Associations between adolescent friends' responses during problem talk and depressive symptoms

The present study examined how friends' responses to each other during problem talk predicted depressive symptoms over time. Participants included 271 adolescent friend dyads (69 female and 69 male early adolescent dyads; 72 female and 61 male middle adolescent dyads; 66.4% White and 26.6% Black). The adolescents were observed discussing a problem with the friend and reported on depressive symptoms at the time of observation and 9 months later. Friends' responses were coded into one of nine response type categories (i.e., four positive/engaged response types, one neutral response type, and four negative/disengaged response types). Actor-partner interdependence models revealed significant actor and partner effects for both positive and negative responses. Notably, receiving and/or producing positive/engaged responses, including saying something supportive, sharing related experiences, and asking questions, were associated with lower depressive symptoms over time. Receiving and/or producing negative/disengaged responses, including sharing one's own experience in a distracting way, changing the subject, saying something unsupportive or minimizing the problem, and saying nothing at all heightened risk for depressive symptoms. Additionally, significant Actor × Partner interactions revealed that greater differences between the friends in the degree to which they produced supportive responses were associated with increased depressive symptoms and that both friends saying nothing at all was associated with increased depressive symptoms. When gender and grade differences were found, the associations typically were particularly strong for middle-adolescent girls. These results highlight the importance of attending to friends' specific behaviors in social support contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Co-rumination between friends: Considering the roles of outcome expectations, relationship provisions, and perceptions of problems

Despite its implications for adjustment, little is known about factors that support co-rumination in friendships. The current multi-method, longitudinal study addressed this question with 554 adolescents (Mage  = 14.50; 52% girls; 62% White; 31% Black; 7% Asian American) from the Midwestern United States in 2007-2010. Adolescents were observed talking about problems with a friend and reported on their outcome expectations for problem disclosures, relationship provisions during problem talk, and problem perceptions after problem talk. Participants reported on outcome expectations again 9 months later. Results indicate that the positive relationship provisions associated with co-rumination may outweigh negative problem perceptions in predicting adolescents' outcome expectations for problem disclosures over time. Implications for the potentially reinforcing nature of co-rumination are discussed.

Say you'll be there: Associations between observed verbal responses, friendship quality, and perceptions of support in young adult friendships

Friendships are a primary source of social support during young adulthood; however, little is known about the factors associated with young adults feeling greater support during interactions with friends. We examined how micro-level verbal responses and macro-level judgments of friendship quality were associated with perceptions of support following an interaction between friends. Same-gender friend dyads (N = 132; 66.2% female; 18-24 years, M age = 19.63) took turns speaking about a problem, then participants rated their perceptions of support given and received following the task. We coded each participant's verbal responses while in the listening role. Actor Partner Interdependence Models (APIMs) revealed significant partner effects for negative engagement responses, such that greater negative engagement responses were linked with the partner perceiving poorer support both given and received. Models revealed significant actor effects for supportive responses, such that greater supportive responses predicted the actor perceiving better support both given and received. Additionally, models revealed significant actor effects of friendship quality predicting actors' perceiving better support both given and received. Finally, exploratory models revealed minimal interactions between a few types of verbal responses and positive friendship quality. Taken together, results suggest that (a) negative verbal responding styles may be more meaningfully associated with partners' perceptions of support in the moment than are supportive behaviours, whereas (b) supportive verbal responding styles may be more meaningfully associated with actors' perceptions of support in the moment, and (c) actors' judgments of friendship quality are strongly associated with their overall perceptions of support, and a critical factor to consider in future research.

Adolescents' Online Connections with Friends during COVID-19: An Assessment of the Forms of Communication and Their Association with Emotional Adjustment

The COVID-19 pandemic and subsequent stay-at-home orders limited adolescents' ability to connect with friends in person, leading adolescents to rely on digital forms of communication to interact with friends. The present study (N = 168 adolescents ages 11-20, 51.40% female) examined the types of digital communication adolescents used to connect with friends during the pandemic stay-at-home orders and how each form of digital communication related to adolescents' emotional adjustment. The results showed texting to be the most common way adolescents connected with friends. Boys were more likely than girls to talk with friends through social gaming. Synchronous forms of communication (i.e., texting, video calls, and social gaming) were associated with reduced loneliness and depressive symptoms and higher flourishing. Connecting with friends by posting or responding on social media was not associated with adolescent well-being. These results suggest that forms of digital communication that allowed adolescents to talk with friends in real time were particularly important for adolescents' emotional well-being during the COVID-19 pandemic.

Co-rumination and conversational self-focus: Adjustment implications of problem talk in adolescents' friendships

Friendships are central relationships during adolescence. Given the increased experience of stress during adolescence, friends are especially critical sources of support at this time. Although experiencing social support is related to well-being, adolescents' experiences sharing problems with friends is not always positive. In this chapter, we consider two forms of problematic talk, co-rumination and conversational self-focus. Co-rumination refers to conversations about problems that is excessive, repetitive, speculative, and focused on negative affect. Conversational self-focus refers to adolescents re-directing conversations about friends' problems to oneself. Both co-rumination and conversational self-focus are associated with depressive symptoms. However, whereas co-rumination draws friends together and is associated with positive friendship quality, adolescents who engage in conversational self-focus are increasingly rejected by friends. Directions for future research and applied implications of studying social support processes between friends are discussed.

Longitudinal Change in Adolescent Depression and Anxiety Symptoms from before to during the COVID-19 Pandemic

This study aimed to examine changes in depression and anxiety symptoms from before to during the first 6 months of the COVID-19 pandemic in a sample of 1,339 adolescents (9-18 years old, 59% female) from three countries. We also examined if age, race/ethnicity, disease burden, or strictness of government restrictions moderated change in symptoms. Data from 12 longitudinal studies (10 U.S., 1 Netherlands, 1 Peru) were combined. Linear mixed effect models showed that depression, but not anxiety, symptoms increased significantly (median increase = 28%). The most negative mental health impacts were reported by multiracial adolescents and those under 'lockdown' restrictions. Policy makers need to consider these impacts by investing in ways to support adolescents' mental health during the pandemic.

Friends' discussions of interpersonal and noninterpersonal problems during early and middle adolescence: Associations with co-rumination

Friendships are important sources of support during adolescence. However, a growing literature indicates some adolescents co-ruminate, or talk with friends about problems in a way that is excessive, speculative, and negatively focused, which confers risk for internalizing problems. Still, previous research had not examined the types of problems co-ruminators discuss. Using self-reported co-rumination and observations of friends' conversations about problems, the present study of early and middle adolescents addressed this gap. Participants (N = 628) were approximately half female (52% of the sample) and primarily European American and African American (63% and 29% of the sample, respectively). Adolescents who reported greater co-rumination spent more time discussing interpersonal problems with friends, including problems with families, peers, and romantic interests. Interpersonal problems may lend themselves to co-rumination because they can be ambiguous, multifaceted, and difficult to resolve. In contrast, co-rumination was not related spending more time discussing noninterpersonal problems. In addition, middle adolescents were observed to spend more time than early adolescents discussing problems related to developmentally salient tasks (e.g., romantic relationships, academics), and girls spent more time than boys discussing interpersonal problems. Taken together, the findings contribute to a more comprehensive understanding of co-rumination. Moreover, the study has applied implications in that findings suggest that adolescents experiencing interpersonal problems may be at elevated risk of co-ruminating. In addition to steering these adolescents away from co-rumination, fostering better problem-solving skills for interpersonal problems may lead to the resolution of these problems before they become topics of co-rumination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Boys' and Girls' Interactions With Same-Gender Friends and Other-Gender Friends: A Focus on Problem Disclosures

The current study examines adolescents' subjective experiences interacting with same-gender and other-gender friends, with a focus on interactions involving disclosure about personal problems. Participants were 510 youth (65% White or European American, 26% Black or African American) in seventh grade (n = 244; M = 13.01 years; 51% girls) and tenth grade (n = 266; M = 16.03 years; 52% girls). Adolescents completed an event-contingent sampling assessment to record interactions with same-gender and other-gender friends. Results indicated that middle adolescents were more likely to interact with other-gender friends than early adolescents. Girls were more likely to report problem disclosure interactions than boys; however, boys reported more positive subjective experiences in problem disclosure interactions with other-gender friends than did girls.

Adolescent Adjustment During COVID-19: The Role of Close Relationships and COVID-19-related Stress

During the COVID-19 pandemic, adolescents' typical social support systems have been disrupted. The present study examined adolescent adjustment during the pandemic (summer, 2020) while controlling for pre-pandemic adjustment (2017-2018) in 170 youth (ages 12-20) from Missouri and Florida. We also examined whether positive and negative relationship qualities with four close others (i.e., mothers, fathers, siblings, and best friends) interacted with COVID-related stress to impact adolescent adjustment. In general, we found that close relationships impacted adolescent adjustment in expected directions (i.e., positive relationships better for adjustment, negative relationships more detrimental), but while mothers and fathers impacted adolescent adjustment in largely similar ways to pre-pandemic studies, influences of relationships with best friends and sibling were more impacted by COVID-related stress.

Relations of friendship experiences with depressive symptoms and loneliness in childhood and adolescence: A meta-analytic review

Well-established psychological theories indicate that interpersonal relationships and emotional well-being are linked in fundamental ways (Coyne, 1976; Sullivan, 1953). Indeed, difficulties in close relationships can contribute to emotional adjustment problems, and emotional problems can adversely affect close relationships. Moreover, different close relationships are especially significant in terms of development and adjustment at different stages of the life span. The current review focuses on childhood and adolescence, developmental stages at which friendships are particularly important. This article presents the results of 16 meta-analyses including 589 unique effects from 233 studies that examine concurrent and longitudinal associations between youths' friendship experiences (number of friends, positive friendship quality, negative friendship quality) and their emotional adjustment (depressive symptoms and loneliness). Studies examining these associations are mixed in regard to whether significant effects emerge. The current research synthesis provides more stable estimates of the effects. In fact, relatively small but significant concurrent and longitudinal associations emerged between the 3 indices of friendship with depressive symptoms and loneliness. The results also suggest that friendship experiences may be more closely linked with loneliness than depressive symptoms and that negative friendship quality may be related to friendship experiences more strongly than number of friends or positive friendship quality. Interestingly, some of the relations were found to be stronger for younger youth. Implications for prevention and intervention efforts are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Co-Rumination Exacerbates Stress Generation among Adolescents with Depressive Symptoms

Through stress generation, individuals' own thoughts and behaviors can actually lead to increases in their experience of stress. Unfortunately, stress generation is especially common among individuals who are already suffering from elevated depressive symptoms. However, despite the acknowledgement that some individuals with depressive symptoms generate greater stress than others, few studies have identified specific factors that could exacerbate stress generation among individuals with depressive symptoms. The present study examines co-rumination as a factor that might exacerbate stress generation among adolescents with depressive symptoms using a short-term longitudinal design. Considering these processes among adolescents was critical given that many youth experience increases in depressive symptoms at this developmental stage and that co-rumination also becomes more common at adolescence. Participants were 628 adolescents (326 girls; 302 boys) who reported on their depressive symptoms, experiences of stress, and co-rumination with a best friend. Interpersonal stressors (peer and family stress) and non-interpersonal stressors (school and sports stress) were assessed. Consistent with past research, adolescents with depressive symptoms experienced greater interpersonal and non-interpersonal stress over time. Importantly, co-rumination interacted with both depressive symptoms and gender in predicting increases in peer stress. Depressive symptoms predicted the generation of peer stress only for girls who reported high levels of co-rumination with friends. Implications for protecting youth with depressive symptoms against stress generation are discussed.

Understanding Popularity in the Peer System

Much research has focused on youth who are rejected by peers; who engage in negative behavior, including aggression; and who are at risk for adjustment problems. Recently, researchers have become increasingly interested in high-status youth. A distinction is made between two groups of high-status youth: those who are genuinely well liked by their peers and engage in predominantly prosocial behaviors and those who are seen as popular by their peers but are not necessarily well liked. The latter group of youth is well known, socially central, and emulated, but displays a mixed profile of prosocial as well as aggressive and manipulative behaviors. Research now needs to address the distinctive characteristics of these two groups and their developmental precursors and consequences. Of particular interest are high-status and socially powerful aggressors and their impact on their peers. The heterogeneity of high-status youth complicates the understanding of the social dynamics of the peer group, but will lead to new and important insights into the developmental significance of peer relationships.

Girls' and boys' problem talk: Implications for emotional closeness in friendships

This research highlights the critical role of gender in the context of problem talk and social support in adolescents' friendships. Early- and middle-adolescents' (N = 314 friend dyads; Ms = 13.01 and 16.03 years) conversations about problems were studied using observation and a short-term longitudinal design. Mean-level gender differences emerged in that girls participated in problem talk more than boys and responded in a more positive and engaged manner to friends' statements about problems (e.g., by saying something supportive, asking a question) than did boys. Interestingly, boys used humor during problem talk more than girls. Despite mean-level differences, there were not gender differences in the functional significance of participating in problem talk and positive engaged responses in that these behaviors predicted increased friendship closeness for both boys and girls. In contrast, humor during problem talk predicted increased closeness only for boys, highlighting an understudied pathway to closeness in boys' friendships.

Pathways to poor anticoagulation control

BACKGROUND

While a considerable amount is known about which patient-level factors predict poor anticoagulation control with warfarin, measured by percent time in therapeutic range (TTR), less is known about predictors of time above or below target.

OBJECTIVE

To identify predictors of different patterns of international normalized ratio (INR) values that account for poor control, including 'erratic' patterns, where more time is spent both above and below INR target, and unidirectional patterns, where time out of range is predominantly in one direction (low or high).

METHODS

We studied 103 897 patients receiving warfarin with a target INR of 2-3 from 100 Veterans Health Administration sites between October 2006 and September 2008. Our outcomes were percent time above and below the target range. Predictors included patients' demographics, comorbidities, and other clinical data.

RESULTS

Predictors of erratic patterns included alcohol abuse (5.2% more time below and 3.7% more time above, P < 0.001 for all results), taking > 16 medications (4.6% more time below and 1.8% more time above compared to taking seven or fewer medications), and four or more hospitalizations during the study (6.6% more time below and 2% more time above compared to no hospitalization). In contrast, predictors like cancer, non-alcohol drug abuse, dementia, and bipolar disorder were associated with more time below the target range (3.4%, 5.2%, 2.6%, and 3.2%, respectively) and less (or similar) time above range.

CONCLUSION

Different patient-level factors predicted unidirectional below-target and 'erratic' patterns of INR control. Distinct interventions are necessary to address these two separate pathways to poor anticoagulation.

Associations of Mothers' Friendship Quality with Adolescents' Friendship Quality and Emotional Adjustment

Little research has examined the association of parents' friendships with adolescent's well-being, perhaps because the association was considered too distal. However, developmental theories suggest that contexts in which parents, but not their children, are situated may be related to child development (Bronfenbrenner, 1979; 1986). The current work examined associations between the quality of mothers' own friendships and their adolescent children's friendship quality and emotional adjustment. Fifth-, eighth-, and eleventh-graders (N = 172) whose mothers' friendships were characterized by conflict and antagonism reported having friendships that were high in negative friendship qualities as well as elevated internalizing symptoms. These associations held after controlling for mother-child relationship quality, suggesting that mothers' friendships may have a unique association with adolescents' adjustment.

Brief report: adolescents' co-rumination with mothers, co-rumination with friends, and internalizing symptoms

The current research examined co-rumination (extensively discussing, rehashing, and speculating about problems) with mothers and friends. Of interest was exploring whether adolescents who co-ruminate with mothers were especially likely to co-ruminate with friends as well as the interplay among co-rumination with mothers, co-rumination with friends, and anxious/depressed symptoms. Early- to mid-adolescents (N = 393) reported on co-rumination and normative self-disclosure with mothers and friends and on their internalizing symptoms in this cross-sectional study. Co-rumination with mothers (but not normative self-disclosure) was concurrently associated with adolescents' co-rumination with friends. In addition, the relation between co-rumination with mothers and adolescents' anxious/depressed symptoms reported previously (Waller & Rose, 2010) became non-significant when co-rumination with friends was statistically controlled. This suggests that the relation between friendship co-rumination and anxious/depressed symptoms may help explain the relation between mother-child co-rumination and anxious/depressed symptoms. Potential implications for promoting adolescents' well-being are discussed.

INR targets and site-level anticoagulation control: results from the Veterans AffaiRs Study to Improve Anticoagulation (VARIA)

BACKGROUND

Not all clinicians target the same International Normalized Ratio (INR) for patients with a guideline-recommended target range of 2-3. A patient's mean INR value suggests the INR that was actually targeted. We hypothesized that sites would vary by mean INR, and that sites of care with mean values nearest to 2.5 would achieve better anticoagulation control, as measured by per cent time in therapeutic range (TTR).

OBJECTIVES

To examine variations among sites in mean INR and the relationship with anticoagulation control in an integrated system of care.

PATIENTS/METHODS

We studied 103,897 patients receiving oral anticoagulation with an expected INR target between 2 and 3 at 100 Veterans Health Administration (VA) sites from 1 October 2006 to 30 September 2008. Key site-level variables were: proportion near 2.5 (that is, percentage of patients with mean INR between 2.3 and 2.7) and mean risk-adjusted TTR.

RESULTS

Site mean INR ranged from 2.22 to 2.89; proportion near 2.5, from 30 to 64%. Sites' proportions of patients near 2.5, below 2.3 and above 2.7 were consistent from year to year. A 10 percentage point increase in the proportion near 2.5 predicted a 3.8 percentage point increase in risk-adjusted TTR (P < 0.001).

CONCLUSIONS

Proportion of patients with mean INR near 2.5 is a site-level 'signature' of care and an implicit measure of targeted INR. This proportion varies by site and is strongly associated with site-level TTR. Our study suggests that sites wishing to improve TTR, and thereby improve patient outcomes, should avoid the explicit or implicit pursuit of non-standard INR targets.

Co-rumination mediates contagion of internalizing symptoms within youths' friendships

Peer contagion of internalizing symptoms was examined within youths' friendships over 6 months. Children (Grades 3 and 5) and adolescents (Grades 7 and 9) paired in 274 reciprocal same-sex friendship dyads completed measures of depressive and anxiety symptoms, co-rumination, and self-disclosure. Depression contagion was present for all youth, and anxiety contagion was found in the sample of girls and older boys. Although normative self-disclosure did not mediate the contagion effects, co-rumination mediated the depression contagion effect for adolescents and the anxiety contagion effect in the sample of girls and older boys. Implications for interventions with youth at risk for developing internalizing symptoms are discussed.

How girls and boys expect disclosure about problems will make them feel: implications for friendships

Although girls disclose to friends about problems more than boys, little is known about processes underlying this sex difference. Four studies (Ns = 526, 567, 769, 154) tested whether middle childhood to mid-adolescent girls and boys (ranging from 8 to 17 years old) differ in how they expect that talking about problems would make them feel. Girls endorsed positive expectations (e.g., expecting to feel cared for, understood) more strongly than boys. Despite common perceptions, boys did not endorse negative expectations such as feeling embarrassed or worried about being made fun of more than girls. Instead, boys were more likely than girls to expect to feel "weird" and like they were wasting time. Sex differences in outcome expectations did help to account for girls' greater disclosure to friends.

Prospective associations between friendship adjustment and social strategies: friendship as a context for building social skills

The proposal that friendships provide a context for the development of social skills is widely accepted. Yet little research exists to support this claim. In the present study, children and adolescents (N = 912) were presented with vignettes in which a friend encountered a social stressor and they could help the friend and vignettes in which they encountered a stressor and could seek help from the friend. Social strategies in response to these vignettes were assessed in the fall and spring of the school year. Different indicators of friendship adjustment had unique effects on youths' strategies in response to helping tasks. Whereas having more friends predicted decreases in avoidant or hostile strategies, having high-quality friendships predicted emotionally engaged strategies that involved talking about the problem. Moreover, whereas having more friends predicted increases in relatively disengaged strategies, like distraction and acting like the problem never happened, having high-quality friendships predicted decreases in these strategies. The present study also tested whether youths' strategies in the fall predicted changes in friendship adjustment by the spring. Only strategies which may be seen as major friendship transgressions (i.e., avoiding or blaming the friend when the friend encounters a problem) predicted changes in friendship over time. Collectively, these results provide important new information on the interplay between social competencies and friendship experiences and suggest that friendships may provide a critical venue for the development of important relationship skills.

The "cost of caring" in youths' friendships: considering associations among social perspective taking, co-rumination, and empathetic distress

The current research considered the costs of caring in youths' friendships. The development of a new construct, empathetic distress, allowed for a direct test of the commonly held belief that females suffer greater vicarious distress in response to close others' stressors and problems than do males. Empathetic distress refers to one's strongly sharing a relationship partner's distress over problems to the point of taking on the partner's distress and experiencing it as one's own. This new construct was examined in an ethnically diverse sample of early adolescents who responded to a series of questionnaires in their classrooms. Results indicated that girls did experience greater empathetic distress in friendships than did boys. In addition, the current research revealed that social perspective taking in friendships (i.e., the social-cognitive ability to infer and understand the friend's perspective) had adjustment trade-offs in that it predicted greater positive friendship quality but also greater empathetic distress in the friendship. Interestingly, the associations of social perspective taking with both positive friendship quality and empathetic distress were partially mediated by co-rumination or excessive discussion of problems. Applied implications of the findings that girls' greater social perspective taking and associated co-rumination contributed both to their greater positive friendship quality but also to greater costs of caring in the form of empathetic distress are discussed.

Contraction-induced skeletal muscle FAT/CD36 trafficking and FA uptake is AMPK independent

The aim of this study was to investigate the molecular mechanisms regulating FA translocase CD36 (FAT/CD36) translocation and FA uptake in skeletal muscle during contractions. In one model, wild-type (WT) and AMP-dependent protein kinase kinase dead (AMPK KD) mice were exercised or extensor digitorum longus (EDL) and soleus (SOL) muscles were contracted, ex vivo. In separate studies, FAT/CD36 translocation and FA uptake in response to muscle contractions were investigated in the perfused rat hindlimb. Exercise induced a similar increase in skeletal muscle cell surface membrane FAT/CD36 content in WT (+34%) and AMPK KD (+37%) mice. In contrast, 5-aminoimidazole-4-carboxamide ribonucleoside only induced an increase in cell surface FAT/CD36 content in WT (+29%) mice. Furthermore, in the perfused rat hindlimb, muscle contraction induced a rapid (1 min, +15%) and sustained (10 min, +24%) FAT/CD36 relocation to cell surface membranes. The increase in cell surface FAT/CD36 protein content with muscle contractions was associated with increased FA uptake, both in EDL and SOL muscle from WT and AMPK KD mice and in the perfused rat hindlimb. This suggests that AMPK is not essential in regulation of FAT/CD36 translocation and FA uptake in skeletal muscle during contractions. However, AMPK could be important in regulation of FAT/CD36 distribution in other physiological situations.

Brief report: Activities in heterosexual romantic relationships: grade differences and associations with relationship satisfaction

Whereas much research addresses relations of youths' heterosexual romantic relationships with sexual and/or delinquent activities, less attention has been paid to youths' more normative, day-to-day activities with romantic partners. This gap in the literature is problematic given that these activities define the substance of the relationships and likely are connected to relationship satisfaction. In the current study, 223 youths in fifth (28 boys; 32 girls), eighth (31 boys; 40 girls), and eleventh (36 boys; 56 girls) grades reporting current romantic relationships indicated their engagement in activities with romantic partners and relationship satisfaction. Findings revealed important grade differences in activity involvement, with eighth- and eleventh-graders reporting higher engagement than fifth-graders, especially in out-of-school activities. Additionally, engagement in out-of-school activities was most strongly associated with relationship satisfaction for all grades.

Patient characteristics associated with oral anticoagulation control: results of the Veterans AffaiRs Study to Improve Anticoagulation (VARIA)

BACKGROUND

In patients receiving oral anticoagulation, improved control can reduce adverse outcomes such as stroke and major hemorrhage. However, little is known about patient-level predictors of anticoagulation control.

OBJECTIVES

To identify patient-level predictors of oral anticoagulation control in the outpatient setting.

PATIENTS/METHODS

We studied 124,619 patients who received oral anticoagulation from the Veterans Health Administration from October 2006 to September 2008. The outcome was anticoagulation control, summarized using percentage of time in therapeutic International Normalized Ratio range (TTR). Data were divided into inception (first 6 months of therapy; 39,447 patients) and experienced (any time thereafter; 104,505 patients). Patient-level predictors of TTR were examined by multivariable regression.

RESULTS

Mean TTRs were 48% for inception management and 61% for experienced management. During inception, important predictors of TTR included hospitalizations (the expected TTR was 7.3% lower for those with two or more hospitalizations than for the non-hospitalized), receipt of more medications (16 or more medications predicted a 4.3% lower than for patients with 0-7 medications), alcohol abuse (-4.6%), cancer (-3.1%), and bipolar disorder (-2.9%). During the experienced period, important predictors of TTR included hospitalizations (four or more hospitalizations predicted 9.4% lower TTR), more medications (16 or more medications predicted 5.1% lower TTR), alcohol abuse (-5.4%), female sex (- 2.9%), cancer (-2.7%), dementia (-2.6%), non-alcohol substance abuse (-2.4%), and chronic liver disease (-2.3%).

CONCLUSIONS

Some patients receiving oral anticoagulation therapy are more challenging to maintain within the therapeutic range than others. Our findings can be used to identify patients who require closer attention or innovative management strategies to maximize benefit and minimize harm from oral anticoagulation therapy.

Relational and Overt Aggression in Childhood and Adolescence: Clarifying Mean-Level Gender Differences and Associations with Peer Acceptance

Research on relational aggression has drawn attention to how girls may be likely to aggress, but the role of gender is not fully understood. There are opposing views regarding whether relational aggression is most common among girls. Current findings demonstrate that when gender differences in relational aggression are assessed with peer nominations, gender differences favoring girls are more likely: a) in adolescence than childhood and b) when statistical overlap with overt aggression is controlled. Results also indicated that associations of relational aggression with peer acceptance depend on the aggressor's gender, the peer rater's gender, and whether overlap with overt aggression is controlled. Associations of relational aggression with lower acceptance became non-significant when overt aggression was controlled, suggesting that relational aggression displayed in isolation may not damage acceptance. In fact, in mid-adolescence, girls' relational aggression predicted greater liking by boys. Reducing relational aggression among adolescent girls may be especially challenging if the behavior is linked with acceptance by boys.

Conversational Self-Focus in Adolescent Friendships: Observational Assessment of an Interpersonal Process and Relations with Internalizing Symptoms and Friendship Quality

Although youth with internalizing symptoms experience friendship difficulties, surprisingly little is known about their problematic interpersonal behaviors. The current observational study identifies a new construct, conversational self-focus, defined as the tendency to direct the focus of conversations to the self and away from others. Results indicated that youth with internalizing symptoms were especially likely to engage in self-focus when discussing problems with friends and that doing so was related to their friends perceiving the relationship as lower in quality, particularly helping. Content analyses further indicated that self-focused youth talked about themselves in ways that were distracting from their friends' problems and that they changed the subject abruptly. Last, conversational self-focus was not redundant with related constructs of rumination and self-disclosure. This research highlights the importance of intervention efforts aimed at teaching self-focused youth ways to cope with distress that are more effective and will not damage their friendships.

Do perceived popular adolescents who aggress against others experience emotional adjustment problems themselves?

Aggression is associated with a host of behavioral, social, and emotional adjustment difficulties. However, some aggressive youth are perceived as "popular" by peers. Although these perceived popular aggressive youth appear relatively well adjusted, especially in the social domain, the emotional well-being of these youth is understudied. The current findings indicate that perceived popularity buffers adolescents who hurt others through relational aggression from internalizing symptoms. In contrast, perceived popularity did not buffer adolescents who engaged in overt verbal and physical aggression from internalizing symptoms. The results suggest that relationally aggressive perceived popular adolescents may be especially resistant to intervention if their aggression helps them manipulate their social worlds but does not contribute to internalizing symptoms.

Friends' knowledge of youth internalizing and externalizing adjustment: accuracy, bias, and the influences of gender, grade, positive friendship quality, and self-disclosure

Some evidence suggests that close friends may be knowledgeable of youth's psychological adjustment. However, friends are understudied as reporters of adjustment. The current study examines associations between self- and friend-reports of internalizing and externalizing adjustment in a community sample of fifth-, eighth-, and eleventh-grade youth. The study extends prior work by considering the degree to which friends' reports of youth adjustment are accurate (i.e., predicted by youths' actual adjustment) versus biased (i.e., predicted by the friend reporters' own adjustment). Findings indicated stronger bias effects than accuracy effects, but the accuracy effects were significant for both internalizing and externalizing adjustment. Additionally, friends who perceived their relationships as high in positive quality, friends in relationships high in disclosure, and girls perceived youths' internalizing symptoms most accurately. Knowledge of externalizing adjustment was not influenced by gender, grade, relationship quality, or self-disclosure. Findings suggest that friends could play an important role in prevention efforts.

Boys' and girls' motivations for refraining from prompting friends to talk about problems

Girls' and boys' peer relationships are thought to have unique strengths and weaknesses. However, developmentalists have done a better job of identifying strengths of girls' friendships than boys' friendships. The present research was aimed at better understanding boys' friendship strengths. The study focused on the frequency with which youth ( N = 514) reported that they would prompt a friend to talk about problems. It was hypothesized that boys would be more likely than girls to refrain from prompting friends to talk about problems due to prosocial motivations (e.g., not wanting to embarrass the friend; wanting to distract the friend). However, contrary to predictions, girls' motivations were more prosocial and less selfish than were boys' motivations. Moreover, a similar relation was found for boys and girls between their likelihood of prompting a friend to talk about problems and their friends' reports of emotional connection. Implications for research aimed at uncovering boys' friendship strengths are discussed.

Warfarin dose management affects INR control

BACKGROUND

Little is known about how patterns of warfarin dose management contribute to percentage time in the therapeutic International Normalized Ratio (INR) range (TTR).

OBJECTIVES

To quantify the contribution of warfarin dose management to TTR and to define an optimal dose management strategy.

PATIENTS/METHODS

We enrolled 3961 patients receiving warfarin from 94 community-based clinics. We derived and validated a model for the probability of a warfarin dose change under various conditions. For each patient, we computed an observed minus expected (O - E) score, comparing the number of dose changes predicted by our model to the number of changes observed. We examined the ability of O - E scores to predict TTR, and simulated various dose management strategies in the context of our model.

RESULTS

Patients were observed for a mean of 15.2 months. Patients who deviated the least from the predicted number of dose changes achieved the best INR control (mean TTR 70.1% unadjusted); patients with greater deviations had lower TTR (65.8% and 62.0% for fewer and more dose changes respectively, Bonferroni-adjusted P < 0.05/3 for both comparisons). On average, clinicians in our study changed the dose when the INR was 1.8 or lower/3.2 or higher (mean TTR: 68%); optimal management would have been to change the dose when the INR was 1.7 or lower/3.3 or higher (predicted TTR: 74%).

CONCLUSIONS

Our observational study suggests that INR control could be improved considerably by changing the warfarin dose only when the INR is 1.7 or lower/3.3 or higher. This should be confirmed in a randomized trial.

Relational and Overt Aggression in Childhood and Adolescence: Clarifying Mean-Level Gender Differences and Associations with Peer Acceptance

Research on relational aggression has drawn attention to how girls may be likely to aggress, but the role of gender is not fully understood. There are opposing views regarding whether relational aggression is most common among girls. Current findings demonstrate that when gender differences in relational aggression are assessed with peer nominations, gender differences favoring girls are more likely: a) in adolescence than childhood and b) when statistical overlap with overt aggression is controlled. Results also indicated that associations of relational aggression with peer acceptance depend on the aggressor's gender, the peer rater's gender, and whether overlap with overt aggression is controlled. Associations of relational aggression with lower acceptance became non-significant when overt aggression was controlled, suggesting that relational aggression displayed in isolation may not damage acceptance. In fact, in mid-adolescence, girls' relational aggression predicted greater liking by boys. Reducing relational aggression among adolescent girls may be especially challenging if the behavior is linked with acceptance by boys.

Warfarin for atrial fibrillation in community-based practise

BACKGROUND

Previous studies of anticoagulation for atrial fibrillation (AF) have predominantly occurred in academic settings or randomized trials, limiting their generalizability.

OBJECTIVE

To describe the management of patients with AF anticoagulated with warfarin in community-based practise.

METHODS

We enrolled 3396 patients from 101 community-based practises in 38 states. Data included demographics, comorbidities, and International Normalized Ratio (INR) values. Outcomes included time in therapeutic INR range (TTR), stroke, and major hemorrhage.

RESULTS

The mean TTR was 66.5%, but varied widely among patients: 37% had TTR above 75%, while 34% had TTR below 60%. The yearly rates of major hemorrhage and stroke were 1.90 per 100 person-years and 1.00 per 100 person-years. Four percent of patients (n = 127) were intentionally targeted to a lower INR, and spent 42.7% of time with an INR below 2.0, compared to 18.8% for patients with a 2.0-3.0 range (P < 0.001). Mean TTR for new warfarin users (57.5%) remained below that of prevalent users through the first six months. Patients with interruptions of warfarin therapy had lower TTR than all others (61.6% vs. 67.2%, P < 0.001), which corrected after deleting low peri-procedural INR values (67.0% vs. 67.4%, P = 0.73).

CONCLUSIONS

Anticoagulation control varies widely among patients taking warfarin for AF. TTR is affected by new warfarin use, procedural interruptions, and INR target range. In this community-based cohort of predominantly prevalent warfarin users, rates of hemorrhage and stroke were low. The risk versus benefit of a lower INR target range to offset bleeding risk remains uncertain.

Co-ruminating increases stress hormone levels in women

Same-sex friendships are an important source of social support and typically contribute to positive adjustment. However, there can be adjustment trade-offs if the friends co-ruminate (i.e., talk excessively about problems) in that co-rumination is related to having close friendships but also to increased internalizing symptoms. The current study utilized an experimental manipulation that elicited co-rumination in young women and thus mirrored an everyday response to stress. Observed co-rumination was associated with a significant increase in the stress hormone, cortisol (after controlling for self-reported co-rumination and for cortisol levels assessed before the discussion of problems). These findings suggest that co-rumination can amplify, rather than mitigate, the hormonal stress response to personal life stressors.

Effect of training in the fasted state on metabolic responses during exercise with carbohydrate intake

Skeletal muscle gene response to exercise depends on nutritional status during and after exercise, but it is unknown whether muscle adaptations to endurance training are affected by nutritional status during training sessions. Therefore, this study investigated the effect of an endurance training program (6 wk, 3 day/wk, 1-2 h, 75% of peak Vo(2)) in moderately active males. They trained in the fasted (F; n = 10) or carbohydrate-fed state (CHO; n = 10) while receiving a standardized diet [65 percent of total energy intake (En) from carbohydrates, 20%En fat, 15%En protein]. Before and after the training period, substrate use during a 2-h exercise bout was determined. During these experimental sessions, all subjects were in a fed condition and received extra carbohydrates (1 g.kg body wt(-1) .h(-1)). Peak Vo(2) (+7%), succinate dehydrogenase activity, GLUT4, and hexokinase II content were similarly increased between F and CHO. Fatty acid binding protein (FABPm) content increased significantly in F (P = 0.007). Intramyocellular triglyceride content (IMCL) remained unchanged in both groups. After training, pre-exercise glycogen content was higher in CHO (545 +/- 19 mmol/kg dry wt; P = 0.02), but not in F (434 +/- 32 mmol/kg dry wt; P = 0.23). For a given initial glycogen content, F blunted exercise-induced glycogen breakdown when compared with CHO (P = 0.04). Neither IMCL breakdown (P = 0.23) nor fat oxidation rates during exercise were altered by training. Thus short-term training elicits similar adaptations in peak Vo(2) whether carried out in the fasted or carbohydrate-fed state. Although there was a decrease in exercise-induced glycogen breakdown and an increase in proteins involved in fat handling after fasting training, fat oxidation during exercise with carbohydrate intake was not changed.

Prospective associations of co-rumination with friendship and emotional adjustment: considering the socioemotional trade-offs of co-rumination

Co-ruminating, or excessively discussing problems, with friends is proposed to have adjustment tradeoffs. Co-rumination is hypothesized to contribute both to positive friendship adjustment and to problematic emotional adjustment. Previous single-assessment research was consistent with this hypothesis, but whether co-rumination is an antecedent of adjustment changes was unknown. A 6-month longitudinal study with middle childhood to midadolescent youths examined whether co-rumination is simultaneously a risk factor (for depression and anxiety) and a protective factor (for friendship problems). For girls, a reciprocal relationship was found in which co-rumination predicted increased depressive and anxiety symptoms and increased positive friendship quality over time, which, in turn, contributed to greater co-rumination. For boys, having depressive and anxiety symptoms and high-quality friendships also predicted increased co-rumination. However, for boys, co-rumination predicted only increasing positive friendship quality and not increasing depression and anxiety. An implication of this research is that some girls at risk for developing internalizing problems may go undetected because they have seemingly supportive friendships.

A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys

Theory and research on sex differences in adjustment focus largely on parental, societal, and biological influences. However, it also is important to consider how peers contribute to girls' and boys' development. This article provides a critical review of sex differences in several peer relationship processes, including behavioral and social-cognitive styles, stress and coping, and relationship provisions. The authors present a speculative peer-socialization model based on this review in which the implications of these sex differences for girls' and boys' emotional and behavioral development are considered. Central to this model is the idea that sex-linked relationship processes have costs and benefits for girls' and boys' adjustment. Finally, the authors present recent research testing certain model components and propose approaches for testing understudied aspects of the model.

A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys

Theory and research on sex differences in adjustment focus largely on parental, societal, and biological influences. However, it also is important to consider how peers contribute to girls' and boys' development. This article provides a critical review of sex differences in several peer relationship processes, including behavioral and social-cognitive styles, stress and coping, and relationship provisions. The authors present a speculative peer-socialization model based on this review in which the implications of these sex differences for girls' and boys' emotional and behavioral development are considered. Central to this model is the idea that sex-linked relationship processes have costs and benefits for girls' and boys' adjustment. Finally, the authors present recent research testing certain model components and propose approaches for testing understudied aspects of the model.

A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioral development of girls and boys

Theory and research on sex differences in adjustment focus largely on parental, societal, and biological influences. However, it also is important to consider how peers contribute to girls' and boys' development. This article provides a critical review of sex differences in several peer relationship processes, including behavioral and social-cognitive styles, stress and coping, and relationship provisions. The authors present a speculative peer-socialization model based on this review in which the implications of these sex differences for girls' and boys' emotional and behavioral development are considered. Central to this model is the idea that sex-linked relationship processes have costs and benefits for girls' and boys' adjustment. Finally, the authors present recent research testing certain model components and propose approaches for testing understudied aspects of the model.

Overt and relational aggression and perceived popularity: developmental differences in concurrent and prospective relations

Relations of overt and relational aggression with perceived popularity among children and early adolescents were examined in 2 studies (Ns = 607 and 1,049). Among older youths, positive concurrent relations found between overt aggression and perceived popularity became nonsignificant when relational aggression was controlled, whereas positive associations found between relational aggression and perceived popularity held when overt aggression was controlled. Aggression and perceived popularity were not positively related for the younger participants. The 2nd study also examined the temporal ordering of these relations over 6 months. For older girls, positive relations between relational aggression and perceived popularity were bidirectional. For older boys, relational aggression did not predict increased perceived popularity, but perceived popularity predicted increased relational aggression. Implications for intervention are discussed.

Children's Strategies and Goals in Response to Help-Giving and Help-Seeking Tasks Within a Friendship

The present research tested whether children's responses to help-giving and help-seeking friendship tasks predicted how many friends they had and the quality of their best friendship. Fifth-grade children (N=511; typically 10 or 11 years old) responded to vignettes in which they could either give help to a friend or seek help from a friend. Children's strategies and goals in both contexts were significantly correlated with the number of friends children had. Responses in the help-giving context but not in the help-seeking context were significantly associated with friendship quality. Although gender differences in strategies and goals were found, strategies and goals were related to the number of friends and friendship quality for both boys and girls.

Friendships of aggressive youth: Considering the influences of being disliked and of being perceived as popular

Past research provides conflicting evidence regarding whether aggressive youth have problems in the domain of friendship. The current study tested whether being disliked by peers exacerbates the negative effects of aggression on friendship and whether being perceived as popular by peers mitigates these damaging effects. Participants were 607 third-, fifth-, seventh-, and ninth-grade students. Support for the hypothesis that being disliked or being perceived as popular would moderate relations between aggression and friendship adjustment was found for the association between relational aggression and friendship conflict. Specifically, relational aggression was associated with having conflictual friendships for youth who were disliked but not for youth who were perceived as popular. In addition, similarity between friends was found in terms of how aggressive youth were as well as in terms of how disliked they were and how popular they were perceived to be. Implications for the well-being and development of aggressive youth are discussed.

Overt and Relational Aggression and Perceived Popularity: Developmental Differences in Concurrent and Prospective Relations

Relations of overt and relational aggression with perceived popularity among children and early adolescents were examined in 2 studies (Ns = 607 and 1,049). Among older youths, positive concurrent relations found between overt aggression and perceived popularity became nonsignificant when relational aggression was controlled, whereas positive associations found between relational aggression and perceived popularity held when overt aggression was controlled. Aggression and perceived popularity were not positively related for the younger participants. The 2nd study also examined the temporal ordering of these relations over 6 months. For older girls, positive relations between relational aggression and perceived popularity were bidirectional. For older boys, relational aggression did not predict increased perceived popularity, but perceived popularity predicted increased relational aggression. Implications for intervention are discussed.

Friends as reporters of children's and adolescents' depressive symptoms

Obtaining information from multiple informants is important when assessing youth depression. Past studies have utilized adults' reports of youths' emotional functioning and aggregate reports from classmates but have not considered close friends as reporters of depressive symptoms. This is surprising given the important roles of friends as companions and confidants. This study investigated relations between friend-reported depressive symptoms and youths' self-reports. From a larger sample of fifth-, seventh-, and ninth-grade participants, self-reports and friend reports of depressive symptoms and friend reports of friendship quality were available for a subset of 367 participants. Significant positive relations emerged between friend reports and self-reports of affective depressive symptoms for girls and youth in high-quality friendships. Relations between friend reports and self-reports were stronger for conduct-related than affective depressive symptoms and reached significance for boys as well as for girls and for youth in low-quality friendships as well as for youth in high-quality friendships. Implications for identifying at-risk youth are discussed.