The moderating role of diabetes distress on the effect of a randomized eHealth intervention on glycemic control in Black adolescents with type 1 diabetes.

OBJECTIVE: Due to systemic inequities, Black adolescents with type 1 diabetes are more likely to have suboptimal glycemic control and high rates of diabetes distress, but tailored interventions for this population are lacking. In primary outcomes of a randomized clinical trial, a family-based eHealth intervention improved glycemic control in Black adolescents with type 1 diabetes and elevated depressive symptoms. The present study is a secondary analysis of these clinical trial data examining the moderating effect of diabetes distress on the efficacy of the intervention. METHODS: Using secondary data from a multicenter randomized clinical trial (Clinicaltrials.gov [NCT03168867]), caregiver-adolescent dyads were randomly assigned to either up to three sessions of an eHealth parenting intervention (n = 75) or a standard medical care control group (n = 74). Black adolescents (10 years, 0 months to 14 years, 11 months old) with type 1 diabetes and a caregiver willing to participate were eligible. Adolescents reported their diabetes distress at baseline, and hemoglobin A1c (HbA1c) data were collected at baseline, 6-, 13-, and 18-month follow-up. RESULTS: No between-group contrasts emerged in a linear mixed-effects regression (p's > .09). Within-group contrasts emerged such that adolescents assigned to the intervention who reported high diabetes distress had lower HbA1c at the 18-month follow-up relative to baseline (p = .004); the 18-month decrease in HbA1c was -1.03%. CONCLUSIONS: Black adolescents with type 1 diabetes and high levels of diabetes distress showed significant decreases in HbA1c following a family-based eHealth intervention, suggesting diabetes distress may be a key moderator of intervention efficacy within this population.

Age and Sex Differences in the Associations Among Socioeconomic Status, Affective Reactivity to Daily Stressors, and Physical Health in the MIDUS Study.

BACKGROUND: Low socioeconomic status (SES) is robustly associated with increased risks of morbidity and mortality. Affective reactivity to daily stressors has been proposed to be a mediator for this association. However, few longitudinal studies have empirically tested the indirect effect of SES on health through affective reactivity to daily stressors. PURPOSE: This study aimed to test the indirect effect of SES on physical health via affective reactivity to daily stressors over a 10-year period and to explore age and sex differences in such indirect effect. METHODS: Data were drawn from a subsample of 1,522 middle-aged and older adults (34-83 years of age, 57.2% female, 83.5% White) from the Midlife in the United States study. SES (i.e., education, household income, indicators of financial distress) was assessed in 2004-2006. Affective reactivity to daily stressors was computed using data collected during the 8-day daily stress assessment in 2004-2009. Self-reported physical health conditions were assessed in 2004-2006 and 2013-2014. RESULTS: There was a significant indirect effect of lower SES on more physical health conditions via elevated negative affective reactivity to daily stressors among women but not men. The indirect effect of SES on physical health conditions via negative affective reactivity to daily stressors was consistent across the middle and older adulthood. CONCLUSIONS: Our findings suggest that negative affective reactivity to daily stressors might be a key intermediate process contributing to persistent SES disparities in physical health, particularly among women.

Individuals from low socioeconomic backgrounds tend to experience poor physical health, partially because they might be more vulnerable to stress exposure due to limited resources to cope with stress than those from high socioeconomic backgrounds. This study examined the indirect link between socioeconomic status (SES) and physical health through emotional responses following exposure to stress. We also explored whether there were age and sex differences in this indirect link. We analyzed the survey and daily diary data from 1,522 middle-aged and older adults. Individuals reported indicators of SES and a count of medical health conditions. Individuals also reported their experiences of stressors and negative and positive emotions each day over 8 days to capture changes in negative and positive emotions on stressor days versus non-stressor days. We found that among women, but not men, lower SES was related to larger increases in negative emotions on stressor days, which, in turn, was related to more chronic health conditions. Differences in individuals' negative emotions following exposure to daily stressors may be a critical indirect pathway linking SES to physical health.

Perceived Stress Mediates Associations Between Grit and Health-Related Quality of Life.

Grit, characterized by passion and perseverance in the pursuit of long-term goals, may be associated with enhanced quality of life and reduced levels of perceived chronic stress. We hypothesized that reduced levels of perceived stress may mediate the association between facets of grit (i.e., Perseverance and Consistency) and healthy functioning. We conducted two studies, one with college students and one with community adults, to test this hypothesis (cumulative N = 600). In both studies, facets of grit were assessed using the Short Grit Scale, levels of perceived chronic stress were assessed via the Perceived Stress Scale, and health-related quality of life was measured using selected questions from the Medical Outcome Study Short Form-36. Consistent with our hypothesis, perceived stress levels significantly mediated the relation between Grit-Perseverance and health-related quality of life in both college students and community adults. Our data suggest that individuals with high Grit-Perseverance experience lower perceived stress, which may result in improved health-related quality of life. Additionally, perceived stress partially mediated the relation between Grit-Consistency and health-related quality of life, but only in community adults. These novel findings suggest that the association between Grit-Perseverance and perceived chronic stress may differ for college students and community adults. Overall, our work indicates that perceived stress may be a key mediator through which facets of grit are related to healthy functioning in college students and community adults.

Rumination and Gender in the Relation Between Perceived Threat and State Anxiety During COVID-19.

OBJECTIVES: Perception of and subsequent responses to counter threats by disease, such as COVID-19, are essential for engagement in self-protective behaviors. But, associated increases in anxiety that accompany the threat of disease may negatively impact well-being. Therefore, identifying variables that may modulate the association between perceived threat from COVID-19 and anxiety is important. We conducted a study to examine the moderating roles of two subtypes of rumination (brooding and reflection) in the association between perceived threat from COVID-19 and state anxiety. Additionally, as both COVID-19 outcomes and the tendency to ruminate differ across genders, we explored gender as a second moderator. METHODS: Participants (N = 300; Men = 144) were recruited online in April 2020 and completed measures of state anxiety, brooding and reflective rumination, and perceived threat from COVID-19. RESULTS: Moderation regression analyses revealed that perceived threat and brooding were independently associated with increased state anxiety. Reflective rumination and gender, however, significantly moderated the relation between perceived threat and state anxiety. For men, reflective rumination strengthened the association between threat and anxiety. For women, reflective rumination weakened this association; women with the highest scores in reflective rumination also reported high state anxiety at low, medium, and high perceived threat levels. CONCLUSIONS: These findings illuminate gender differences in the relations between perceived threat, rumination, and experienced state anxiety during the pandemic.

Differential Associations between Strategies of Emotion Regulation and Facets of Grit in College Students and Adults.

According to socioemotional selectivity theory, motivation influences emotion regulation. Grit is a motivation orientation defined by the passionate pursuit of long-term goals. We conducted two studies to determine the relation between facets of grit and two emotion regulation strategies: cognitive reappraisal and expressive suppression. In Study 1, we examined the relation between these variables in college students (20-24 year olds), and Study 2 focused on community adults (25-72 year olds). Facets of grit were assessed using the Short Grit Scale and habitual use of emotion regulation strategies was assessed using the Emotion Regulation Questionnaire. We combined data from both studies and conducted regression analyses to examine the role of each facet of grit, participant's age, and the interaction between age and facets of grit in the habitual use of either reappraisal or suppression as strategies to regulate emotions. The regression analyses revealed that both facets of grit were positively associated with reappraisal regardless of age. However, the facets of grit differed in their associations with expressive suppression. Grit-Consistency was negatively associated with expressive suppression, regardless of age. But, a significant interaction effect with participant's age emerged for Grit-Perseverance. Specifically, Grit-Perseverance was positively associated with expressive suppression only in individuals below the age of 31. Overall, the data suggest that the relations between facets of grit and habitual use of emotion regulation strategy may vary with age. Additionally, our work indicates adults with high levels of grit may experience healthy emotional functioning, particularly later in adulthood.