estimate associations of daily positive events with cortisol awakening response (CAR), diurnal cortisol slope, and area under the curve (AUC). At the between-person level, people who experienced more frequent positive events exhibited a steeper diurnal cortisol slope, controlling for daily stressors, daily affect, and other covariates. At the within-person level, positive events in the morning (but not prior-night or afternoon/evening events) predicted steeper decline in cortisol across that day; positive events were also marginally associated with lower same-day AUC. Associations were not mediated by daily positive affect, and positive events did not buffer against stressor-related cortisol alterations. These findings indicate that individual differences and day-to-day variations in daily positive events are associated with diurnal cortisol patterns, independent of stressors and affect.

Positive Affect and Health Behaviors Across 5 Years in Patients With Coronary Heart Disease: The Heart and Soul Study

OBJECTIVES

Positive psychological states are linked to superior health and longevity, possibly due to behavioral factors. We evaluated cross-sectional and 5-year associations between positive affect and health behaviors in patients with coronary heart disease (CHD).

METHODS

Outpatients with CHD reported positive affect, physical activity, sleep quality, medication adherence, cigarette smoking, and alcohol use at baseline (n = 1022) and 5 years later (n = 662). Covariates in regression analyses included demographics, cardiac disease severity, and depressive symptoms.

RESULTS

At baseline, higher positive affect (per 1 standard deviation) was associated with better health behaviors: physical activity (odds ratio [OR] = 1.52, 95% 95% confidence interval [CI] = 1.30-1.77, p < .001), sleep quality (OR = 1.24, 95% CI = 1.04-1.48, p = .015), medication adherence (OR = 1.46, 95% CI = 1.12-1.90, p = .005), and nonsmoking (OR = 1.29, 95% CI = 1.06-1.57, p = .012), but was unrelated to alcohol use. Baseline positive affect did not predict health behaviors at follow-up, accounting for baseline behaviors. However, increases in positive affect across 5 years co-occurred with improvements in physical activity (B = 0.023, standard error [SE] = 0.008, p = .002), sleep quality (B = 0.011, SE = 0.005, p = .039), and medication adherence (B = 0.014, SE = 0.004, p < .001), but not smoking status (OR = 1.07, 95% CI = 0.73-1.55, p = .74).

CONCLUSIONS

Positive affect was associated with health behaviors among patients with CHD. Efforts to sustain or enhance positive affect may be promising for promoting better health behaviors.

Affective reactivity to daily stressors is associated with elevated inflammation

OBJECTIVE

Inflammation increases the risk of chronic diseases, but the links between emotional responses to daily events and inflammation are unknown. We examined individual differences in affective reactivity to daily stressors (i.e., changes in positive and negative affect in response to stressors) as predictors of inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP).

METHODS

A cross-sectional sample of 872 adults from the National Study of Daily Experiences (substudy of Midlife in the United States II) reported daily stressors and affect during telephone interviews for 8 days. Blood samples were obtained at a separate clinic visit and assayed for inflammatory markers. Multilevel models estimated trait affective reactivity slopes for each participant, which were inputted into regression models to predict inflammation.

RESULTS

People who experienced greater decreases in positive affect on days when stressors occurred (i.e., positive affect reactivity) had elevated log IL-6, independent of demographic, physical, psychological, and behavioral factors (B = 1.12, SE = 0.45, p = .01). Heightened negative affect reactivity was associated with higher log CRP among women (p = .03) but not men (p = .57); health behaviors accounted for this association in women.

CONCLUSIONS

Adults who fail to maintain positive affect when faced with minor stressors in everyday life appear to have elevated levels of IL-6, a marker of inflammation. Women who experience increased negative affect when faced with minor stressors may be at particular risk of elevated inflammation. These findings add to growing evidence regarding the health implications of affective reactivity to daily stressors.

Daily positive events and inflammation: findings from the National Study of Daily Experiences

BACKGROUND

Inflammation is implicated in the development of chronic diseases and increases the risk of mortality. People who experience more daily stressors than others have higher levels of inflammation, but it is unknown whether daily positive events are linked to inflammation.

OBJECTIVE

To examine the association of daily positive events with 3 inflammatory markers, interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen.

METHOD

A cross-sectional sample of 969 adults aged 35-86 from the Midlife in the United States Study completed telephone interviews for 8 consecutive evenings. Participants reported positive experiences that occurred over the past 24h. Blood samples were obtained at a separate clinic visit and later assayed for inflammatory markers. Regression analyses evaluated the frequency of daily positive events (defined as the percent of study days with at least 1 positive event) as a predictor of each inflammatory marker. Covariates included information on demographics, physical health, depressive symptoms, dispositional and behavioral factors, and daily positive and negative affect.

RESULTS

On average, participants experienced positive events on 73% of days (SD=27%). The frequency of daily positive events was associated with lower IL-6 (p<0.001) and CRP (p=0.02) in the overall sample, and lower fibrinogen among women (p=0.01). The association remained for IL-6 in the fully adjusted model, but was no longer significant for CRP and fibrinogen after controlling for household income and race. Effects were more pronounced for participants in the lowest quartile of positive event frequency than for those in the top 3 quartiles, suggesting that lack of positivity in daily life may be particularly consequential for inflammation. Furthermore, interpersonal positive events were more predictive of lower IL-6 overall and lower fibrinogen in women than non-interpersonal positive events.

CONCLUSION

Daily positive events may serve a protective role against inflammation.

Depressive symptoms, cardiovascular disease severity, and functional status in older adults with coronary heart disease: the heart and soul study

OBJECTIVES

To compare the contributions of depressive symptoms and cardiovascular disease (CVD) severity to functional decline in individuals with coronary heart disease.

DESIGN

Longitudinal.

SETTING

Twelve outpatient clinics in the San Francisco Bay area.

PARTICIPANTS

Older adults (N = 960; mean age 67) with stable coronary heart disease recruited between September 2000 and December 2002.

MEASUREMENTS

At baseline, depressive symptoms and angina pectoris were assessed according to self-report, and left ventricular ejection fraction (LVEF) and exercise capacity were evaluated using echocardiography and exercise treadmill testing. Difficulty performing activities of daily living and instrumental activities of daily living was assessed at baseline and annually for the next 5 years. Covariates included demographic characteristics, comorbid conditions, cognitive function, social support, and health behaviors. Five years later, 658 participants returned for follow-up assessments.

RESULTS

Higher baseline depressive symptoms predicted greater risk of functional decline over 5 years, whereas higher baseline exercise capacity was associated with lower risk of functional decline. In 658 participants who returned for follow-up, 5-year changes in depressive symptoms and exercise capacity were associated with 5-year changes in functional status. Angina pectoris frequency and LVEF were not associated with functional decline or change in functional status, after adjusting for covariates and other predictors.

CONCLUSION

In older adults with coronary heart disease, depressive symptoms and lower exercise capacity predicted functional decline over 5 years. In contrast, other traditional measures of CVD severity (LVEF and angina pectoris) were not independently predictive of subsequent functional status. These findings suggest that efforts to ameliorate depressive symptoms may be as important as treating CVD severity to enhance functional status.

Development of a measure of asthma-specific quality of life among adults

PURPOSE

A key goal in asthma treatment is improvement in quality of life (QoL), but existing measures often confound QoL with symptoms and functional impairment. The current study addresses these limitations and the need for valid patient-reported outcome measures by using state-of-the-art methods to develop an item bank assessing QoL in adults with asthma. This article describes the process for developing an initial item pool for field testing.

METHODS

Five focus group interviews were conducted with a total of 50 asthmatic adults. We used "pile sorting/binning" and "winnowing" methods to identify key QoL dimensions and develop a pool of items based on statements made in the focus group interviews. We then conducted a literature review and consulted with an expert panel to ensure that no key concepts were omitted. Finally, we conducted individual cognitive interviews to ensure that items were well understood and inform final item refinement.

RESULTS

Six hundred and sixty-one QoL statements were identified from focus group interview transcripts and subsequently used to generate a pool of 112 items in 16 different content areas.

CONCLUSIONS

Items covering a broad range of content were developed that can serve as a valid gauge of individuals' perceptions of the effects of asthma and its treatment on their lives. These items do not directly measure symptoms or functional impairment, yet they include a broader range of content than most existent measures of asthma-specific QoL.

Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis

Do positive psychology interventions-that is, treatment methods or intentional activities aimed at cultivating positive feelings, positive behaviors, or positive cognitions-enhance well-being and ameliorate depressive symptoms? A meta-analysis of 51 such interventions with 4,266 individuals was conducted to address this question and to provide practical guidance to clinicians. The results revealed that positive psychology interventions do indeed significantly enhance well-being (mean r=.29) and decrease depressive symptoms (mean r=.31). In addition, several factors were found to impact the effectiveness of positive psychology interventions, including the depression status, self-selection, and age of participants, as well as the format and duration of the interventions. Accordingly, clinicians should be encouraged to incorporate positive psychology techniques into their clinical work, particularly for treating clients who are depressed, relatively older, or highly motivated to improve. Our findings also suggest that clinicians would do well to deliver positive psychology interventions as individual (versus group) therapy and for relatively longer periods of time.