Anger, Anxiety, and Depression as Risk Factors for Cardiovascular Disease: The Problems and Implications of Overlapping Affective Dispositions

Anger Expression Styles, Cynical Hostility, and the Risk for the Development of Type 2 Diabetes or Diabetes-Related Heart Complications: Secondary Analysis of the Health and Retirement Study

OBJECTIVE

Limited research has examined associations between trait anger and hostility and incident type 2 diabetes (T2D) and diabetes-related heart complications. However, anger expression styles (i.e., anger-in, anger-out) have not been examined. The present study used secondary data to examine the associations between anger expression styles, cynical hostility, and the risk of developing T2D (objective 1) or diabetes-related heart complications (objective 2).

METHODS

Self-report data came from participants aged 50 to 75 years in the Health and Retirement Study. Anger-in (anger that is suppressed and directed toward oneself, anger-out (anger directed toward other people or the environment), and cynical hostility were measured at baseline (2006 or 2008). Follow-up data (i.e., diabetes status or diabetes-related heart complications status) were collected every 2 years thereafter until 2020. The objective 1 sample included 7898 participants without T2D at baseline, whereas the objective 2 sample included 1340 participants with T2D but without heart complications at baseline.

RESULTS

Only anger-in was significantly associated with incident T2D after controlling for sociodemographic characteristics (hazard ratio = 1.08, 95% confidence interval = 1.01-1.16), but the association did not hold after further adjustment for depressive symptoms. Only anger-out was significantly associated with incident diabetes-related heart complications after adjusting for sociodemographic characteristics, health-related covariates, and depressive symptoms (hazard ratio = 1.21, 95% confidence interval = 1.02-1.39).

CONCLUSIONS

Anger expression styles were differentially related to diabetes outcomes. These findings demonstrate the value of expanding the operationalization of anger beyond trait anger in this literature and encourage further investigation of anger expression styles.

Functioning in an Illness and Quality of Life versus the Prevalence of Depression and Anxiety Disorders in Patients with High Cardiovascular Risk

BACKGROUND

A chronic disease occurring in a person's life is a stressor, disrupting every aspect of their life.

OBJECTIVES

This study aims to assess the relationship between functioning in chronic illness and quality of life with the prevalence of symptoms of depression and anxiety in patients with high cardiovascular risk.

MATERIAL AND METHODS

This study included 200 patients (aged 18-80 years) under the care of a primary care physician, diagnosed with hypertension and/or hypercholesterolemia, and/or diabetes between 6 and 24 months before the enrollment. The presented analysis assessed the symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); and the quality of life of patients with cardiovascular disease using the Heart Quality of Life (HeartQoL) questionnaire and functioning in chronic illness using the Functioning in Chronic Illness Scale (FCIS).

RESULTS

The HADS scores amounted to 4.34 ± 3.414 points for the HADS-Anxiety subscale and 3.20 ± 2.979 points for the HADS-Depression subscale. The score indicative of functioning in chronic illness assessed with the FCIS was 98.32 ± 13.89 points. The independent predictors of HADS-anxiety were HeartQoL Emotional and FCIS Global, while HeartQoL Global and FCIS Global were the independent predictors for HADS-depression. Better functioning in chronic illness (FCIS Global) was associated with less frequent symptoms of anxiety and depression based on the HADS: HADS-Anxiety (R Spearmann = -0.3969; p < 0.0001) and HADS-Depression (R Spearmann = -0.5884; p < 0.0001). Higher HeartQoL scores, both globally, as well as in emotional and physical dimensions, were associated with a lower severity of anxiety and depression assessed with the HADS: HADS-Anxiety (R Spearmann = -0.2909; p = 0.0001) and HADS-Depression (R Spearmann = -0.2583; p = 0.0002).

CONCLUSIONS

The quality of life and functioning in chronic illness are connected with symptoms of depression and anxiety. When assessing the severity of the depression symptoms in relation to the individual aspects of functioning in chronic illness, the areas requiring supportive-educational intervention can be identified. The assessment of both functioning in a chronic disease and the severity of the depression symptoms should be included in a standard nursing diagnosis and further supportive and educational intervention.

Health-related quality of life in patients with inborn errors of immunity: A systematic review and meta-analysis

BACKGROUND

Inborn Errors of Immunity (IEI) significantly affect patients' health-related quality of life (HRQOL), presenting greater challenges than those faced by the healthy population and other chronic disease sufferers. Current research lacks comprehensive integration of this critical issue.

OBJECTIVE

This study explores HRQOL in IEI patients, identifies impacting factors, and advocates for increased research focus on their quality of life.

METHODS

Following systematic review and meta-analysis guidelines, a search of Scopus and PubMed until November 15, 2023, yielded 1633 publications. We evaluated the literature, assessed study quality, and compared the HRQOL of IEI patients to that of healthy individuals and other chronic disease patients.

RESULTS

Of 90 articles and 10,971 IEI patients analyzed, study quality varied (nine good, 63 moderate, and 18 poor). The Short Form-36 (SF-36) and Pediatric Quality of Life Inventory generic core scales (PedsQL) were the primary generic instruments used among adults and children, respectively, with 12 studies each using the disease-specific instruments. Meta-analysis showed IEI patients have significantly lower scores in general health, physical and mental health, and social and emotional roles compared to healthy populations. We noted significant differences between self and proxy reports, indicating caregiver anxiety and perception disparities.

CONCLUSION

Despite limitations like small sample sizes and reliance on generic instruments, this research underscores the substantially lower HRQOL among IEI patients, emphasizing the need for a patient-centered, multidisciplinary approach to improve their life quality and calling for more focused attention on IEI patients and their caregivers' HRQOL.

Positive cardiovascular health: longitudinal investigation of sustained health behavior in a cross-lagged model

Objective

Our study focuses on the role of psychological states in the development of cardiovascular disease (CVD) and explores the potential of positive psychological factors in reducing CVD risk. While existing research has predominantly examined negative mental states and risk behavior, this longitudinal study takes a novel approach by investigating positive psychological wellbeing and its impact on sustained health behavior.

Method

The research involved participants (n = 502) with medium to high cardiovascular risk who underwent a comprehensive risk assessment in 2012, followed by written risk communication. Health behavior and psychological variables were measured in 2012 and 2019. A cross-lagged panel was employed to repeat measures of a cardiovascular health index with latent factors.

Results

Results indicated an excellent fit for the model (RMSEA = 0.0644, CFI = 0.936, TLI = 0.921, SRMR = 0.050), with significant associations between the observed variables (p < 0.05) and created latent factors. Furthermore, the model implied significant bivariate correlations (p < 0.05) between latent constructs of sustained health behavior and positive psychological states in 2012 and 2019. A significant regression relationship between Health Awareness Index 2012 and 2019, between Psychological wellbeing in 2012 and 2019 (B = 1.103 p = 0.038), latent factors could be identified (B = 1.103 p = 0.038) using cross-lagged panel model. Results highlighted the importance of cardiovascular health awareness, subjective risk perception, and self-directed efforts in facilitating health behavior change.

Conclusion

Relationships between psychological wellbeing and health awareness emphasize that positive experiences and reinforcement are crucial in sustaining optimal health behavior. Our findings offer a new perspective on cardiovascular risk screening and preventive interventions. Extending cardiovascular risk screening with psychological measures may broaden prevention opportunities by including psychological elements reinforcing positive psychological states. The findings suggest that an effective prevention program must consider stabilizing and maintaining positive psychological states to achieve lasting improvements in cardiovascular health.

Personality traits and self-control: The moderating role of neuroticism

Self-control is important for mental and physical health, and personality traits are vital antecedents for self-control. Previous studies suggest that conscientiousness and extraversion enhance self-control, whereas neuroticism hampers it. However, the link between personality and self-control has mostly been studied using a narrow conceptualization of self-control, as the ability to resist impulses, thus excluding initiatory self-control. Also, no studies have examined whether and how personality traits interact with one another to increase, or reduce, self-control. Data were collected on two occasions from 480 military cadets (31.04% female) to examine the relationship between the Big Five personality traits and self-control (general, inhibitory, and initiatory self-control). Furthermore, the study investigated the moderating role of neuroticism, as a trait and as individual facets, on the relationship between the other personality traits and self-control. Although neuroticism correlated negatively with all self-control dimensions, there were unique relations only with general and inhibitory self-control. Extraversion correlated positively with all self-control dimensions but was only uniquely related to initiatory self-control. Conscientiousness correlated positively with all self-control dimensions and this pattern persisted when we assessed the unique effects. Openness to experience and agreeableness correlated positively with general and inhibitory self-control but had no unique effects on any of the self-control dimensions. Neuroticism negatively moderated the relationship between extraversion and both general and inhibitory self-control, and the relationship between conscientiousness and both general and initiatory self-control. The facet-level analysis confirmed the general patterns and provided further detail on which facets of neuroticism were the most influential as moderators. In conclusion, the study highlights the critical role of different types of self-control, and that neuroticism plays a cardinal role for the effects of conscientiousness and extraversion on self-control.

A Cross-Sectional Study of Health-Related Quality of Life in Patients with Predominantly Antibody Deficiency

Health-related quality of life (HRQoL) measures individual well-being across physical, psychological, and social domains. Patients with predominantly antibody deficiency (PAD) are at risk for morbidity and mortality, however, the effect of these complications on HRQoL requires additional study. Patients with PAD were asked to voluntarily complete the Centers for Disease Control (CDC) HRQoL-14 Healthy Days Measure questionnaire. These results were compared to data from the CDC-initiated Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional questionnaire including questions from CDC-HRQOL-14. Statistical analyses included two-proportion Z-test, t-tests, and analysis of variance. 83 patients with PAD completed the survey. Patients were sub-stratified into mild (23.7%), moderate (35.5%), severe (40.8%), and secondary (8.4%) PAD. "Fair or poor" health status was reported in 52.6% of PAD patients. Mental health challenges ≥ 14 days/month occurred in 25% of patients. Physical health issues ≥ 14 days/month was reported in 44.7% of patients. Activity limitations were noted by 80.3% of patients. There were no statistically significant differences by PAD severity. Patients with autoimmune and inflammatory disease co-morbidities reported more mental health challenges compared to those without (78% vs. 54.3%, p = 0.02). Compared to the CDC-BRFSS data, significantly more patients with PAD reported "fair or poor" health status (53% vs 12.0%; p < 0.0001), mental health challenges (24.1% vs 14.7%; p = 0.02), and poor physical health (44.6% vs 8.0%; p < 0.0001). Patients with PAD had significantly reduced HRQoL compared to CDC-BRFSS respondents from a similar geographical region. Decreased HRQoL was prevalent across all PAD severity levels. Additional research is needed to improve HRQoL for patients with PAD.

Affect variability and cortisol in context: The moderating roles of mean affect and stress

Positive and negative affect have been shown to have implications for hormones like cortisol but how moment to moment changes in affect (i.e., affect variability) influence cortisol secretion is less well understood. Additionally, context characteristics such as mean affect and stress may influence the association between affect variability and cortisol output. In the current study, we examined affect, stress, and cortisol data from 113 participants (age range = 25-63, M = 35.63, SD = 11.34; 29% male; 42% White/Caucasian, 37% Asian or Pacific Islander, 13% Hispanic/Latino, 4% Black/African American, 1% Native American, Eskimo, or Aleut, 4% selected "other" for their race/ethnicity). Participants completed ecological momentary assessments assessing positive and negative affect and stress four times per day for five days and provided saliva samples at each time point. Saliva was assayed for cortisol, and area under the curve with respect to ground was computed. In a three-way interaction, both positive affect mean level and stress moderated the association between positive affect variability and cortisol (b = -1.55, t(100) = -3.29, SE = 0.47, p <.01, β = -4.05). When breaking down this three-way interaction, in the context of low stress and high mean positive affect, variability was positively related to total cortisol output. In contrast, in the context of high stress and high mean positive affect, variability was negatively related to total cortisol output. While greater positive affect variability is generally worse for health-relevant outcomes (as prior research has shown and as we show here at low levels of stress), at high levels of stress, fluctuation in affect may be adaptive. For someone experiencing a high stress week, having fluctuations in positive affect may mean that they are adaptively changing to meet their environmental needs especially when they typically report high mean positive affect levels. There were no associations between negative affect variability and cortisol secretion nor did mean negative affect or stress play a moderating role for negative affect variability. This study provides evidence that positive affect variability's association with cortisol secretion throughout the day may vary based on stress and mean positive affect levels.

Effects of coaches' autonomy support on athletes' aggressive behavior and athlete burnout: verification of the mediating effects of coach-athlete relationship and team efficacy

Purpose

This study investigated the relationships between perceived autonomy support, coach-athlete relationship, team efficacy, aggressive behavior, and athlete burnout among team sports athletes. It verified the mediating effects of the coach-athlete relationship and team efficacy on the relationship between autonomy support and athlete burnout.

Design methodology and approach

A questionnaire survey on autonomy support, coach-athlete relationships, aggressive behavior, and athlete burnout was administered to 336 team sports athletes (292 male athletes and 44 female athletes). A cross-sectional research design was used to collect the data. To analyze the collected data, frequency, reliability, descriptive statistical, and correlation analyses were performed using SPSS version 26.0. In addition, confirmatory factor analysis, convergent validity tests, and structural model analysis were conducted using AMOS version 24.0. Bootstrapping was used to examine the mediating effects.

Results

The fit of the measurement model was assessed by calculating the fit indices as follows: x 2 = 329.689, df = 124, p < 0.001, TLI = 0.945, CFI = 0.956, RMSEA = 0.070 (90% CI = 0.061-0.080), and SRMR = 0.060. Autonomy support positively affected the coach-athlete relationship (β = 0.841) and team efficacy (β = 0.338). The coach-athlete relationship positively affected team efficacy (β = 0.479). Furthermore, autonomy support did not significantly influence aggressive behavior (β = -0.053), and negatively affected athlete burnout (β = -0.305). The coach-athlete relationship also did not significantly affect aggressive behavior (β = 0.054), and negatively affected athlete burnout (β = -0.303). Team efficacy negatively affected aggressive behavior (β = -0.516) and athlete burnout (β = -0.201). Finally, autonomy support was found to affect athlete burnout through the coach-athlete relationship and team efficacy.

Conclusion

Considering that autonomy support affects athlete burnout through coach-athlete relationship and team efficacy, coaches need to enhance the quality of the coach-athlete relationship and improve team efficacy to reduce athlete burnout. Above all, the study findings suggest that coaches need to provide autonomy-supportive behaviors.

A Cross-Sectional Study of Health-Related Quality of Life in Patients with Predominantly Antibody Deficiency

Health-related quality of life (HRQoL) measures individual well-being across physical, psychological, and social domains. Patients with predominantly antibody deficiency (PAD) are at risk for morbidity and mortality, however, the effect of these complications on HRQoL requires additional study. Patients with PAD were asked to voluntarily complete the Centers for Disease Control (CDC) HRQoL-14 Healthy Days Measure questionnaire. These results were compared to data from the CDC-initiated Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional questionnaire including questions from CDC-HRQOL-14. Statistical analyses included two-proportion Z-test, t-tests, and analysis of variance. 83 patients with PAD completed the survey. Patients were sub-stratified into mild (23.7%), moderate (35.5%), severe (40.8%), and secondary (8.4%) PAD. "Fair or poor" health status was reported in 52.6% of PAD patients. Mental health challenges ≥ 14 days/month occurred in 25% of patients. Physical health issues ≥ 14 days/month was reported in 44.7% of patients. Activity limitations were noted by 80.3% of patients. There were no statistically significant differences by PAD severity. Patients with autoinflammatory disease co-morbidities reported more mental health challenges compared to those without (78% vs. 54.3%, p = 0.02). Compared to the CDC-BRFSS data, significantly more patients with PAD reported "fair or poor" health status (53% vs 12.0%; p < 0.0001), mental health challenges (24.1% vs 14.7%; p = 0.02), and poor physical health (44.6% vs 8.0%; p < 0.0001). Patients with PAD had significantly reduced HRQoL compared to CDC-BRFSS respondents from a similar geographical region. Decreased HRQoL was prevalent across all PAD severity levels. Additional research is needed to improve HRQoL for patients with PAD.

Mean Affect Moderates the Association between Affect Variability and Mental Health

Increasing evidence suggests that within-person variation in affect is a dimension distinct from mean levels along which individuals can be characterized. This study investigated affect variability's association with concurrent and longitudinal mental health and how mean affect levels moderate these associations. The mental health outcomes of depression, panic disorder, self-rated mental health, and mental health professional visits from the second and third waves of the Midlife in the United States Study were used for cross-sectional (n = 1,676) and longitudinal outcomes (n = 1,271), respectively. These participants took part in the National Study of Daily Experiences (NSDE II), where they self-reported their affect once a day for 8 days, and this was used to compute affect mean and variability. Greater positive affect variability cross-sectionally predicted a higher likelihood of depression, panic disorder, mental health professional use, and poorer self-rated mental health. Greater negative affect variability predicted higher panic disorder probability. Longitudinally, elevated positive and negative affect variability predicted higher depression likelihood and worse self-rated mental health over time, while greater positive affect variability also predicted increased panic disorder probability. Additionally, mean affect moderated associations between variability and health such that variability-mental health associations primarily took place when mean positive affect was high (for concurrent mental health professional use and longitudinal depression) and when mean negative affect was low (for concurrent depression, panic disorder, self-rated mental health, and longitudinal self-rated mental health). Taken together, affect variability may have implications for both short- and long-term health and mean levels should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-024-00238-0.

Emotion suppression and acute physiological responses to stress in healthy populations: a quantitative review of experimental and correlational investigations

Emotion suppression may be linked to poor health outcomes through elevated stress-related physiology. The current meta-analyses investigate the magnitude of the association between suppression and physiological responses to active psychological stress tasks administered in the laboratory. Relevant articles were identified through Medline, PsychINFO, PubMed, and ProQuest. Studies were eligible if they (a) used a sample of healthy, human subjects; (b) assessed physiology during a resting baseline and active psychological stress task; and (c) measured self-report or experimentally manipulated suppression. Twenty-four studies were identified and grouped within two separate random effects meta-analyses based on study methodology, namely, manipulated suppression (k = 12) and/or self-report (k = 14). Experimentally manipulated suppression was associated with greater physiological stress reactivity compared to controls (Hg = 0.20, 95% CI [0.08, 0.33]), primarily driven by cardiac, hemodynamic, and neuroendocrine parameters. Self-report trait suppression was not associated with overall physiological stress reactivity but was associated with greater neuroendocrine reactivity (r = 0.08, 95% CI [0.01, 0.14]). Significant moderator variables were identified (i.e., type/duration of stress task, nature of control instructions, type of physiology, and gender). This review suggests that suppression may exacerbate stress-induced physiological arousal; however, this may differ based upon the chosen methodological assessment of suppression.

The effect of a prosocial environment on health and well-being during the first COVID-19 lockdown and a year later

The outset of the COVID-19 pandemic was characterized by prolonged periods of chronic stress and social isolation. While studies have investigated the changes to well-being (WB) during this period, the impact of the social environment on long-term physical and mental health requires further study. This study aimed to assess the factors influencing WB and health outcomes, with the hypothesis that a positive social environment would play a significant immediate and long-term role in improving WB and preventing the effects of anxiety associated with the pandemic. At time point 1 (April 2020), an Israeli sample of 206 participants (84% female, mean age 31.5) responded to traditional questionnaires assessing mental health and social support. Factors affecting WB were assessed within subjects during the first COVID-19 lockdown for 6 weeks using a daily survey (Beiwe phone application). A year later, in May 2021, at time point 2, the initial questionnaires were readministered to a subset of the same participants (N = 94). We found that anxiety during the first lockdown adversely affected WB and predicted health and WB deterioration a year later. In contrast, a high quality of social relationships was associated with better short- and long-term WB, and mitigated the adverse effects of anxiety. Daily activities, including physical activity, meditation, and romantic relations, were also positively associated with WB during the first lockdown but did not have long-term effects. In summary, our study underscores the enduring health advantages of a positive social environment, particularly during stressful periods. These results have implications for health policymakers: programs which support individuals with high anxiety and low support, by integrating them into community-based interventions, promise to enhance well-being (WB) and health, as well as to fortify the community as a whole.

Health-related quality of life in patients with inborn errors of immunity: a bibliometric analysis

Background

Inborn Errors of Immunity (IEI) are characterized by a heightened susceptibility to infections, allergies, and various other health complications. Health-Related Quality of Life (HRQOL) in patients with IEI is a critical area of research that demands attention due to the impact of IEI on patients' lives. This study utilized bibliometric methods, aiming to comprehensively explore the research content and hotspots in the field of HRQOL in patients with IEI.

Methods

This bibliometric analysis utilized data from the Science Citation Index Expanded (SCIE) and Social Sciences Citation Index (SSCI) within the Web of Science core datasets up to January 1, 2024. The study focused on literature that addressed HRQOL in IEI patients, involving a total of 1,807 authors and 309 articles published across 112 journals. The analysis included publication volume and growth trends, country and institutional contributions, authorship, and journal analysis.

Results

The research found that despite the importance of HRQOL in IEI, the volume of publications in this field remains consistently low, with no significant increase in trend. The USA leads in publication and citation volumes, reflecting a geographical imbalance in research contributions. Key journals in this field include the Journal of Clinical Immunology, Frontiers in Immunology, and the Journal of Allergy and Clinical Immunology. The study highlights that while treatments like hematopoietic stem cell transplants and gene therapy have improved patient IEI survival rates, they still often come with significant side effects impacting HRQOL. The analysis underlines the need for comprehensive HRQOL assessments in IEI, considering the physical and psychological impacts of treatments.

Conclusions

This study represents a bibliometric analysis focusing on HRQOL in patients with. It underscores the need for more extensive and systematic research in this area, emphasizing the importance of a multidisciplinary approach. Despite advancements in medical treatments for IEI, there is a crucial need to focus on HRQOL to enhance patient satisfaction and overall well-being. The findings advocate for more personalized treatment plans and a better understanding of the psychosocial needs of patients with IEI to improve their quality of life.

Sex and Gender Differences in Psychosocial Risk Profiles Among Patients with Coronary Heart Disease - the THORESCI-Gender Study

BACKGROUND

Psychosocial factors tend to cluster and exhibit differences associated with sex assigned at birth. Gender disparities, though, remain uncharted so far. The current study aimed to first explore the clustering of eight established psychosocial risk factors among patients with coronary heart disease (CHD), followed by examining how sex and gender differences characterize these psychosocial risk profiles, while adjusting for the effect of age.

METHOD

In total, 532 patients with CHD (Mage = 68.2 ± 8.9; 84% male) completed the comprehensive psychosocial screener and questionnaires to gauge gender identity, traits, and sociocultural norm scores. A three-step latent profile analysis (LPA) was performed to identify latent profiles and their correlates.

RESULTS

LPA revealed six psychosocial risk profiles: (1) somewhat distressed overall (32%); (2) low distress (27%); (3) anger, hostility, and Type D (15%); (4) emotional distress and trauma (11%); (5) anxiety (9%); and (6) high overall distress (7%). Masculine traits and older age increased the odds to belong to the low distress profile (#2), while feminine traits and a feminine gender norm score increased the chance to belong to profiles with moderate to high distress. The effects of gender identity and feminine traits were sex dependent.

CONCLUSION

The current study's findings explain heterogeneity among patients with CHD by considering the joint occurrence of psychosocial risk factors, and the role of sex, age, and gender within those profiles. Being more sensitive to the roles that sex, gender, and an integrated set of risk factors play may ultimately improve treatment and adherence.

Psychological Distress and the Risk of Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease

BACKGROUND

Psychological distress is a recognized risk factor in patients with coronary heart disease (CHD), but its clinical significance is unclear.

OBJECTIVES

The purpose of this study was to determine if an index of psychological distress is independently associated with adverse outcomes and significantly contributes to risk prediction.

METHODS

Pooled analysis of 2 prospective cohort studies of patients with stable CHD (N = 891). A psychological distress score was constructed using measures of depression, anxiety, anger, perceived stress, and post-traumatic stress disorder, measured at baseline. The study endpoint included cardiovascular death or first or recurrent nonfatal myocardial infarction or hospitalization for heart failure at 5.9 years.

RESULTS

In both cohorts, first and recurrent events occurred more often among those in the highest tertile of distress score than those in the lowest tertile. After combining the 2 cohorts, compared with the lowest tertile, the hazards ratio for having a distress score in the highest tertile was 2.27 (95% CI: 1.69-3.06), and for the middle tertile, it was 1.52 (95% CI: 1.10-2.08). Adjustment for demographics and clinical risk factors only slightly weakened the associations. When the distress score was added to a traditional clinical risk model, C-statistic, net reclassification index, and integrative discrimination index all significantly improved.

CONCLUSIONS

Among patients with CHD, a composite measure of psychological distress was significantly associated with an increased risk of adverse events and significantly improved risk prediction.

Variety ACEs and risk of developing anxiety, depression, or anxiety-depression co-morbidity: the 2006-2022 UK Biobank data

Objectives

Adverse childhood experiences (ACEs) and anxiety-depression co-morbidity are attracting widespread attention. Previous studies have shown the relationship between individual psychiatric disorders and ACEs. This study will analyze the correlation between anxiety-depression co-morbidity and different levels of ACEs.

Methods

Seven categories of ACE and four classifications of psychiatric disorders were defined in a sample of 126,064 participants identified by the UK Biobank from 2006-2022, and correlations were investigated using logistic regression models. Then, to explore nonlinear relationships, restricted spline models were developed to examine differences in sex and age across cohorts (n = 126,064 for the full cohort and n = 121,934 for the European cohort). Finally, the impact of the category of ACEs on psychiatric disorders was examined.

Results

After controlling for confounders, ACEs scores showed dose-dependent relationships with depression, anxiety, anxiety-depression co-morbidity, and at least one (any of the first three outcomes) in all models. ACEs with different scores were significantly positively correlated with the four psychiatric disorders classifications, with the highest odds of anxiety-depression co-morbidity (odds ratio [OR] = 4.87, 95% confidence intervals [CI]: 4.37 ~ 5.43), p = 6.08 × 10-178. In the restricted cubic spline models, the risk was relatively flat for females at ACEs = 0-1 and males at ACEs = 0-2/3 (except in males, where ACEs were associated with a lower risk of anxiety, all other psychiatric disorders had an increased risk of morbidity after risk smoothing). In addition, the risk of having anxiety, depression, anxiety-depression co-morbidity, and at least one of these disorders varies with each category of ACEs.

Conclusion

The prevalence of anxiety-depression comorbidity was highest across ACE scores after controlling for confounding factors and had a significant effect on each category of ACEs.

Affect variability and physical health: The moderating role of mean affect

Research has only begun to explore how affect variability relates to physical health and has typically not assessed long-term associations nor considered the moderating role of mean affect. Therefore, we used data from the Midlife in the United States Study waves 2 (N = 1512) and 3 (N = 1499) to test how affect variability predicted concurrent and long-term physical health while also testing the moderating role of mean affect. Results indicated that greater negative affect variability was associated concurrently with a greater number of chronic conditions (p = .03) and longitudinally with worse self-rated physical health (p < .01). Greater positive affect variability was associated concurrently with more chronic conditions (p < .01) and medications (p < .01) and longitudinally with worse self-rated physical health (p = .04). Further, mean negative affect played a moderating role such that at lower levels of mean negative affect, as affect variability increased, so did the number of concurrent chronic conditions (p < .01) and medications (p = .03) and the likelihood of reporting worse long-term self-rated physical health (p < .01). Thus, the role of mean affect should be considered when testing short- and long-term associations between affect variability and physical health.

Association Between Insomnia, Stress Events, and Other Psychosocial Factors and Incident Atrial Fibrillation in Postmenopausal Women: Insights From the Women's Health Initiative

Background The association between psychosocial factors and atrial fibrillation (AF) is poorly understood. Methods and Results Postmenopausal women from the Women's Health Initiative were retrospectively analyzed to identify incident AF in relation to a panel of validated psychosocial exposure variables, as assessed by multivariable Cox proportional hazard regression and hierarchical cluster analysis. Among the 83 736 women included, the average age was 63.9±7.0 years. Over an average of 10.5±6.2 years follow-up, there were 23 954 cases of incident AF. Hierarchical cluster analysis generated 2 clusters of highly correlated psychosocial variables: the Stress Cluster included stressful life events, depressive symptoms, and insomnia, and the Strain Cluster included optimism, social support, social strain, cynical hostility, and emotional expressiveness. Incident AF was associated with higher values in the Stress Cluster (hazard ratio [HR], 1.07 per unit cluster score [95% CI, 1.05-1.09]) and the Strain Cluster (HR, 1.03 per unit cluster score [95% CI, 1.00-1.05]). Of the 8 individual psychosocial predictors that were tested, insomnia (HR, 1.04 [95% CI, 1.03-1.06]) and stressful life events (HR, 1.02 [95% CI, 1.01-1.04]) were most strongly associated with increased incidence of AF in Cox regression analysis after multivariate adjustment. Subgroup analyses showed that the Strain Cluster was more strongly associated with incident AF in those with lower traditional AF risks (P for interaction=0.02) as determined by the cohorts for heart and aging research in genomic epidemiology for atrial fibrillation score. Conclusions Among postmenopausal women, 2 clusters of psychosocial stressors were found to be significantly associated with incident AF. Further research is needed to validate these associations.

Relationship between Perceived Stress, Obesity, and Hypertension in Korean Adults and Older Adults

BACKGROUND

Perceived stress has a significant effect on metabolic diseases, including obesity and hypertension. However, the association between stress levels, obesity, and hypertension according to age and sex is not fully understood. Therefore, this study investigated the relationship between stress levels and obesity and hypertension in Korean adults and older adults.

METHODS

We analyzed data from the 2015 survey of the Korea National Physical Fitness Project conducted by the Korea Institute of Sports Science and the Korea Ministry of Culture, Sports, and Tourism. Of the 3457 participants, 2829 were adults (20-64 years old) and 628 were older adults (≥65 years old). The correlation between obesity and hypertension according to the degree of perceived stress (low, medium, and high) was analyzed using the chi-square test. Binary logistic regression analysis was used to investigate the influence of perceived stress levels on obesity and hypertension. Age, body mass index (BMI), blood pressure, exercise frequency, smoking, breakfast, and sleeping hours were included as covariates.

RESULTS

In adult males, perceived stress levels, age, and diastolic blood pressure were found to have a significant impact on obesity rates, whereas age and breakfast had a significant effect on hypertension rates. In adult females, age and systolic blood pressure were found to significantly influence obesity rates, whereas age, BMI, and exercise frequency had a significant impact on hypertension rates. In older adult females, perceived stress levels and systolic blood pressure were found to significantly impact obesity rates, and sleep duration influenced the rates of hypertension. The effect of perceived stress level on obesity and hypertension rates was less pronounced in the elderly population than in the adult population.

CONCLUSIONS

This study revealed age and sex differences in the relationship between perceived stress, obesity, and hypertension among Koreans. These findings contribute to a better understanding of the complex relationship between perceived stress and metabolic disorders and emphasize the need for a deeper understanding of the specific factors involved in the prevention and management of metabolic diseases.

Polygenic liabilities underlying job stress and exhaustion over a 10-year follow-up: A general population study

We investigated whether individuals, who have a high polygenic loading for schizophrenia and major depression (PGL) but have not developed the respective disorders, are still susceptible to experience milder forms of ill-being in terms of job strain or exhaustion. We used the population-based Young Finns Study data (n = 928). PGL was assessed with a cumulative score of the polygenic risk scores for schizophrenia and depression. Participants (24-49-year-olds) evaluated their exhaustion levels and perceived job characteristics over a 10-year follow-up (2001, 2007, 2011). Participants with diagnosed psychotic or affective disorders were excluded. We found that high PGL did not predict less favorable perceptions of job environment (job strain, demands, control, satisfaction, social support at work) but high PGL predicted a higher trajectory of exhaustion in early adulthood and middle age. Additionally, high (vs. low) PGL predicted a stronger increase in exhaustion at increased levels of job strain. These findings remained after controlling for sex, socioeconomic factors, health behaviors, and cognitive performance. In conclusion, individuals with high PGL may have an elevated liability to experience exhaustion especially in early adulthood and middle age (despite they perceive their job environment similarly than others), and especially and at high levels of job strain.

Effect of modernized collaborative care for depression on depressive symptoms and cardiovascular disease risk biomarkers: eIMPACT randomized controlled trial

Although depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, Mage = 59 years, 78% female, 50% Black, 46% with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and psychiatrists). Outcomes were depressive symptoms and CVD risk biomarkers at 12 months. Intervention participants, versus usual care participants, exhibited moderate-to-large (Hedges' g = -0.65, p < 0.01) improvements in depressive symptoms. Clinical response data yielded similar results - 43% of intervention participants, versus 17% of usual care participants, had a ≥ 50% reduction in depressive symptoms (OR = 3.73, 95% CI: 1.93-7.21, p < 0.01). However, no treatment group differences were observed for the CVD risk biomarkers - i.e., brachial flow-mediated dilation, high-frequency heart rate variability, interleukin-6, high-sensitivity C-reactive protein, β-thromboglobulin, and platelet factor 4 (Hedges' gs = -0.23 to 0.02, ps ≥ 0.09). Our modernized collaborative care intervention - which harnessed technology to maximize access and minimize resources - produced clinically meaningful improvements in depressive symptoms. However, successful depression treatment did not lower CVD risk biomarkers. Our findings indicate that depression treatment alone may not be sufficient to reduce the excess CVD risk of people with depression and that alternative approaches are needed. In addition, our effective intervention highlights the utility of eHealth interventions and centralized, remote treatment delivery in safety net clinical settings and could inform contemporary integrated care approaches. Trial Registration:ClinicalTrials.gov Identifier: NCT02458690.

Age Discrepancies Across Two Decades: Desiring to be Younger Is Associated with Daily Negative Affect Over Three Waves of Assessment

Negative perceptions of aging and older adulthood, including the idealization of youth, are common in the United States. Past work has found that holding negative perceptions of aging is closely associated with poor mental and physical health consequences, yet few studies have examined how these perceptions impact day-to-day experiences. The current study had two objectives: (1) investigate whether age discrepancy (specifically desiring to be younger than one's chronological age) was related to daily negative affect and (2) examine whether this relationship changed as participants aged over time. We utilized the Midlife in the United States (MIDUS) diary study, a longitudinal measurement burst study with three waves of 8-day daily diaries indexing approximately 20 years. Participants (N = 2398; Mage [baseline] = 46.85, SD = 12.24; 54.7% women; 92.4% White) reported their desired age as well as daily negative affect at each wave. Using multilevel modeling, we examined whether age discrepancy predicted daily negative affect across 3 waves of observation. Results supported a significant relationship between age discrepancy and daily negative affect. However, no interactions among age discrepancy and baseline age or time across study were found. This suggests that the relationship between age discrepancy and daily negative affect was consistent across waves and participants over a 20-year period and provides evidence for the pernicious effect of deidentifying with one's real age on daily life. Daily experiences can act as potential risk or protective factors and shape developmental trajectories. Reducing ageism through societal interventions or increasing personal acceptance of aging through targeted interventions are two potential pathways of promoting health and well-being across the lifespan.

Association of ADHD symptoms with type 2 diabetes and cardiovascular comorbidities in adults receiving outpatient diabetes care

Background

The relationship between attention-deficit/hyperactivity disorder (ADHD) symptoms and type 2 diabetes mellitus (T2D) and its cardiovascular outcomes have not been sufficiently studied.

Methods

2,986 adults with T2D from the Joslin Diabetes Center at Upstate Medical University were assessed for ADHD-like symptoms, executive dysfunction, and emotional control using the Adult Self-Report Scale V1.1 (ASRS) expanded version. Surveys were sent electronically, and clinical data were obtained from the electronic medical record. Pearson chi-square test was used for categorical variables association. When ASRS scores were the dependent variable, negative binomial regression correcting for demographic variables that were associated with the ASRS scores was used.

Results

155 (49.2%) of respondents met DSM-5 criteria for ADHD using the ASRS scores; Only ten (3.6%) of respondents had an ICD10 diagnosis of ADHD in their medical record; Forty-three (13.7%) had either a diagnosis of ADHD in the medical history or were taking medications used by people with ADHD. Higher levels of ADHD-like symptoms were found in patients with T2D compared with population norms. There was a modest association of the ASRS executive dysfunction subscale with overall cardiovascular comorbidities (p = 0.03). However, the p-value did not survive the multiple testing correction. Both ADHD-like symptoms and symptoms associated with emotional control, however, were not associated with specific cardiovascular diseases, hypertension, or with HbA1c, LDL-cholesterol, triglycerides, ALT, creatinine, or eGFR.

Conclusion

Our results suggest that adults with T2D attending a tertiary care diabetes clinic are at risk for having ADHD-like symptoms, highlighting the importance of screening for ADHD symptoms in this specialty setting and referring undiagnosed adult patients for further assessment and treatment of ADHD. Larger studies are needed to clarify the relationship between ADHD-like symptoms, executive dysfunction, and emotional control with diabetic control and comorbidities.

Understanding the effect of angina on general and dimensions of psychological distress: findings from understanding society

Background

The current study aimed to examine how the general and dimensions of psychological distress are affected by angina.

Methods

First, a confirmatory factor analysis (CFA) was used to produce the three-factor solution of the GHQ-12. Second, a predictive normative modeling approach to predict the expected scores for 1,081 people with angina based on a model trained on demographics from 8,821 age and sex-matched people without angina. Finally, one-sample t-tests were used to determine the differences between the actual psychological distress scores and expected psychological distress scores in participants with angina.

Results

There were three underlying structures of the GHQ-12 labeled as GHQ-12A (social dysfunction & anhedonia), GHQ-12B (depression & anxiety), and GHQ-12C (loss of confidence). Moreover, participants with angina had more psychological distress as indicated by the GHQ-12 summary score (Cohen's d = 0.31), GHQ-12A (Cohen's d = 0.34), GHQ-12B (Cohen's d = 0.21), and GHQ-12C (Cohen's d = 0.20) comparing to controls.

Conclusion

The current study implies that GHQ-12 is a valid measure of psychological distress in people with angina, and there is a need to consider the dimensions of psychological distress in angina rather than solely focusing on certain dimensions of psychological distress such as depression or anxiety issues in people with angina. Clinicians should come up with interventions to reduce psychological distress in people with angina which can then lead to better outcomes.

Transdiagnostic behavioral and genetic contributors to repetitive negative thinking: A machine learning approach

BACKGROUND

Repetitive negative thinking (RNT) is a symptom that can negatively impact the treatment and course of common psychiatric disorders such as depression and anxiety. We aimed to characterize behavioral and genetic correlates of RNT to infer potential contributors to its genesis and maintenance.

METHODS

We applied a machine learning (ML) ensemble method to define the contribution of fear, interoceptive, reward, and cognitive variables to RNT, along with polygenic risk scores (PRS) for neuroticism, obsessive compulsive disorder (OCD), worry, insomnia, and headaches. We used the PRS and 20 principal components of the behavioral and cognitive variables to predict intensity of RNT. We employed the Tulsa-1000 study, a large database of deeply phenotyped individuals recruited between 2015 and 2018.

RESULTS

PRS for neuroticism was the main predictor of RNT intensity (R²=0.027,p<0.001). Behavioral variables indicative of faulty fear learning and processing, as well as aberrant interoceptive aversiveness, were significant contributors to RNT severity. Unexpectedly, we observed no contribution of reward behavior and diverse cognitive function variables.

LIMITATIONS

This study is an exploratory approach that must be validated with a second, independent cohort. Furthermore, this is an association study, limiting causal inference.

CONCLUSIONS

RNT is highly determined by genetic risk for neuroticism, a behavioral construct that confers risk to a variety of internalizing disorders, and by emotional processing and learning features, including interoceptive aversiveness. These results suggest that targeting emotional and interoceptive processing areas, which involve central autonomic network structures, could be useful in the modulation of RNT intensity.

Independent Associations Between Trait-Anger, Depressive Symptoms and Preclinical Atherosclerotic Progression

BACKGROUND

Previous research from our group found that recent depressive symptoms were associated with 3-year change in carotid intima-media thickness (CA-IMT), a biomarker of cardiovascular disease risk, in an initially healthy sample of older adults. Trait measures of anxiety, anger, and hostility did not predict 3-year CA-IMT progression in that report.

PURPOSE

The current study sought to reexamine these associations at a 6-year follow-up point.

METHODS

Two-hundred seventy-eight participants (151 males, mean age = 60.68 years) from the original sample completed an additional IMT reading 6 years following the initial baseline assessment.

RESULTS

Though not significant at 3-years, trait-anger emerged as a predictor of IMT progression at the 6-year point. When examined in separate regression models, both depression and trait-anger (but not anxiety or hostility) predicted 6-year IMT change (b = .017, p = .002; b = .029, p = .01, respectively). When examined concurrently, both depression and anger were independently associated with 6-year IMT progression (b = .016, p = .010, b = .028, p = .022, respectively). Exploratory analyses suggest that the relative contributions of anger and depression may differ for males and females.

CONCLUSIONS

The use of sequential follow-ups is relatively unique in this literature, and our results suggest a need for further research on the timing and duration of psychosocial risk exposures in early stages of cardiovascular disease.

The personality meta-trait of stability and carotid artery atherosclerosis

BACKGROUND

Several personality traits increase the risk for atherosclerotic cardiovascular disease. Because many of these traits are correlated, their associations with disease risk could reflect shared variance, rather than unique contributions of each trait. We examined a higher-order personality trait of Stability as related to preclinical atherosclerosis and tested whether any such relationship might be explained by correlated variation in cardiometabolic risk factors.

METHOD

Among 798 community volunteers, lower-order traits of Neuroticism, Agreeableness, and Conscientiousness were modeled as latent variables (from self- and informant ratings) and used to estimate the second-order factor, Stability. Cardiometabolic risk was similarly modeled from indicators of glycemic control, blood pressure, adiposity, and lipids. Carotid artery atherosclerosis was measured as intima-media thickness (IMT) by duplex ultrasonography.

RESULT

A structural equation model incorporating direct and indirect effects showed lower Stability associated with greater IMT, and this relationship was accounted for by the indirect pathway via cardiometabolic risk. Secondary analyses showed that: (1) Neuroticism, Agreeableness, and Conscientiousness were unrelated to IMT independent of Stability; and (2) Stability predicted variation in IMT when estimated from informant-, but not self-rated, traits.

CONCLUSION

Personality traits may associate with atherosclerotic burden through their shared, rather than unique, variance, as reflected in Stability.

Taking Heart: Cardiac Symptoms and Nightmares Differentiate Nightmare Proneness and Psychological Distress among Young Adults

Introduction  Nightmare proneness, a trait-like disposition to experience frequent nightmares, has been strongly related to psychological distress. The aim of the present study was to examine if cardiac symptoms and hypothetically-related variables, nightmares, and perceived physical health could be used to differentiate nightmare proneness and psychological distress. Materials and Methods  In the present cross-sectional study, 254 young adults completed measures of nightmare proneness, psychological distress, cardiac symptoms, nonspecific and posttraumatic nightmares, nightmare distress, health behaviors, perceptions of physical health, perceived stress, Type-D personality, sleep fragmentation, and dream recall. Results  After controlling for psychological distress, nightmare proneness remained significantly correlated with nightmares, nightmare distress, cardiac symptoms, sleep fragmentation, physical health, perceived stress, and Type-D personality. After controlling for nightmare proneness, distress remained correlated with perceived stress and Type-D personality. Regression analyses indicated that after accounting for all variables, nightmare distress, physical health, and nightmare proneness predicted cardiac symptoms. Posttraumatic nightmares, sleep fragmentation, distress, perceived stress, Type-D personality, and chest pain predicted nightmare proneness. Conclusion  Nightmare proneness and psychological distress can be considered separate constructs. The findings were consistent with those of previous research and supported the theoretical propositions that nightmare proneness includes hyperarousal, vulnerability to stressors, and concretization, a mental process in which vague internal states are made more concrete.

First results from post-COVID inpatient rehabilitation

Background

COVID-19 is associated with various symptoms and psychological involvement in the long term. In view of the multifactorial triggering and maintenance of the post-COVID syndrome, a multimodal therapy with somatomedical and psychotherapeutic content is expedient. This paper compares the psychological stress of post-COVID patients and their course in rehabilitation to psychosomatic and psychocardiological patients.

Method

Observational study with control-groups and clinical, standardized examination: psychological testing (BDI-II, HELATH-49), 6-MWT as somatic parameter, two measurement points (admission, discharge). Sample characteristics, including work related parameters, the general symptom-load and the course of symptoms during rehabilitation are evaluated.

Results

At admission in all measures post-COVID patients were significantly affected, but less pronounced than psychosomatic or psychocardiological patients (BDI-II post-COVID = 19.29 ± 9.03, BDI-II psychosomatic = 28.93 ± 12.66, BDI-II psychocardiology = 24.47 ± 10.02). During rehabilitation, in all complaint domains and sub-groups, symptom severity was significantly reduced (effect sizes ranging from d = .34 to d = 1.22). Medium positive effects were seen on self-efficacy (d = .69) and large effects on activity and participation (d = 1.06) in post-COVID patients. In the 6-MWT, the walking distance improved by an average of 76.43 ± 63.58 meters (d = 1.22). Not a single patient deteriorated in walking distance, which would have been a possible sign of post exercise malaise (PEM).

Conclusion

Post-COVID patients have a slighter psychological burden as psychocardiological or psychosomatic patients. Although rehabilitation is not curative, post-COVID patients benefit significantly from the interventions and there were no signs of PEM.

Further examinations of attitudes toward discrete emotions, with a focus on attitudes toward anger

The present research aimed to better understand individual differences in attitudes towards emotions with a focus on anger. We report findings of four studies conducted with American and Polish individuals. Results showed that individuals who have more positive attitudes toward anger are higher in trait anger (Studies 1-4), are more likely to think about getting revenge (Study 1), and expect that getting revenge will make them feel good (Studies 1-2). In addition, these individuals are lower in agreeableness and lower in the tendency to engage in avoidance when angered (Studies 1-4). They score lower in humility (Studies 3-4), lower in secure romantic attachment but higher in anxious and avoidance attachment (Study 3). Finally, they are more likely to believe a wide range of conspiracies (Studies 2-4). Discussion focuses on the implications of these results.

Testing the Associations Between State and Trait Anxiety, Anger, Sadness, and Ambulatory Blood Pressure and Whether Race Impacts These Relationships

BACKGROUND

Anxiety, anger, and sadness are related to elevated ambulatory blood pressure (ABP), yet it is unclear whether each emotion exerts unique effects. Moreover, an understanding of who might be most susceptible to the negative effects of these emotions is limited, with the trait tendency to experience them or one's race as potential moderators.

PURPOSE

The study examined the potential for differential effects of momentary anxiety, anger, and sadness on ABP. The study assessed whether a trait tendency to experience these negative emotions and/or race (Black vs. non-Black) would moderate these relationships.

METHODS

Participants (n = 153) completed trait anxiety, anger, and depressive symptoms measures at baseline. ABP was collected over two 24-hour periods 3-4 months apart. Momentary measures of anxiety, anger, and sadness were assessed via ecological momentary assessment (EMA) after each ABP reading.

RESULTS

Momentary anxiety consistently predicted diastolic blood pressure but not systolic blood pressure. Momentary anger and sadness did not predict blood pressure (BP). Conditional effects were found with momentary anxiety and anger predicting elevated BP in those individuals with trait anxiety/anger at its mean. Trait anxiety and depression consistently predicted heightened BP in Black participants. Trait anger did not moderate the relationships between negative emotions and ABP.

CONCLUSIONS

Findings suggest that momentary anxiety and anger should be given attention as potential risk factors for hypertension and highlight the unique perspective of EMA methods. Black participants who were more anxious and depressed experienced heightened BP, with anxiety and depression providing possible intervention targets in improving racial disparities in cardiovascular health.

Perceived Support Protects Against Negative Affective Experiences of Momentary Solitude: An Ecological Momentary Assessment Study

OBJECTIVES

Momentary solitude (the objective state of being alone) has a strong association with negative affective experiences in older people, but little is known about how the role of social relationship characteristics on relationship between momentary solitude and affect. We examined the momentary association between momentary solitude and negative affect (NA), and whether such association was moderated by the structural and functional aspects of social relationships.

METHODS

A sample of 153 late-middle-aged and older adults were recruited and provided a total of 6,742 ecological momentary assessment surveys, of which momentary solitudes were reported for 1,885 (28%) surveys. Hierarchical linear model was used to examine how social networks and social support moderated the association of momentary solitude with NA experiences.

RESULTS

The association of momentary solitude with NA experiences was significant among middle-aged and older adults (b = 0.025, SE = 0.008, p < .01). Family networks had the main effect on NA. Perceived social support buffered against increased NA in momentary solitude: Individuals with a higher level of perceived support reported fewer increases in NA during momentary solitude than those perceiving a lower level of support.

DISCUSSION

Momentary solitude was experienced less negatively for middle-aged and older persons embedded in a context of higher levels of perceived social support. Practitioners need to pay more attention to the promotion of social resources when delivering programs to improve the subjective well-being of late-middle-aged and older adults.

Resentment Is Like Drinking Poison? The Heterogeneous Health Effects of Affective Polarization

Affective polarization-the tendency for individuals to exhibit animosity toward those on the opposite side of the partisan divide-has increased in the United States in recent years. This article presents evidence that this trend may have consequences for Americans' health. Structural equation model analyses of nationally representative survey data from Pew Research Center's American Trends Panel (n = 4,685) showed heterogeneous relationships between affectively polarized attitudes and self-rated health. On one hand, such attitudes were directly negatively associated with health such that the polarized political environment was proposed to operate as a sociopolitical stressor. Simultaneously, affective polarization was positively associated with political participation, which in turn was positively associated with health, although the direct negative effect was substantially larger than the indirect positive one. These results suggest that today's increasingly hostile and pervasive form of partisanship may undermine Americans' health even as it induces greater political engagement.

Associations Between Mental Health and Oral Health in Saudi Arabia: An Online Survey-Based Cross-Sectional Study

Background Mental disorders cause psychological stress and lead to poor lifestyle behaviors and an increased risk of poor oral health. This study aims to explore the potential association between mental illnesses with oral health and personal oral care in the Saudi population. Methodology Saudi Arabians aged ≥18 years were eligible to participate in this cross-sectional study. The study questionnaire had the following five sections: demographics, a brief depression severity measure (Patient Health Questionnaire-9), a brief generalized anxiety disorder measurement tool (Generalized Anxiety Disorder-7), an oral health measurement tool, and personal oral health care. The data were analyzed using SPSS software version 26 (IBM Corp., Armonk, NY, USA). The results were presented as numbers and (percentages) or mean and standard deviations (SD). Results This study included a total of 522 participants. The mean score for dental health and care was 4 (SD = 1.9) and 13.6 (SD = 1.9), respectively, reflecting a moderate level of dental health and positive dental care. Males had better oral health, whereas females had better dental care. A college degree or higher was linked to better dental care, and chronic diseases were linked to lower dental health scores. Minimal depression had a significantly higher dental care score than mild-to-severe depression. Depression and anxiety did not affect dental health. Conclusions This study showed that minimal depression was associated with a higher dental care score than mild-to-severe depression. However, the degree of depression was not associated with dental health. Furthermore, anxiety had no association with dental health or care.

Associations between affective factors and high-frequency heart rate variability in primary care patients with depression

OBJECTIVE

Depression is a risk factor for cardiovascular disease (CVD), and subgroups of people with depression may be at particularly elevated CVD risk. Lower high-frequency heart rate variability (HF HRV), which reflects diminished parasympathetic activation, is a candidate mechanism underlying the depression-CVD relationship and predicts cardiovascular events. Few studies have examined whether certain depression subgroups - such as those with co-occurring affective factors - exhibit lower HF HRV. The present study sought to assess associations between co-occurring affective factors and HF HRV in people with depression.

METHODS

Utilizing baseline data from the 216 primary care patients with depression in the eIMPACT trial, we examined cross-sectional associations of depression's co-occurring affective factors (i.e., anxiety symptoms, hostility/anger, and trait positive affect) with HF HRV. HF HRV estimates were derived by spectral analysis from electrocardiographic data obtained during a supine rest period.

RESULTS

Individual regression models adjusted for demographics and depressive symptoms revealed that anxiety symptoms (standardized regression coefficient β = -0.24, p = .002) were negatively associated with HF HRV; however, hostility/anger (β = 0.02, p = .78) and trait positive affect (β = -0.05, p = .49) were not. In a model further adjusted for hypercholesterolemia, hypertension, diabetes, body mass index, current smoking, CVD prevention medication use, and antidepressant medication use, anxiety symptoms remained negatively associated with HF HRV (β = -0.19, p = .02).

CONCLUSION

Our findings suggest that, in adults with depression, those with comorbid anxiety symptoms have lower HF HRV than those without. Co-occurring anxiety may indicate a depression subgroup at elevated CVD risk on account of diminished parasympathetic activation.

Evaluation of rosmarinic acid against myocardial infarction in maternally separated rats

Depression and coronary heart diseases are the common comorbid disorder affecting humans globally. The present study evaluated the effectiveness of rosmarinic acid (RA) against myocardial infarction (MI) in comorbid depression induced by maternal separation in rats. Maternal stress is one of the childhood crises that may be a potential risk factor for coronary heart disease in later part of life. As per protocol, 70-80% of pups were separated daily for 3 h between postnatal day 1 (PND1) and postnatal day 21 (PND21). Forced-swim test, sucrose preference test, and electrocardiography were performed during the experiment. Body weight was measured on PND0, PND35, and PND55. Orally rosmarinic acid (25 mg/kg and 50 mg/kg) and fluoxetine (10 mg/kg) was done from PND35 to PND55. On PND53 and PND54, isoproterenol (100 mg/kg, subcutaneously) was administered to induce myocardial infarction. On PND55, blood was collected and animals sacrificed, and plasma corticosterone, brain-derived neurotrophic factor, cardiac biomarkers, interleukine-10, and anti-oxidant parameters were measured. Rosmarinic acid and fluoxetine ameliorated the maternal separation-induced increase in immobility period, anhedonia, body weight, ST elevation, corticosterone, creatine kinase-MB (CK-MB), and lactate dehydrogenase (LDH). At the same time, both drugs elevated the tissue levels of BDNF, IL-10, glutathione, and superoxide dismutase activity. This study provides the first experimental evidence that maternal stress is an independent risk factor of cardiac abnormalities in rats. Moreover, maternal stress synergistically increases the severity of cardiac abnormalities induced by isoproterenol. Interestingly, fluoxetine and rosmarinic acid effectively ameliorated behavioral anomalies and myocardial infarction in maternally separated rats. Schematic representation of possible molecular mechanism of action of rosmarinic acid against MS-induced myocardial infarction. RA, rosmarinic acid; MS, maternal separation; PND, postnatal days; ISO, isoproterenol; BDNF, brain-derived neurotrophic factor; GSH, glutathione; SOD, superoxide dismutase; IL-10, interleukin-10; MI, myocardial infarction.

Mental disorder, psychological problems and terrorist behaviour: A systematic review and meta-analysis

Background

The link between mental health difficulties and terrorist behaviour has been the subject of debate for the last 50 years. Studies that report prevalence rates of mental health difficulties in terrorist samples or compare rates for those involved and not involved in terrorism, can inform this debate and the work of those responsible for countering violent extremism.

Objectives

To synthesise the prevalence rates of mental health difficulties in terrorist samples (Objective 1-Prevalence) and prevalence of mental health disorders pre-dating involvement in terrorism (Objective 2-Temporality). The review also synthesises the extent to which mental health difficulties are associated with terrorist involvement compared to non-terrorist samples (Objective 3-Risk Factor).

Search Methods

Searches were conducted between April and June 2022, capturing research until December 2021. We contacted expert networks, hand-searched specialist journals, harvested records from published reviews, and examined references lists for included papers to identify additional studies.

Selection Criteria

Studies needed to empirically examine mental health difficulties and terrorism. To be included under Objective 1 (Prevalence) and Objective 2 (Temporality), studies had to adopt cross-sectional, cohort, or case-control design and report prevalence rates of mental health difficulties in terrorist samples, with studies under Objective 2 also needing to report prevalence of difficulties before detection or involvement in terrorism. For Objective 3 (Risk Factor) studies where there was variability in terrorist behaviour (involved vs. not involved) were included.

Data Collection and Analysis

Captured records were screened in DisillterSR by two authors. Risk of bias was assessed using Joanna Briggs Institute checklists, and random-effects meta-analysis conducted in Comprehensive Meta-Analysis software.

Results

Fifty-six papers reporting on 73 different terrorist samples (i.e., studies) (n = 13,648) were identified. All were eligible for Objective 1. Of the 73 studies, 10 were eligible for Objective 2 (Temporality) and nine were eligible for Objective 3 (Risk Factor). For Objective 1, the life-time prevalence rate of diagnosed mental disorder in terrorist samples (k = 18) was 17.4% [95% confidence interval (CI) = 11.1%-26.3%]. When collapsing all studies reporting psychological problems, disorder, and suspected disorder into one meta-analyses (k = 37), the pooled prevalence rate was 25.5% (95% CI = 20.2%-31.6%). When isolating studies reporting data for any mental health difficulty that emerged before either engagement in terrorism or detection for terrorist offences (Objective 2: Temporality), the life-time prevalence rate was 27.8% (95% CI = 20.9%-35.9%). For Objective 3 (Risk Factor), it was not appropriate to calculate a pooled effect size due the differences in comparison samples. Odds ratios for these studies ranged from 0.68 (95% CI = 0.38-1.22) to 3.13 (95% CI = 1.87-5.23). All studies were assessed as having high-risk of bias which, in part, reflects challenges conducting terrorism research.

Author's Conclusions

This review does not support the assertion that terrorist samples are characterised by higher rates of mental health difficulties than would be expected in the general population. Findings have implications for future research in terms of design and reporting. There are also implications for practice with regards the inclusion of mental health difficulties as indicators of risk.

Mental Health, Material Possessions, and Social Capital During COVID-19: A Study of the United States Urban Working-Age Population

This study evaluates the associations between the urban working-age population's mental health, material possession, and social capital during the COVID-19 pandemic. The specific stressors examined in this empirical analysis are income level, food insecurity, and virtual psychological support. This paper further examines the differences across the employed and unemployed population groups. We obtained data from the COVID-19 Household Impact Survey and constructed four measures of mental health conditions: Nervous, Depressed, Lonely, and Hopeless. Our empirical analyses use an ordinal regression model that takes both time and regional factors into consideration to control for potential time effects and time-invariant confounders that only vary between regions. For the employed group, the main results suggest that lower income and food insecurity is correlated with a higher frequency of mental health symptoms, while virtual psychological support predicts a better mental health status. For the unemployed group, food insecurity is negatively associated with mental health, and virtual psychological might help alleviate nervousness and depression.

Facial Emotion Expression and the Inducibility of Myocardial Ischemia During Cardiac Stress Testing: The Role of Psychological Background Factors

OBJECTIVE

Negative emotional states, such as anger and anxiety, are associated with the onset of myocardial infarction and other acute clinical manifestations of ischemic heart disease. The likelihood of experiencing these short-term negative emotions has been associated with long-term psychological background factors such as depression, generalized anxiety, and personality factors. We examined the association of acute emotional states preceding cardiac stress testing (CST) with inducibility of myocardial ischemia and to what extent psychological background factors account for this association.

METHODS

Emotional states were assessed in patients undergoing CST (n = 210; mean [standard deviation] age = 66.9 [8.2] years); 91 (43%) women) using self-report measures and video recordings of facial emotion expression. Video recordings were analyzed for expressed anxiety, anger, sadness, and happiness before CST. Psychological background factors were assessed with validated questionnaires. Single-photon emission computed tomography was used to evaluate inducibility of ischemia.

RESULTS

Ischemia occurred in 72 patients (34%). Emotional states were not associated with subsequent inducibility of ischemia during CST (odds ratio between 0.93 and 1.04; p values > .50). Psychological background factors were also not associated with ischemia (odds ratio between 0.96 and 1.06 per scale unit; p values > .20) and did not account for the associations of emotional states with ischemia.

CONCLUSIONS

Emotional states immediately before CST and psychological background factors were not associated with the inducibility of ischemia. These findings indicate that the well-documented association between negative emotions with acute clinical manifestations of ischemic heart disease requires a different explanation than a reduced threshold for inducible ischemia.

Health Effects of Happiness in China

The demand for improving health status of Chinese residents is growing with the rapid economic development. Happiness, which could be improved by some brief, self-administered, and cost-effective interventions, is reported to be associated with mortality, longevity, and self-rated health. Therefore, it is essential to assess the effect of happiness on health in China. Using data from the Chinese General Social Survey 2017, the present study explored the effect of happiness on health among Chinese residents after controlling for demographic variables, socioeconomic factors, social relationships, locations, and insurance plan. The happiness effect across subsamples by age and resident type and the mediator role of happiness were also evaluated. Based on an ordered probit regression model, we found that the effect of happiness on health was significantly positive in full sample and all subsamples. Using a structural equation model, we demonstrated that happiness could partially mediate the relationship between socioeconomic factors, social relationships factors, and health. Our data supplement the existing literature on the relationship between happiness and health and provide evidence for policymakers and stakeholders focusing on happiness as a health strategy to improve overall societal wellbeing.

Early Adversity and Changes in Cortisol and Negative Affect in Response to Interpersonal Threats in the Laboratory

Adverse childhood experiences, such as abuse and neglect, are associated with poor health outcomes. This association may be partially explained by differences in stress physiology. Though most early adverse experiences occur within the context of interpersonal relationships, stress exposures manipulated in the laboratory rarely involve interpersonal interactions beyond the mere presence of others. This study examines whether adverse childhood experiences are associated with differences in affective and cortisol reactivity to two stressors which may more closely resemble the powerlessness and the lack of control characteristic of many adverse childhood experiences: a dominant (vs. submissive) interaction partner and lower (vs. higher) social status. We also manipulate social-evaluative threat as a test of whether these interpersonal stressors are more germane to stress reactivity associated with early adversity than the performance anxiety evoked by more traditional laboratory stressors, such as the Trier Social Stress Test. The results partially support the hypothesis that participants with greater early adversity may be more reactive to interpersonal stressors reminiscent of early adverse experience. Given the interpersonal nature of most adverse childhood experiences, conceptualizing and measuring associations with stress physiology in an interpersonal context may more closely capture the psychological and biological embedding of these early experiences.

Respiration rate during a stress task moderates neuroticism and perceived stress in older adults

BACKGROUND

Research suggests that respiration rate is related to psychological factors such as neuroticism and perceived stress in addition to physiological factors. However, it is unclear how respiration rate during a laboratory stress task relates to the relationship between neuroticism and perceived stress.

PARTICIPANTS AND PROCEDURE

This cross-sectional secondary analysis examined respiration rate during a stress task in moderating the relationship between neuroticism and perceived stress in a sample of generally healthy older adults (n = 64). Respiration data were collected during an auditory oddball paradigm and the Portland Arithmetic Stress Task (PAST), a laboratory-based cognitive stressor.

RESULTS

The results indicated that respiration rate during the PAST significantly moderated the relationship between neuroticism and perceived stress (p = .031), such that participants who exhibited a very low (-1.78 SD) respiration rate showed a non-significant relationship between neuroticism and perceived stress, whereas participants with average (mean; p < .001) and elevated respiration rates (+1 SD; p < .001) exhibited a significant positive relationship between neuroticism and perceived stress.

CONCLUSIONS

These findings add to a body of literature suggesting that stress reactivity is an important link between personality factors and negative outcomes. However, this is the first study to our knowledge to examine the role of physiological stress reactivity in buffering this relationship. The results suggest that individuals higher in neuroticism may attenuate the relationship between stress vulnerability and perceived stress through decreased physiological stress reactivity, particularly by exhibiting slow breathing during a stressor.

Dissecting the Association of Genetically Predicted Neuroticism with Coronary Artery Disease: A Two-Sample Mendelian Randomization Study

Background: Observational studies on the association between neuroticism and coronary artery disease (CAD) are still rare, and the results of existing studies are not consistent. The present study aimed to explore causal associations of neuroticism with CAD. Methods: The summary-level data of GWAS for neuroticism and 12 items used to assess neuroticism were extracted from the UK Biobank, and included up to 380,506 participants. The general data for CAD were obtained from the CARDIoGRAMplusC4D consortium, which assembled 60,801 CAD patients and 123,504 non-cases. Single-nucleotide polymorphisms associated with neuroticism and 12 items at genome-wide significance were explored as instrumental variables. Two-sample Mendelian randomization (TSMR) analyses were performed to evaluate causal associations amongst the genetically predicted neuroticism and 12 items with CAD. Results: The present TSMR study did not reveal the genetic association of neuroticism with CAD. The calculated ORs for CAD using inverse-variance weighted, weighted median, and MR-Egger analysis were 1.12 (p-value = 0.187), 0.99 (p-value = 0.943), and 0.82 (p-value = 0.683), respectively. Further TSMR analysis of 12 dichotomous items for assessing neuroticism suggested that mood swings genetically increased the risk of CAD (OR = 1.67, p-value < 0.001). Conclusions: This study reported no genetically causal association of neuroticism with CAD. The present study also found that mood swings may genetically increase the risk of CAD. These findings may highlight the potential of mood control as a preventive measure for CAD.

Trajectory of Recovery in PROMIS Global Physical Health After Surgical Fracture Fixation

INTRODUCTION

Patient-reported outcomes (PROs) provide data on the effect of conditions and treatments on patients' lives without third party interpretation. Mounting evidence suggests that PROs may be useful in elective procedure decision making, but its utility in trauma remains unclear. Longitudinally collected PROs may prove effective in identifying patients recovering below the norm. We sought to document recovery trajectory in patients with and without complication and to evaluate the sources of variability in functional recovery after injury.

METHODS

This retrospective study included 831 patients with trauma, identified via Current Procedural Terminology (CPT) codes for surgical extremity and/or pelvic/acetabular fracture management between 2014 and 2018. Global Physical Health (GPH) scores collected via the PROMIS Global Health in a 14-month window after injury were analyzed using mixed-effects modeling.

RESULTS

A curvilinear GPH recovery trajectory was observed where patients demonstrated an initial positive recovery trajectory (B = 1.28, P < 0.001) gradually decelerating over time (B = -0.07, P < 0.001). Patients who experienced complications requiring revision surgery demonstrated markedly lower GPH scores. Several notable predictors of postoperative physical health recovery were identified, including both between-person (B = 0.52, 95% CI, 0.48 to 0.56) and within-person (B = 0.41, 95% CI, 0.36 to 0.46) Global Mental Health (GMH) score, Body Mass Index (BMI) (B = -0.07, 95% CI, -0.12 to -0.02), two or more psychiatric diagnoses (B = -0.97, 95% CI, -1.84 to 0.09), Injury Severity Score 10 to 15 and 16+ (B = -2.62, 95% CI, -4.81 to 0.42 and B = -2.17, 95% CI, -3.60 to 0.74, respectively), readmission for complication (B = -2.64, 95% CI, -3.60 to 1.68), and lower extremity or multiextremity fracture (relative to upper extremity) (B = -3.61, 95% CI, 4.45 to 2.78, B = -4.11, 95% CI, -5.77 to 2.44, respectively). Additional analysis suggests that GMH scores are related to the presence of psychiatric diagnoses.

DISCUSSION

This study establishes a normal course of recovery as reflected by PROMIS GPH score to serve as an index for monitoring individual postoperative course. Patients who experienced a complication demonstrated markedly lower GPH across all time points, potentially allowing earlier identification of at-risk patients. Furthermore, GMH may represent a modifiable risk factor that could profoundly affect physical recovery.

LEVEL OF EVIDENCE

Level III (Prognostic Study = Retrospective Cohort).

Conscientiousness moderates the relationship between neuroticism and health-risk behaviors among adolescents

Health-Risk-Behaviors (HRBs) are considered significant antecedent conditions of adolescents' poor health and mortality. Prevention of any adverse health outcome requires an in-depth understanding of the risk and protective factors associated with its development and maintenance. Among other potential causal pathways, the "neuroticism- HRBs-adverse health" link has been supported in previous studies. Trait neuroticism has been associated with poor health and HRBs, but several moderators were also observed, which might transform neuroticism into a desirable phenomenon, that is, healthy neuroticism, that leads to better health. Conscientiousness is one such potential moderator; however, the moderating effect of conscientiousness in the neuroticism-HRBs link has not been explored extensively among adolescents, especially in India; therefore, no conclusive evidence is available. Thus, the present study was planned to explore the moderating effect of conscientiousness in the relationship between neuroticism and HRBs among adolescents. The study was conducted in India and its cross-sectional sample, procured through a multi-stage stratified random sampling, consists of 648 (364 males) adolescents (M_age  = 16.08). Participants provided relevant information on standardized questionnaires. Moderated regression analysis was applied to test the stated hypotheses. Individuals high on neuroticism and low on conscientiousness reported more indulgence in health-risk behaviors than individuals high on both neuroticism and conscientiousness. It indicates that a higher level of conscientiousness may reduce the negative impact that neuroticism has on HRBs. The findings imply that the assessment of conscientiousness and strategies to increase the same should be part of interventional programs to achieve adolescents' wellbeing.

Emotion Regulation Difficulties Mediate the Relationship between Neuroticism and Health-Risk Behaviours in Adolescents

Health-Risk-Behaviors (HRBs) are significant antecedent conditions of adolescents' poor health and mortality. Prevention of avoidable adverse health outcomes requires an in-depth understanding of the factors associated with such outcomes. Among other possible pathways, the 'Neuroticism- HRBs-adverse health' link has been supported in previous studies. However, more extensive exploration of this link is required to identify the underlying modifiable risk factors. In the present study, one such factor, namely, emotion regulation difficulties, was explored to see its mediating effect in the relationship between neuroticism and HRBs-the first two constructs of the mentioned link. In this quantitative study, a total of 759 adolescents belonging to the Indian state of Punjab (Males= 402; M(age)=16.08) provided relevant information on a set of standardized questionnaires. Mediation analysis supported the major hypothesis of the present study. The results suggest that emotion regulation difficulty may be a significant mediator in the neuroticism-HRBs link. One's difficulty in regulating emotions might be an underlying mechanism through which high neuroticism increases the probability of indulging in HRBs, resulting in adverse health outcomes. The study implies that the assessment of emotion regulation difficulties should be included in interventional programs aimed at achieving adolescents' wellbeing, and early intervention may avoid progression toward adverse health outcomes in adulthood.

Transdiagnostic Cognitive-Behavioral Therapy for Depression and Anxiety Disorders in Cardiovascular Disease Patients: Results From the CHAMPS Pilot-Feasibility Trial

OBJECTIVE

The aim of the Cardiovascular Health in Anxiety and Mood Problems Study (CHAMPS) is to pilot the Unified Protocol (UP) for the transdiagnostic treatment of depression and anxiety disorders in patients recently hospitalized for cardiovascular diseases (CVDs) and evaluate the feasibility.

METHODS

The present study is a controlled, block randomized pragmatic pilot-feasibility trial incorporating qualitative interview data, comparing UP (n = 9) with enhanced usual care (EUC, n = 10). Eligible trial participants had a recent CVD-cause admission and were above the severity threshold for depression or anxiety denoted by Patient Health Questionnaire (PHQ-9) total scores ≥10 and/or Generalized Anxiety Disorder (GAD-7) total scores ≥7 respectively on two occasions, and met criteria for one or more depression or anxiety disorders determined by structured clinical interview. Study outcomes were analyzed as intention-to-treat using linear mixed models and qualitative interview data were analyzed with content analysis.

RESULTS

Quantitative and qualitative measured indicated acceptability of the transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders. Satisfaction with UP was comparable to antidepressant therapy and higher than general physician counseling. However, there were difficulties recruiting participants with current disorders and distress on two occasions. The UP was associated with a reduction in total number of disorders determined by blinded raters. Linear mixed models indicated that a significantly greater reduction in anxiety symptoms was evident in the UP group by comparison to the EUC group (GAD-7, p between groups = 0.011; Overall Anxiety Severity and Impairment Scale, p between groups = 0.013). Results favored the UP group by comparison to EUC for change over 6 months on measures of physical quality of life and harmful alcohol use. There was no difference between the two groups on changes in depression symptoms (PHQ-9), stress, metacognitive worry beliefs, physical activity, or adherence.

DISCUSSION

In conclusion, this feasibility trial indicates acceptability of transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders that is tempered by difficulties with recruitment. Larger trials are required to clarify the efficacy of transdiagnostic depression and anxiety disorder CBT in populations with CVDs and depressive or anxiety disorders.

CLINICAL TRIAL REGISTRATION

https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12615000555550, identifier: ACTRN12615000555550.

The subcomponents of affect scale (SAS): validating a widely used affect scale

OBJECTIVE

There is a need for a brief affect scale that also encompasses different components of affect relevant for researchers interested in physiological and health outcomes. The Subcomponents of Affect Scale (SAS) meets this need. This 18-item scale has nine positive and nine negative affect items encompassing six subscales (calm, well-being, vigour, depression, anxiety, anger). Previous research using the SAS has demonstrated its predictive validity, but no work has tested its subscale structure or longitudinal validity.

DESIGN

Data from the Common Cold Project in which individuals (N = 610) completed the SAS over the course of seven days were used.

RESULTS

Confirmatory factor analysis demonstrated the reliability of the subscale structure of the SAS across seven days (positive affect subscale structure: CFIs ≥ 0.98; negative affect subscale structure: CFIs ≥ 0.94 with day 6 CFI = 0.91) and tests of factorial invariance showed the scale is valid to use over time.

CONCLUSIONS

These results confirm the psychometric validity of the subscale structure of the SAS and imply that the subscales can be used longitudinally, allowing for its use in health research as well as non-health research that can benefit from its subscale structure and longitudinal capabilities.

Correlates of COVID-19 Pandemic on Anxiety among Adults in Appalachia, USA

BACKGROUND

Anxiety problems have increased in the COVID-19 pandemic worldwide. However, very little is known about the anxiety rates in the new normal phase of the disease when adults have been assumed to be adjusted. The study aimed to find out the difference in anxiety in a convenience sample of Appalachian adults during the new normal phase of the COVID-19 pandemic, examine its association with sociodemographic factors, and compare it with the anxiety levels before the pandemic as recalled by the participants.

STUDY DESIGN

A cross-sectional study.

METHODS

The Generalized Anxiety Disorder-7 scale was used in the present study. The Chi-square test was used to examine the difference between the severity of anxiety before and during the new normal phase of the COVID-19 pandemic in terms of sociodemographic and behavioral correlates. Pearson correlation was used to see the strength of the association between anxiety and age.

RESULTS

Although the anxiety rate was stabilized by the time people approached the new normal phase of the COVID-19 pandemic, its severity increased significantly among those with preexisting anxiety (P=0.001). Anxiety was found highly associated with female and minority gender, student status, lower education and income level, marital status, cohabitation with parents, and cigarette consumption (P=0.001). A slight inverse association was observed between age and anxiety before and during the new normal phase of the COVID-19 pandemic (P=0.001).

CONCLUSION

The young and females seem to be suffering from a higher burden of anxiety. Research is suggested to identify ways to develop social support-based community programs to address this issue.