Health-Related Social Control and Perceived Stress Among High-Risk Latina Mothers with Type 2 Diabetes and Their At-Risk Adult Daughters.

BACKGROUND: Diabetes-related multi-morbidity and cultural factors place Latinas with diabetes at increased risk for stress, which can threaten illness management. Families provide an ideal focus for interventions that seek to strengthen interpersonal resources for illness management and, in the process, to reduce stress. The current study sought to examine whether participating in a dyadic intervention was associated with reduced perceived stress and, furthermore, whether this association was mediated by persuasion and pressure, two forms of health-related social control. METHOD: Latina mothers with diabetes and their at-risk adult daughters participated in either (1) a dyadic intervention that encouraged constructive collaboration to improve health behaviors and reduce stress, or (2) a usual-care minimal control condition. Actor-partner interdependence model analysis was used to estimate the effect of the intervention on dyads' perceived stress, and mother-daughter ratings of health-related social control as potential mediators. RESULTS: Results revealed that participating in the intervention was associated with significantly reduced perceived stress for daughters, but not for mothers (ß = - 3.00, p = 0.02; ß = - 0.57, p = 0.67, respectively). Analyses also indicated that the association between the intervention and perceived stress was mediated by persuasion, such that mothers' who experienced more health-related persuasion exhibited significantly less post-intervention perceived stress (indirect effect = - 1.52, 95% CI = [- 3.12, - 0.39]). Pressure exerted by others, however, did not evidence a mediating mechanism for either mothers or daughters. CONCLUSION: These findings buttress existing research suggesting that persuasion, or others' attempts to increase participants' healthy behaviors in an uncritical way, may be a driving force in reducing perceived stress levels.

Do cultural values have a role in health equity? A study of Latina mothers and daughters.

OBJECTIVES: Recently, there has been a call to better understand Latino health and arrive at effective approaches for achieving health equity via research focusing on the association between cultural factors and health. This study examined whether familism, a cultural value that emphasizes warm and close family relationships, would attenuate the negative effects that perceived stress, a psychological process that can worsen health, can have on two physical health indicators- number of health conditions and bodily pain. METHOD: Latina mothers (n = 85, Mage = 52.68, SD = 6.60) with Type 2 diabetes and their daughters (n = 86, Mage = 27.69, SD = 7.61) whose weight put them at risk for also developing the condition were recruited to take part in a larger intervention study aimed at improving weight loss/dietary intake. Participants completed measures of familism, perceived stress, health conditions, and bodily pain. RESULTS: Results indicated that in the daughters, familism and perceived stress interacted to predict health conditions and bodily pain. As familism decreased, stress was associated with more health conditions and more bodily pain. These interactions were not significant for the mothers. CONCLUSIONS: First, familism has the potential to buffer the negative effect of stress in ways that are protective for health among Latinas at risk for diabetes. Second, this buffering effect has boundary conditions, suggesting that a better understanding is needed of how, for whom, and under what circumstances familism can be beneficial for health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Care, control, or both? Characterizing major dimensions of the mandated treatment relationship.

Current conceptualizations of the therapeutic alliance may not capture key features of therapeutic relationships in mandated treatment, which may extend beyond care (i.e., bond and affiliation) to include control (i.e., behavioral monitoring and influence). This study is designed to determine whether mandated treatment relationships involve greater control than traditional treatment relationships, and if so, whether this control covaries with reduced affiliation. In this study, 125 mental health court participants described the nature of their mandated treatment relationships using the INTREX (Benjamin, L., 2000, SASB/INTREX: Instructions for administering questionnaires, interpreting reports, and giving raters feedback (Unpublished manual). Salt Lake City, UT: University of Utah, Department of Psychology), a measure based on the interpersonal circumplex theory and assesses eight interpersonal clusters organized by orthogonal axes of affiliation and control. INTREX cluster scores were statistically compared to existing data from three separate voluntary treatment samples, and structural summary analyses were applied to distill the predominant theme of mandated treatment relationships. Compared with voluntary treatment relationships, mandated treatment relationships demonstrate greater therapist control and corresponding client submission. Nonetheless, the predominant theme of these relationships is affiliative and autonomy-granting. Although mandated treatment relationships involve significantly greater therapist control than traditional relationships, they remain largely affiliative and consistent with the principles of healthy adult attachment.

Suicidal ideation and social exchanges among at-risk veterans referred for a behavioral health assessment.

PURPOSE: The current study examined the independent association between positive (e.g., emotional and instrumental support) and negative (e.g., insensitive behavior, unwanted advice from others) social exchanges and suicidal ideation among veterans referred for a behavioral health assessment. METHODS: The sample included 606 veterans [mean age = 54.96 (SD = 14.96)] referred by primary care for a clinical mental health/substance abuse (MH/SA) assessment following a positive MH/SA screen. Data on sociodemographics, MH/SA conditions (e.g., depression, PTSD, anxiety, and alcohol abuse), the self-reported frequency of positive and negative social exchanges, and suicidal ideation were extracted from clinical interviews and evaluated. RESULTS: Veterans were primarily male, non-married, and had adequate financial resources, and approximately half were White. 74.4 and 20.3% met criteria for a MH/SA condition and suicidal ideation, respectively. Multiple logistic regression analyses revealed that, adjusting for sociodemographics, physical functioning, and comorbid MH/SA conditions, veterans reporting more frequent negative exchanges with network members were significantly more likely to report suicidal ideation. Positive exchanges, in contrast, were not significantly related to the outcome. Inadequate finances and MH/SA conditions also were significantly related to suicidal ideation. CONCLUSIONS: Findings highlight the value of exploring the quality of social exchanges among veterans in primary care who screen positive for behavioral health issues, as such information has the potential to inform screening and intervention efforts aimed at reducing suicidal ideation.

Setbacks in diet adherence and emotional distress: a study of older patients with type 2 diabetes and their spouses.

OBJECTIVES: We investigated patients' difficulties in managing their diet (i.e. diet setbacks) and associations with change in disease-specific and general emotional distress (diabetes distress and depressive symptoms) among patients with type 2 diabetes and their spouses. METHOD: Data for this study were collected in couples' homes (N=115 couples) using structured interviews and self-administered questionnaires at three time points: baseline (T1), six months after baseline (T2) and 12 months after baseline (T3). RESULTS: Patients' diet setbacks were associated with an increase in their diabetes distress in the shorter-term (over six months). Patients' diet setbacks were not associated with longer-term change in diabetes distress or with change in depressive symptoms at either time point (six months or one year). In contrast, spouses' perceptions of patients' diet setbacks were associated with increases in their own diabetes distress at both time points (over six months and one year), and also with an increase in their depressive symptoms in the longer-term (over one year). CONCLUSION: Findings reveal detrimental consequences of patients' diet nonadherence for emotional well-being that extend to the well-being of their spouses.

Does Diversity of Social Ties Really Matter More for Health and Leisure Activity than Number of Social Ties? Evidence from Later Adulthood.

OBJECTIVES: Claims that the diversity of social ties matters more for health than the sheer number of ties have largely gone untested. This study accordingly compared the unique associations of number versus diversity of social ties with key health-related outcomes: functional limitations and leisure activities. Additionally, positive and ambivalent ties were distinguished. METHODS: Social networks, health, and leisure activities were assessed in a national sample of older adults (N = 874; ages 65-91). RESULTS: Regression analyses revealed that number of ties related to each outcome at a magnitude comparable to, or exceeding, that of diversity in most models. For positive ties, number related more strongly than diversity to greater leisure activities. For ambivalent ties, number related more strongly than diversity to worse functional limitations. DISCUSSION: Contrary to prevailing views, diversity of ties is not necessarily more important than number of ties. Findings extend scientific understanding and approaches to interventions.

A Change for the Worse: Negative Social Exchanges are Associated with an Accelerated Decline in Self-Rated Health Over Time.

OBJECTIVES: Age-associated accelerated declines in physical health vary across individuals, and researchers have suggested that individual differences in decline may vary as a function of stressors. The relation of one such stressor, negative social exchanges, to accelerated declines in self-rated health is investigated. METHOD: Participants are from a 2-year, 5-wave, national, longitudinal study of social relationships among older adults. Growth curve analyses are used to examine the relation of negative and positive social exchanges to accelerated changes in self-rated health, controlling for age, sex, race/ethnicity, education, and depressive symptoms. RESULTS: Individuals reporting more frequent negative social exchanges showed significantly accelerated declines in physical health. Positive social exchanges were not related to linear or accelerated declines in self-rated health over time. DISCUSSION: The association between negative social exchanges and accelerated deterioration in self-rated health provides general support for hypotheses that interpersonal stressors play an important role age-related physical health decline.

When does Spousal Social Control Provoke Negative Reactions in the Context of Chronic Illness?: The Pivotal Role of Patients' Expectations.

Spouses often monitor and seek to alter each other's health behavior, but such social control attempts can provoke behavioral resistance and emotional distress. Expectations regarding spouses' roles in their partners' health may influence reactions to spousal social control, with resistance and hostility less likely to occur among people who believe spouses should be involved in their partners' health. Evidence consistent with this idea emerged in a study of 191 patients with type 2 diabetes. Patients with greater expectations for spousal involvement (particularly females) generally reacted less negatively to spousal control. The findings help to clarify when people with a chronic illness are likely to resist and resent, rather than appreciate, spousal control.

Spouses use of social control to improve diabetic patients' dietary adherence.

We investigated two types of negative and positive social control strategies, warning and encouragement, used by spouses to urge patients with type II diabetes to improve adherence to the diabetic diet. Warning refers to things a spouse may say or do to caution the patient about the consequences of eating a poor diet, and encouragement refers to things a spouse may say or do to promote healthier food choices by the patient. Our dyadic design (n=109 couples) assessed spouses' use of warning and encouragement (reported by spouses and by patients), as well as patients' reports of dietary adherence. Spouses being actively involved in patients' dietary choices was the largest category of open-ended descriptors of both warning and encouragement. Both spousal warning and encouragement were associated with patients' adherence to the recommended diabetic diet, with warning associated with poorer adherence and encouragement associated with better adherence. Moreover, it was the spouses' perceptions of their own influence attempts, and not patients' reports, that were consequential for patients' adherence. Patients' dietary behavior, and ultimately disease management, appears to be best served when the spouse uses more positively toned and less coercive influence attempts.

Emotions, relationships, health and illness into old age.

There is strong evidence linking relationships and emotions to physical health outcomes. What is critically missing is a more comprehensive understanding of how these important psychosocial factors influence disease over the lifespan. In this narrative review, existing lifespan models of social support and emotion regulation are reviewed and integrated into a general conceptual framework in the health domain. This integrated model takes into account bidirectional links between relationships and emotions, as well as health behaviors, biological pathways, and health. Evidence is consistent with the utility of an integrative model attempting to understand its links to health-relevant pathways and outcomes in older adults. Future work that examines multiple pathways using prospective designs will be necessary for this work to reach its full potential, including intervention and policy opportunities.

Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

OBJECTIVE: The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery. DESIGN: The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery. Data were collected during in-person interviews with 70 married, older adult patients. MAIN OUTCOME MEASURES: Recovery outcomes were assessed as improvement in knee limitations and depressive symptoms at the 3 month follow-up. RESULTS: Spousal pressure and persuasion at one month postsurgery were indirectly associated with patients' recovery outcomes through patients' positive emotional responses to control. CONCLUSION: Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage.

Gaps in Social Support Resources in Later Life: An Adaptational Challenge in Need of Further Research.

Gaps in social support resources in later life may arise when older adults lose social network members due to illness, death, or residential relocation. Gaps also may arise when social networks remain intact but are not well suited to meet older adults' intensifying support needs, such as needs for extended or highly personal instrumental support. Significant gaps in support resources are likely to require adaptive responses by older adults. This discussion highlights theoretical perspectives and illustrates empirical findings regarding the nature and effectiveness of older adults' responses to gaps in their social support resources. The literature examining these issues is relatively small and, as a result, is ripe for further development. Promising directions for future research are suggested.

Stable negative social exchanges and health.

Negative social exchanges with family, friends, and neighbors are known to be an important source of stress in daily life, and chronic stress is theorized to have especially potent impacts on health. Little is known about the health effects of stably high levels of negative social exchanges, however. In a national, longitudinal study of older adults (N = 666), we examined the association between stable negative social exchanges and health over a 2-year period. Trait-state-error models indicated that higher levels of stable negative social exchanges were significantly predictive of lower self-rated health, greater functional limitations, and a higher number of health conditions over 2 years after controlling for initial levels of health and sociodemographic variables. These results highlight the importance of examining continual and recurring interpersonal problems in efforts to understand the health effects of social relationships.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters.

BACKGROUND: Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention. PURPOSE: Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. METHODS: Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group. RESULTS: The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention. CONCLUSION: Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02741037.

Positive and negative social exchanges and disability in later life: an investigation of trajectories of change.

OBJECTIVES: Various aspects of one's social ties are thought to influence the onset, progression, and course of disability in older adulthood. Although the longitudinal course of social ties and physical disability is likely to be marked by fluctuations over time and intraindividual variation, few studies have explored how patterns of change in positive and negative social exchanges relate to patterns of change in disability across time. The current study, therefore, examined the extent to which distinct longitudinal trajectories of positive and negative exchanges were associated with patterns of physical disability. METHODS: We followed a sample of 482 community-dwelling older adults with little to no disability at baseline for 2 years. RESULTS: Results identified multiple, distinct trajectory groups for positive and negative exchanges and disability. Latent class growth analyses revealed that individuals with chronically high or low positive exchanges were likely to experience low and increasing levels of disability. With respect to negative exchanges, individuals with moderately increasing negative exchanges showed patterns of increasing disability and disability remission, whereas chronically low or absent negative exchanges were associated with low and increasing levels of disability. DISCUSSION: Findings highlight the importance of evaluating multiple trajectories of change in older adults' social exchanges and disability.

The joint effects of life stress and negative social exchanges on emotional distress.

OBJECTIVE: Negative social exchanges detract considerably from older adults' emotional health, but little is known about the specific factors that make some older adults more vulnerable than others to such exchanges. This study examined whether stressful life experiences compound the impact of negative social exchanges on emotional distress. We examined both linear and nonlinear models of the joint effects of negative social exchanges and stressful life experiences. METHODS: In-person interviews took place with a representative sample of 916 noninstitutionalized older adults. We examined linear and nonlinear models for three classes of stressful life experiences (relationship losses, disruptive events, and functional impairment). RESULT: Regression analyses that included first-order and second-order interaction terms revealed a linear pattern for loss events and functional impairment, and a nonlinear pattern for disruptive events. DISCUSSION: This study suggests that negative social exchanges and stressful life experiences jointly affect emotional distress, but the particular nature of the joint effects varies by type and level of stressor. Negative social exchanges appear to have more severe effects in the context of some stressors but less severe effects in the context of other stressors.

Pain, positive and negative social exchanges, and depressive symptomatology in later life.

OBJECTIVES: Pain in older adulthood is correlated with both depressive symptomatology and positive and negative social exchanges, but the direction of these relationships remains unclear. This study investigated whether (a) pain is associated with increases in negative exchanges and decreases in positive exchanges and (b) negative exchanges play a greater role than positive exchanges in accounting for the association between pain and depressive symptomatology. METHODS: Data were derived from the Later Life Study of Social Exchanges, a longitudinal survey of noninstitutionalized older adults. Interviews assessed participants' sociodemographic and biopsychosocial characteristics, as well as their interactions with network members. RESULTS: Pain was significantly associated with negative exchanges, and both pain and negative exchanges predicted greater depressive symptomatology over time. Positive social exchanges, however, were not related to either pain or depression. DISCUSSION: The findings underscore the value of examining older adults' social exchanges in efforts to understand pain-induced depressive symptomatology.

Unpacking the Relation between Extraversion and Volunteering in Later Life: The Role of Social Capital.

This study tested the hypothesis that the relation between extraversion and volunteering by older adults is fully mediated by social capital (participation in clubs and organizations, church attendance, and contact with friends). Data for this study come from 888 adults between the ages of 65-90 years old who participated in the Later Life Study of Social Exchanges (LLSSE). In support of our hypothesis, structural equation modeling revealed that extraversion exerted (a) a significant total effect on volunteering (.122), (b) significant indirect effects on volunteering via contact with friends (.042), church attendance (.034), and clubs and organizations (females only: .042), and (c) a non-significant direct effect on volunteering (.010). These findings suggest that social capital provides a viable explanation for the association between extraversion and volunteering.

Close social ties and health in later life: Strengths and vulnerabilities.

The world is aging at an unprecedented rate, with older adults representing the fastest-growing segment of the population in most economically developed and developing countries. This demographic shift leaves much uncharted territory for researchers who study social relationships and health. Social relationships exert powerful influences on physical health in later adulthood, a critical consideration given age-related increases in the prevalence of chronic health conditions and physical disability. A large body of research indicates that older adults report greater satisfaction with their social networks than do younger adults, and that they often take measures to minimize their exposure to negative social encounters. These emotionally satisfying and generally positive social ties afford some health protection against a backdrop of mounting physical limitations and play an important role when juxtaposed with the potentially health-damaging frictions that sometimes emerge in older adults' social relationships. Although most older adults report that they are satisfied with their social ties, some older adults experience frequent conflicts or ambivalent exchanges with members of their social networks, and these experiences detract from their health. In addition, many older adults will experience the loss of one or more close relationships during the course of their lives, with ramifications for their health and, often, for the reorganization of their social lives over time. Understanding how both the strengths and vulnerabilities of close social relationships affect health and well-being in later life is an important goal, particularly in view of the accelerating rate of population aging worldwide. (PsycINFO Database Record

Dealing with negative social exchanges in later life: coping responses, goals, and effectiveness.

Negative exchanges have been shown to detract from psychological well-being in later life, but little research has investigated how older adults respond to such exchanges. The authors examined older adults' coping responses, goals, and effectiveness following a specific negative social exchange. The findings revealed that participants' coping responses and the effectiveness of these responses varied as a function of their coping goals. The results underscore the importance of considering older adults' coping responses and goals when evaluating factors that affect the impact of negative social exchanges on well-being in later life.