Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome.

OBJECTIVE: Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. METHODS: Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. RESULTS: The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). CONCLUSIONS: Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.

COVID-19 distress and interdependence of daily emotional intimacy, physical intimacy, and loneliness in cohabiting couples.

Introduction: COVID-19 has had a profound impact on relationship functioning, though effects have been heterogeneous. Reasons for divergent effects on relationship functioning remain unclear. Theoretical models suggest that it is not just stress exposure that leads to adverse relationships outcomes, but also subjective response to these stressors. Using data from a 14-day intensive longitudinal study of romantic dyads, we hypothesized that COVID-19-related distress would adversely impact one's own and one's partner's report of relationship functioning, on average. Interdependence at the between-couple and within-couple level was also examined. Methods: Participants were 104 female-male romantic couples cohabiting the New York metropolitan area (Mage = 28.86, SDage = 7.69) between August 2020 - April 2021. Couples reported COVID-19 distress during a baseline interview and daily relationship functioning for 14 days. Multilevel models were specified for six outcomes simultaneously: female and male partner daily physical intimacy, emotional intimacy, and loneliness. Interrelationships of the intercepts of the six outcomes were specified, reflecting between-couple associations of each partner's stable outcome tendencies. Interrelationships of the daily residuals of the six outcomes were also specified, reflecting within-couple associations at the daily level. Results: Female partner COVID-19 distress was inversely associated with her own emotional and physical intimacy and positively associated with her own and her partner's loneliness. Male COVID-19 distress was associated with his own loneliness only. There was significant interdependence at the between- and within-couple level, such that greater loneliness in either partner was associated with less intimacy in each member of the couple. Discussion: Only one partner effect for COVID-19 distress emerged, such that female partner distress was associated with male partner loneliness; however, interdependence at the between- and within-couple level suggested that distress may adversely impact relational well-being over time. Future studies should examine reciprocal relationships between COVID-19-related distress and relationship functioning.

A Tribute to the Mind, Methodology and Mentoring of Wayne Velicer.

Wayne Velicer is remembered for a mind where mathematical concepts and calculations intrigued him, behavioral science beckoned him, and people fascinated him. Born in Green Bay, Wisconsin on March 4, 1944, he was raised on a farm, although early influences extended far beyond that beginning. His Mathematics BS and Psychology minor at Wisconsin State University in Oshkosh, and his PhD in Quantitative Psychology from Purdue led him to a fruitful and far-reaching career. He was honored several times as a high-impact author, was a renowned scholar in quantitative and health psychology, and had more than 300 scholarly publications and 54,000+ citations of his work, advancing the arenas of quantitative methodology and behavioral health. In his methodological work, Velicer sought out ways to measure, synthesize, categorize, and assess people and constructs across behaviors and time, largely through principal components analysis, time series, and cluster analysis. Further, he and several colleagues developed a method called Testing Theory-based Quantitative Predictions, successfully applied to predicting outcomes and effect sizes in smoking cessation, diet behavior, and sun protection, with the potential for wider applications. With $60,000,000 in external funding, Velicer also helped engage a large cadre of students and other colleagues to study methodological models for a myriad of health behaviors in a widely applied Transtheoretical Model of Change. Unwittingly, he has engendered indelible memories and gratitude to all who crossed his path. Although Wayne Velicer left this world on October 15, 2017 after battling an aggressive cancer, he is still very present among us.

Posttraumatic stress disorder (PTSD) in a sample of patients evaluated for acute coronary syndrome: A factor analysis of the PTSD checklist for DSM-5 (PCL-5).

The PCL-5 is a psychometrically sound measure of Post-Traumatic Stress Disorder (PTSD) symptoms. Although the scale is commonly applied to past external traumas (e.g., combat, assault), PTSD symptoms have also been assessed about potentially life-threatening cardiovascular events that represent ongoing internal threats. To date, there is a paucity of studies that have examined the updated scale factor structure for PTSD in patients with suspected acute coronary syndromes (ACS). METHODS: Exploratory and confirmatory factor analyses (EFA, CFA) were conducted using PCL-5 data completed by 830 patients enrolled in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Follow-up measurement invariance tests were conducted on pre-selected models and on the best-fitting model identified by EFA to evaluate invariance across diagnosis (confirmed v. rule-out ACS), sex, and language. RESULTS: The EFA identified a two-factor model with "Memories of Trauma" (MT) and "Cognitive Behavioral Symptoms" (CBS) factors offering a balanced fit and interpretability. In CFAs, the Anhedonia CFA model performed the best overall. Measurement invariance tests supported strong invariance across confirmed and ruled-out ACS, male and female sex, and English and Spanish language for all models. LIMITATIONS: Only 34 % of the sample was diagnosed with ACS at discharge, which limits generalizability. CONCLUSION: Our study contributes to the understanding of PTSD in the context of internal traumatic reminders and may guide future research and clinical practice by informing intervention targets to improve health and well-being after suspected ACS.

Trajectories of problem behaviors from 4 to 23 years in former preterm infants.

Premature infants have significant risk for later behavior problems. This study examined growth trajectories of three problem behaviors across five developmental age points from preschool to early adulthood in a well-characterized sample of premature infants. The effects of neonatal risk, gender, and socioeconomic context were modeled on these trajectories. The longitudinal sample was comprised of preterm infants (N = 160) with full variation of neonatal morbidity and birth weight (640-1950 grams). Trajectories of externalizing, internalizing and attention problem behaviors from 4 to 23 years, measured by the Child Behavior Checklist, were tested using latent growth curve modeling. The results indicate individual variation in the number of externalizing and internalizing problems over time. Externalizing problems were not significantly different for males and females, but male scores were consistently higher. Neonatal risk was significantly associated with higher internalizing problems at age 4, but was not predictive at school age and beyond. Attention problem scores increased from early preschool through adolescence for males, but females had little change over the same ages. SES was not predictive of any problem behavior trajectories and no significant two-way interactions were found. The results advance understanding of stability and change of three important problem behaviors through preschool, childhood and adolescence to young adulthood in prematurely born infants in order to inform clinicians about timely assessment and the refinement of effective interventions.