The integration of the cancer experience into identity: Perspectives from young adults

The study explored how young adults with cancer create a cancer identity across the illness trajectory. Young adults with hematological cancers (n = 53, ages 20-39) completed a semi-structured interview and brief questionnaire. Deductive thematic analysis was used to code interviews. Four identity categories (Acceptance, Enrichment, Engulfment, and Rejection) were coded and linked to the cancer stage (pre-treatment, active treatment, post-treatment). Pre-treatment, there was minimal expression about identity. Acceptance during active treatment involved identity work around disclosure and the integration of pre-cancer identity with the treatment experience. Post-treatment, acceptance involved actively making sense of the cancer experience and its long-term impact; Enrichment was more frequent post-treatment. Engulfment was expressed most during treatment. Individuals who remained engulfed post-treatment expressed difficulties moving beyond the patient's identity. Rejection of a cancer identity was rarely expressed. Understanding how young adults integrate the cancer experience into their identity may suggest intervention strategies.

Above and Beyond Number of Illnesses: A Two-Sample Replication of Current Approaches to Depressive Symptoms in Multimorbidity

OBJECTIVES

To expand current models of depressive symptoms in older adults with multimorbidity (MM) beyond the number of illnesses as a predictor of worsened mental health.

METHODS

Two-sample replication study of adults ≥62 years old with ≥ two chronic illnesses, who completed validated questionnaires assessing depressive symptoms, and disease- and treatment-related stressors. Data were analyzed using hierarchical linear regression.

RESULTS

The model of cumulative number of illnesses was worse at explaining variance in depressive symptoms (Sample 1 R2 = .035; Sample 2 R2 = .029), compared to models including disease- and treatment-related stressors (Sample 1 R2 = .37; Sample 2 R2 = .47). Disease-related stressors were the strongest factor associated with depressive symptoms, specifically, poor subjective cognitive function (Sample 1: b = -.202, p = .013; Sample 2: b = -.288, p < .001) and greater somatic symptoms (b = .455, p < .001; Sample 2: b = .355, p < .001).

CONCLUSIONS

Using the number of illnesses to understand depressive symptoms in MM is a limited approach. Models that move beyond descriptive relationships between MM and depressive symptoms are needed.

CLINICAL IMPLICATIONS

Providers should consider the role of somatic symptom management in patients with MM and depressive symptoms.

Intolerance of uncertainty, experiential avoidance, and trust in physician: a moderated mediation analysis of emotional distress in advanced cancer

We tested whether patients' trust in physician moderated the hypothesized indirect association between intolerance of uncertainty (IU; inability to tolerate the unknown) and emotional distress through the mediator, experiential avoidance (EA; efforts to avoid negative emotions, thoughts, or memories), in patients with advanced cancer. The sample included 108 adults with Stage III or IV cancer (53% female; Mage = 63 years) recruited from a metropolitan cancer center. All constructs were measured by standardized self-report instruments. The PROCESS macro for SPSS tested the moderated mediation model. IU evidenced significant direct and indirect relationships with anxiety and depressive symptoms. Trust in physician moderated the indirect relationship between IU and anxiety (not depressive symptoms), albeit in an unexpected direction. Specifically, the indirect relationship between IU and anxiety symptoms through EA was significant for those with moderate to high physician trust but not low trust. Controlling for gender or income did not change the pattern of findings. IU and EA may be key intervention targets, particularly in acceptance-or meaning-based interventions for patients with advanced cancer.

"Your cancer is no longer considered cancer": Psychological reactions to reclassification information and communication preferences

Objective

In 2016, the encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This reclassification removed the word "carcinoma" and the definition of cancer from the diagnosis. While the nomenclature change was expected to psychologically impact patients, that question has not been systematically explored. Using qualitative methods, we aimed to explore the psychological impact of reclassification on thyroid cancer patients and their preferences for receiving reclassification information.

Methods

Semi-structured interviews with nine non-EFVPTC thyroid cancer survivors were conducted. Participants were presented with a hypothetical reclassification scenario, and interview transcripts were analyzed using a thematic content analytic approach.

Results

Participants expressed a range of psychological reactions to reclassification information, primarily negative, including anger, mistrust, and uncertainty, but also relief. All participants expressed difficulty understanding the concept of reclassification. Communication preferences favored conversation with an established medical provider over written materials, such as a letter.

Discussion and conclusion

Communication must align with patient preferences. Being mindful of potential negative psychological reactions when providing information on cancer reclassification is vital.

Innovation

This study examines reactions to cancer reclassification information and preferences for how this information should be communicated.

Multimorbidity and Depressive Symptoms in Older Adults: A Contextual Approach

BACKGROUND AND OBJECTIVES

Among older adults, depressive symptoms increase with each chronic illness; however, specific disease-related stressors (e.g., pain) and contextual moderators (interpersonal, sociocultural, temporal) of this relationship remain understudied. We explored disease-related stressors associated with depressive symptoms and moderating effects of contextual factors on this relationship, guided by a social ecological framework.

RESEARCH DESIGN AND METHODS

Adults ≥62 years with multimorbidity (n = 366) completed validated scales assessing diagnoses, disease-related stressors (pain intensity, subjective cognitive function, physical function, somatic symptoms), and depressive symptoms. Moderators included age, expectations regarding aging, perceived social support, and difficulty affording medications. Data were analyzed using structural equation modeling.

RESULTS

Participants were 62-88 years old, with several comorbidities (M = 3.5; range: 2-9). As hypothesized, disease-related stressors were associated with depressive symptoms (b = 0.64, SE = 0.04, p < .001). The effect of disease-related stressors on depressive symptoms was greater among those reporting low social support (B = 0.70, SE = 0.06, p < .001) than for those reporting high social support (B = 0.46, SE = 0.06, p < .001). The negative effect of disease-related stressors on depressive symptoms was stronger for those with poorer expectations of aging (B = 0.68, SE = 0.07, p < .001), compared to those with more positive expectations (B = 0.47, SE = 0.06, p < .001). Age and difficulties affording medications were not significant moderators.

DISCUSSION AND IMPLICATIONS

Garnering social support and addressing low expectations for aging may prevent the detrimental effect of multimorbidity on mental health.

Behavioral Medicine Research Council (BMRC) statement papers: A new approach to consensus building in behavioral medicine science

The BMRC has initiated a new initiative, the Behavioral Medicine Research Council (BMRC) Scientific Statement papers. The statement papers will move the field forward by guiding efforts to improve the quality of behavioral medicine research and practice and facilitate the dissemination and translation of behavioral medicine research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The indirect influence of 'invisible' support on pulmonary function among adults with chronic obstructive pulmonary disease

Individuals living with chronic obstructive pulmonary disease (COPD) often require support from family or friends. We examined whether invisible support - support that is provided but goes unnoticed - is related to pulmonary function, and whether this association is mediated by depressive symptoms and illness perceptions. Sixty-six dyads of individuals with COPD and their informal caregivers reported on receipt and provision of support, respectively. Those with COPD completed measures of depressive symptoms, illness perceptions and pulmonary function. Although invisible support was not directly related to pulmonary function, mediation analyses revealed a combined indirect effect through lower depressive symptoms and less negative illness perceptions. Interventions teaching skillful delivery of support to caregivers may reduce depressive symptoms and threatening illness cognitions, which may contribute to improvements in symptom burden among patients with COPD.

Psychological adjustment to initial treatment for low-risk thyroid cancer: Preliminary study

BACKGROUND

Low-risk papillary thyroid carcinoma (LR-PTC) can be managed by immediate surgery (IS) or active surveillance (AS). We compare the psychological impact of these treatments on patients with LR-PTC.

METHODS

Psychological data were collected over 1 year, with assessments at the time of treatment decision (T1), at 6 months (T2) and 12 months (T3) follow-up. Assessments included 13 validated psychological tools.

RESULTS

Of 27 enrolled patients, 20 chose AS and 7 chose IS. The average times to T2 and T3 were 5.7 and 11.3 months, respectively. For both groups, Impact of Events Scale scores significantly decreased (p = 0.001) at T2, and depressive/anxiety symptoms remained low.

CONCLUSIONS

This study demonstrates the feasibility of assessing psychological outcomes among patients treated for LR-PTC. Further studies are needed to evaluate the impact of AS versus IS on quality of life and changes that patients experience over longer time periods following their treatment decision.

Dyadic reciprocal associations between self-efficacy and planning predict sedentary behaviour

OBJECTIVES

There are two alternative hypotheses regarding bidirectional associations between self-efficacy and planning in predicting health behaviour change: self-efficacy may establish planning (cultivation hypothesis) or planning may enable the formation of self-efficacy (enabling hypothesis). This study investigates the order in which these two social cognitions are linked in adult-adult dyads in the context of sedentary behaviours (SB).

DESIGN

A longitudinal study with 4 measurement points, spanning 8 months.

METHODS

A total of 320 dyads (age: 18-90 years) were enrolled. Dyads included a focus person (who received the recommendation to reduce SB and intended to change their SB), and their partners, who were willing to support the focus persons and intended to reduce their own SB as well. Data were collected at Time 1 (T1), Time 2 (1 week later, T2), Time 3 (T3, 2 months after T1) and Time 4 (T4, 8 months after T1). SB was measured with accelerometers at (T1 and T4). Mediation models with individual and dyadic reciprocal effects were tested with path analyses.

RESULTS

Only one indirect effect was found: A higher level of partners' SB reduction-specific self-efficacy at T2 was related to the focus person's more frequent planning to reduce SB at T3, which, in turn, predicted lower SB time among partners at T4.

CONCLUSIONS

The findings provide partial support for the cultivation model (self-efficacy prompting planning) and for dyadic reciprocal associations in the context of SB time reduction among adult dyads.

Behavioral Medicine in the COVID-19 Era: Dawn of the Golden Age

(Reprinted from Ann Behav Med 2020; 54:541-543, with permission from Oxford University Press).

Partners' Consensus About Joint Effort and COVID-19 Prevention Among Sexual Minority Men

The current study examined the relevance of relationship functioning to partners' agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with better relationship functioning tend to be more successful at negotiating joint (shared) goals and subsequently accomplishing them. The study recruited 134 cis-male, SARS-CoV-2 negative adults in relationships with cis-male partners from phone-based social networking applications. Participants completed an online survey assessing relationship functioning (Perceived Relationship Components Questionnaire), COVID-19 prevention behaviors, and risk perceptions. Partners' consensus around joint COVID-19 prevention effort was assessed using an adapted version of the Preferences for Sexual Health Outcomes scale. Path analyses indicated that consensus for joint prevention effort predicted social distancing (B = 0.23; p = .001) and the number of other COVID-19 prevention behaviors engaged in (B = 0.17; p = .003) above and beyond perceived risk and relationship functioning. Relationship satisfaction predicted higher levels of consensus for joint COVID-19 prevention effort (B = 0.40; p = .029). Findings suggest that the theoretical foundations of successful HIV prevention interventions that utilize joint goal formation may generalize to the prediction of COVID-19 prevention behavior and may be leveraged to mitigate the risk of SARS-CoV-2 infection among SMM in relationships. Interventions that overlook the potential for dyadic regulation of health behavior may miss opportunities to capitalize on shared coping resources and fail to address relational barriers to prevention.

Cultural values as a resilience resource for Latino/a adolescents and young adults coping with parental cancer

Purpose: Although research on how adolescents and young adults (AYAs) cope with their own cancer is expanding, there is little knowledge on how AYAs cope with a parent's cancer. And, thus, little evidence-based knowledge for how to deliver services. Moreover, most research has been with majority White populations. To fill this gap, we examined whether the cultural values of familismo (familism) and espíritu (spirit) moderate the association between stress appraisals and coping with psychological distress among Latino/AYAs facing a parent's cancer.Design: Cross-sectional, observational.Sample: Thirty eight adolescents and young adults between the ages of 12 and 25 whose mother had breast cancer.Methods: Participants completed standardized measures. Generalized estimating equation analysis was used to analyze the nested data.Results: There was a protective pattern of familismo and espíritu against symptoms of depression. AYAs experienced psychological distress, but those with higher levels of familismo and espíritu fared better than those with lower levels, regardless of the coping strategies they used.Implications: Psychosocial interventions for Latino/a AYAs coping with parental cancer should incorporate or strengthen these values.

The experience of financial stress among emerging adult cancer survivors

Objective: The experience of cancer-related financial stress was examined within the developmental context of emerging adulthood.Methodological approach: This study is a secondary analysis of data drawn from two samples of testicular or hematologic cancer survivors. In-depth interviews from 52 emerging adult (EA) cancer survivors, ages 18-29, were coded by combining thematic analysis with an abductive approach.Findings: Emergent themes included some common to most age groups, including worries about medical costs and availability of health insurance, as well as specific age-related concerns, such as fertility preservation. Financial stress appeared to interrupt developmental tasks of emerging adulthood, including completing an education, establishing independence, and managing relationships. Surprisingly, financial stress was experienced as a benefit for some participants.Conclusion: Financial stress affects EA cancer survivors in unique ways. To provide support, health professionals should consider survivors' developmental life stage to understand their financial stress, and ultimately, to improve quality of life.

Racial/ethnic concordance between patients and researchers as a predictor of study attrition

RATIONALE

The differential attrition of racial/ethnic minority participants in clinical research is a major threat to advancing medical and behavioral science.

OBJECTIVE

Our aim was to examine the influence of racial/ethnic concordance between participants and research staff on study attrition.

METHOD

Data were pooled from participants and clinical research coordinators (CRCs) in six longitudinal studies of respiratory illness. Dyads were classified as concordant if the patient and CRC were of the same racial/ethnic group. Multilevel modeling examined the effect of racial/ethnic concordance on attrition at the first and one-year follow-ups.

RESULTS

Spanish language, lower education, and greater depressive symptoms predicted greater attrition, but these effects disappeared in adjusted models. Race/ethnicity, age, gender and health literacy did not predict attrition. Contrary to hypotheses, attrition was greater among concordant than discordant dyads: Attrition was almost five times greater at first follow-up for Black and Hispanic participants in concordant dyads, and almost four times greater at one year.

CONCLUSIONS

Racial/ethnic concordance between participant and CRCs was related to greater attrition in a highly diverse sample of adults with respiratory illness. Differential attrition of racial/ethnic minorities is a major threat to advancing public health. Interactions with research staff may be critical to bridging the disparities gap.

We are in this together - Aren't we? Congruence of common dyadic coping and psychological distress of couples facing breast cancer

OBJECTIVES

Breast cancer (BC) can be understood as a we-disease, which affects a couple as a unit and requires coping as a unit (eg, common dyadic coping, CDC). However, partners can be incongruent in their perceptions of CDC, for example, because of misunderstandings and lack of mutuality or conflict, which may likely be associated with greater distress. Thus, this paper examines the effect of CDC congruence on individual psychological distress in cancer patients and their partners.

METHODS

Seventy mixed-sex couples in which the woman had nonmetastatic BC completed self-report questionnaires at 2 weeks, 3 months, and 1 year after cancer surgery. CDC congruence measured the difference between patients' and partners' CDC perceptions while controlling for CDC itself.

RESULTS

Multilevel modeling showed negative associations between couples' CDC and psychological distress. Beyond this effect, female patients' psychological distress was associated with CDC congruence with an interaction showing that psychological distress was greater when couples were congruent with low rather than a high CDC.

CONCLUSION

Less congruence was associated with greater psychological distress in BC patients but not their male partners - especially if the couple reported low CDC. Health professionals should identify and address diverging perceptions, so that additional distress can be minimized for BC patients.

Dorothy G. Singer (1927-2016)

Presents an obituary of Dorothy G. Singer (1927-2016) who passed away on November 19, 2016, at Yale New Haven Hospital, at the age of 89. Singer was a professor, research scientist, consultant, child therapist, and author. As the author or coauthor of more than 25 books and 200 scientific and popular articles, Singer brought new insights to child development, particularly in the areas of imaginative play and the effects of TV on children. She was a tireless advocate for the power of play in children's lives. (PsycINFO Database Record

Depression in individuals with chronic obstructive pulmonary disease and their informal caregivers

OBJECTIVE

Individuals with chronic obstructive pulmonary disease (COPD) and their caregivers are at high risk for developing depression. Depression can adversely affect the quality of life of patients and caregivers; however, studies in COPD have largely examined predictors of patient and caregiver depression in isolation. This dyadic study examined individual-level predictors of patient and caregiver depression in COPD (i.e. actor effects) as well as how dyad members effect each other's depression (i.e. partner effects).

METHODS

Survey data were collected from 89 patient-caregiver dyads that were enrolled in a multi-site cohort study.

RESULTS

Participants were predominantly women (61% of patients and 76% of caregivers) and racial/ethnic minorities (65% of patients and 63% of caregivers). Based on PHQ9 cutoffs, 30% of patients and 20% of caregivers had mild depression; 30% of patients and 8% of caregivers had moderate to severe depression. Multilevel models with the dyad as the unit of analysis showed that less frequent patient self-management, higher levels of caregiver burden, and being in poorer health were associated with higher levels of depression for both dyad members. Higher levels of depression in a partner were also associated with higher levels of depression for women, regardless of whether women were patients or caregivers.

CONCLUSION

Findings suggest that similar factors predict patient and caregiver depression in COPD and that women are at increased risk for developing depression when their partners are depressed. Dyadic psychosocial interventions that target patients and their caregivers may thus be beneficial in terms of addressing depression in this this vulnerable population.

Gay men's experiences with prostate cancer: Implications for future research

Gay men's experiences with prostate cancer and its impact on health-related quality of life are poorly understood. This qualitative study explored gay men's experience with prostate cancer with a focus on the emotional, physical, and sexual impact of cancer; support needs; and healthcare interactions. Three semi-structured focus groups of gay men with prostate cancer were conducted. A conventional content analytic approach was used to identify six primary content areas that described poignant aspects of the men's experience with prostate cancer: minority stress, intimacy and sexuality concerns, impact on life outlook, healthcare experiences, social support and the gay community, and intersectional identities.

Letting Oneself Go Isn't Enough: Cognitively Oriented Expressive Writing Reduces Preadolescent Peer Problems

Peer problems are a stressor for many early adolescents, and simple cost-effective tools for managing peer stress are needed. Expressive writing (EW) may be one such tool. With a sample of middle school children aged 12-14 years (n = 119; 53% males), this research evaluates whether cognitively oriented expressive writing (CEW), which focuses more on psychological self-distancing, improves personal well-being better than traditional EW, which focuses more on emotional disclosure. CEW-compared with EW-slightly enhanced long-term social adjustment for the entire sample, and increased positive affect for those early adolescents that reported more peer problems at baseline. These findings suggest that structured writing instructions with early adolescents may be key to improvements.

Testing with feedback improves recall of information in informed consent: A proof of concept study

OBJECTIVE

This study investigates whether applying educational testing approaches to an informed consent video for a medical procedure can lead to greater recall of the information presented.

METHODS

Undergraduate students (n=120) were randomly assigned to watch a 20-min video on informed consent under one of three conditions: 1) tested using multiple-choice knowledge questions and provided with feedback on their answers after each 5-min segment; 2) tested with multiple choice knowledge questions but not provided feedback after each segment; or 3) watched the video without knowledge testing.

RESULTS

Participants who were tested and provided feedback had significantly greater information recall compared to those who were tested but not provided feedback and to those not tested. The effect of condition was stronger for moderately difficult questions versus easy questions.

CONCLUSIONS

Inserting knowledge tests and providing feedback about the responses at timed intervals in videos can be effective in improving recall of information.

PRACTICAL IMPLICATION

Providing informed consent information through a video not only standardizes the material, but using testing with feedback inserted within the video has the potential to increase recall and retention of this material.

The Role of Perceived Self-Efficacy, Perceived Control, and Causal Attributions in Adaptation to Rheumnatoid Arthritis: Distinguishing Mediator from Moderator Effects

To examine mediational versus moderational relationships among perceived control self-efficacy, and causal attributions in adjustment to chronic iUness, data were obtained at two times from 64 rheumatoid arthritis (RA) patients. Adaptational outcomes were operationalized as depression and disability. Greater evidence wasfoundfor moderational than mediational models. Only one of six mediational hypotheses was significant: Self-efficacy mediated the relationship between perceived control and disability. Four of six moderational hypotheses were significant in concurrent adaptation, and three of these remained significant when later adaptation was assessed. Moderational effects differed for depression and disability: When RA controllability or patient selfefficacy was low, internal, global, stable attributions for the cause of a symptom flare were linked to greater depression but less disability. These disparate findings are discussed in terms of the learned-helplessness model and the context of chronic illness.

Researcher Knows Best?

Missing from recent critiques of coping measurement are data demonstrating whether concepts used by researchers are understood by study participants. We asked 101 rheumatoid arthritis patients to complete a structured coping checklist and provide descriptions of their coping for each item checked. Trained researchers coded these open-ended descriptions using the original checklist categories. In general, patients' descriptions of their coping matched researcherderived definitions; however, patients were less likely to interpret cognitive and affective coping strategies in the manner intended by researchers. Patients' descriptions often crossed multiple categories, suggesting complex patterns not captured by most data analytic techniques. Whether they assess coping through structured measures or not, researchers must find ways to examine the multiple meanings and combinations of strategies that constitute the coping process. Keywords

ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM

OBJECTIVE

The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy.

METHODS

We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed.

RESULTS

Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance.

CONCLUSION

With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

How effective are expressive writing interventions for adolescents? A meta-analytic review

This meta-analysis evaluated the effects of the expressive writing intervention (EW; Pennebaker & Beall, 1986) among adolescents. Twenty-one independent studies that assessed the efficacy of expressive writing on youth samples aged 10-18 ears were collected and analyzed. Results indicated an overall mean g-effect size that was positive in direction but relatively small (0.127), as well as significant g-effect sizes ranging from 0.107 to 0.246 for the outcome domains of Emotional Distress, Problem Behavior, Social Adjustment, and School Participation. Few significant effects were found within specific outcome domains for putative moderator variables that included characteristics of the participants, intervention instructions, or research design. Studies involving adolescents with high levels of emotional problems at baseline reported larger effects on school performance. Studies that implemented a higher dosage intervention (i.e., greater number and, to some extent, greater spacing of sessions) reported larger effects on somatic complaints. Overall, the findings suggest that expressive writing tends to produce small yet significant improvements on adolescents' well-being. The findings highlight the importance of modifying the traditional expressive writing protocol to enhance its efficacy and reduce potential detrimental effects. At this stage of research the evidence on expressive writing as a viable intervention for adolescents is promising but not decisive.

Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer

OBJECTIVE

This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.

DESIGN

Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.

MAIN OUTCOME MEASURES

Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.

RESULTS

Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.

CONCLUSIONS

Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

Early changes in socioeconomic status do not predict changes in body mass in the first decade of life

BACKGROUND

Many studies link childhood socioeconomic status (SES) to body mass index (BMI), but few account for the impact of socioeconomic mobility throughout the lifespan.

PURPOSE

This study aims to investigate the impact of socioeconomic mobility on changes in BMI in childhood. Analyses tested whether [1] socioeconomic status influences BMI, [2] changes in socioeconomic status impact changes in BMI, and [3] timing of socioeconomic status mobility impacts BMI.

METHODS

Secondary data spanning birth to age 9 were analyzed. SES and BMI were investigated with gender, birth weight, maternal race/ethnicity, and maternal nativity as covariates. Autoregressive structural equation modeling and latent growth modeling were used.

RESULTS

Socioeconomic status in the first year of life predicted body mass index. Child covariates were consistently associated with body mass index. Rate of change in socioeconomic status did not predict change in body mass index.

CONCLUSIONS

The findings suggest that early socioeconomic status may most influence body mass in later childhood.

Caregivers' burden and depressive symptoms: the moderational role of attachment orientations

OBJECTIVE

The current study explored whether attachment orientations moderate the associations between caregiver burden and depressive symptoms among women coping with their partners' first time acute coronary syndrome. The association between burden and depression was hypothesized to be stronger among caregivers high on anxious attachment than among caregivers low on this dimension. In addition, the association between burden and depressive symptoms was hypothesized to be weaker among caregivers higher on avoidant attachment than among those lower on this dimension.

METHOD

The sample consisted of 111 female caregivers of male patients admitted to the cardiac care unit of a hospital in Israel. Caregivers completed a measure of attachment orientations during patients' hospitalization (baseline). Caregiver burden was measured 1 month later. Depressive symptoms were measured at baseline and again at 6-month follow-up. Structural equation modeling was used to test the moderational models.

RESULTS

The association between caregiver burden and depressive symptoms at follow-up was moderated by attachment-related anxiety but not attachment-related avoidance. Congruent with predictions, a stronger association between caregiver burden and depressive symptoms occurred for caregivers with greater (vs. lower) attachment anxiety.

CONCLUSIONS

The findings shed light on the possible dynamics among attachment orientations and affect regulation when coping with one's partner's illness. The findings are discussed in light of Pietromonaco, Uchino, and Dunkel Schetter's (2013) model of integrating attachment into health psychology research.

Spirometry screening for airway obstruction in asymptomatic smokers

BACKGROUND

Screening spirometry might help identify patients with chronic obstructive pulmonary disease (COPD) at an earlier stage. In this study, we evaluated the prevalence of airway obstruction in a cohort of asymptomatic smokers who underwent spirometry as part of a routine health maintenance examination.

METHODS

The study cohort consisted of a consecutive sample of 386 asymptomatic smokers (≥5 pack-years) without a history of COPD or asthma, who completed spirometry testing as part of a routine health maintenance examination.

RESULTS

Overall, 9 study subjects (2.3%, 95% confidence interval: 1.1-4.4%) had evidence of airway obstruction on spirometry. Univariate and multiple regression analyses showed that the risk of airway obstruction was not significantly associated with age, sex, race, smoking history or past history of respiratory symptoms.

DISCUSSION

Spirometry screening of asymptomatic smokers may help detect a small number of patients with airway obstruction who are at high risk for COPD.

Unrealistic optimism among adolescent smokers and nonsmokers

Two studies were conducted to investigate unrealistic optimism among adolescent cigarette smokers. In the first study, 54 smokers and 304 nonsmokers agreed that there was a strong relationship between smoking and lung cancer. Nonsmokers accurately perceived their chances of contracting lung cancer as below average. However, smokers perceived themselves as having only an average chance of contracting lung cancer. The second study replicated the first in both procedure and results regarding lung cancer, but also added perceptions of the relationship between smoking and two other smoking-related health problems, emphysema and heart attacks. The results were similar: 33 smokers rated their chances of developing emphysema and having heart attacks as higher than 299 nonsmokers, but still viewed their chances as only about average. Finally, perceptions of stress were examined. Smokers perceived themselves to be under more stress than nonsmokers. It was concluded that self-deception as indicated by unrealistic optimism regarding the chances of getting smoking-related diseases characterized adolescent smokers.

Applying theory across settings, behaviors, and populations: translational challenges and opportunities

Basic social psychological theories have much to contribute to our understanding of health problems and health-related behaviors and may provide potential avenues for intervention development. However, for these theories to have broader reach and applicability to the field of health psychology, more work needs to be done in integrating contexts into these theories and addressing more specifically their application across settings, behaviors, and populations. We argue that integration of these theories into a broader multidisciplinary and multilevel ecological framework is needed to enhance their translation into real-world applications. To enhance this translation, we make several recommendations, including breaking down silos between disciplinary perspectives and enhancing bidirectional communication and translation; analyzing boundary conditions of theories; expanding research approaches to move outside the laboratory and maintain a focus on external validity; and conducting efficacy testing of theories with meaningful, relevant endpoints.

Dyadic coping in metastatic breast cancer

OBJECTIVE

Couples facing metastatic breast cancer (MBC) must learn to cope with stressors that can affect both partners' quality of life as well as the quality of their relationship. Common dyadic coping involves taking a "we" approach, whereby partners work together to maintain their relationship while jointly managing their shared stress. This study prospectively evaluated whether common dyadic coping was associated with less cancer-related distress and greater dyadic adjustment for female MBC patients and their male partners.

DESIGN

Couples (N = 191) completed surveys at the start of treatment for MBC (baseline), and 3 and 6 months later.

MAIN OUTCOME MEASURES

Cancer-related distress was assessed with the Impact of Events Scale; dyadic adjustment was assessed using the short-form of the Dyadic Adjustment Scale.

RESULTS

Multilevel models using the couple as the unit of analysis showed that the effects of common positive dyadic coping on cancer-related distress significantly differed for patients and their partners. Whereas partners experienced slightly lower levels of distress, patients experienced slightly higher levels of distress. Although patients and partners who used more common negative dyadic coping experienced significantly greater distress at all times, the association was stronger for patients. Finally, using more common positive dyadic coping and less common negative dyadic coping was mutually beneficial for patients and partners in terms of greater dyadic adjustment.

CONCLUSION

Our findings underscore the importance of couples working together to manage the stress associated with MBC. Future research may benefit from greater focus on the interactions between patients and their partners to address ways that couples can adaptively cope together.

Health psychology: psychological adjustment to chronic disease

Chronic diseases carry important psychological and social consequences that demand significant psychological adjustment. The literature is providing increasingly nuanced conceptualizations of adjustment, demonstrating that the experience of chronic disease necessitates adaptation in multiple life domains. Heterogeneity in adjustment is apparent between individuals and across the course of the disease trajectory. Focusing on cancer, cardiovascular disease, and rheumatic diseases, we review longitudinal investigations of distal (socioeconomic variables, culture/ethnicity, and gender-related processes) and proximal (interpersonal relationships, personality attributes, cognitive appraisals, and coping processes) risk and protective factors for adjustment across time. We observe that the past decade has seen a surge in research that is longitudinal in design, involves adequately characterized samples of sufficient size, and includes statistical control for initial values on dependent variables. A progressively convincing characterization of risk and protective factors for favorable adjustment to chronic illness has emerged. We identify critical issues for future research.

Effects of social stressors on cardiovascular reactivity in Black and White women

BACKGROUND

Behavioral scientists have theorized that perceived racism in social interactions may account for some of the observed disparities in coronary heart disease between Black and White Americans.

PURPOSE

The objective was to examine whether racial stress influences cardiovascular reactivity, a risk factor for cardiovascular disease.

METHODS

We measured cardiovascular responses in Black and White women (n = 80) as they talked about 3 hypothetical scenarios: (a) being accused of shoplifting (racial stressor), (b) experiencing airport delays (nonracial stressor), and (c) giving a campus tour (control).

RESULTS

Relative to White women, Black women had significantly greater mean diastolic blood pressure reactivity (3.81 vs. 0.25 mmHg; p < .05) in response to the racial stressor than in response to the nonracial stressor. Black women exhibited significantly lower heart rate during recovery following the racial stressor than during recovery following the nonracial stressor (-0.37 beats/min vs. 0.86 beats/min; p < .001). Among Black women, those who explicitly made race attributions during the racial stressor had greater systolic but not diastolic blood pressure reactivity than those who did not make racial attributions (8.32 mmHg vs. 2.17 mmHg; p < .05).

CONCLUSIONS

These findings suggest that perceived racism in social interactions may contribute to increased physiological stress for Black women.

Illness intrusion and psychological adjustment to rheumatic diseases: a social identity framework

OBJECTIVE

To examine the extent to which arthritis intruded upon 4 social roles (spouse, homemaker, parent, worker). In accordance with propositions set forth by social identity theory and the identity-relevant stress hypothesis, we hypothesized that 1) illness intrusion would predict psychological well-being and 2) role importance would moderate the relationship between illness intrusion and psychological adjustment, such that intrusion into highly valued roles would be the most psychologically distressing.

METHODS

Participants were recruited from the practices of rheumatologists affiliated with a major urban hospital. A total of 113 individuals (73% women) with diagnosed rheumatic disease completed a mailed questionnaire.

RESULTS

For all 4 roles, illness intrusion was related to decreased psychological well-being. In the worker and parent roles, the effects of illness intrusion on adjustment were moderated by whether respondents valued these particular roles. For example, psychological well-being was lowest among those individuals whose illness intruded greatly upon work and who highly valued their worker role identity.

CONCLUSION

The findings highlight the advantages of assessing both domain-specific illness intrusion and role importance in predicting psychological well-being among persons with rheumatic diseases. Importantly, results also demonstrate the utility of applying a social identity framework in understanding adjustment processes among persons with chronic illness.