Nightly Sleep Predicts Next-Morning Expectations for Stress and Positive Experiences.

OBJECTIVE: Abundant research has linked nightly sleep as an antecedent of daily psychosocial experiences; however, less is known about sleep's influence on daily expectations of these experiences. Therefore, this research examined the day-to-day associations of sleep quality, duration, and efficiency with next-day expectations for stress(ors) and positive experiences, as well as whether these expectations were related to end-of-day reports of physical symptoms. METHODS: In Study 1, U.S. adults ( n = 354; ages 19 to 74) completed twice-daily diaries for 10 weekdays about sleep, expectations for encountering daily stressors and positive events, and physical symptoms. In Study 2, adults in Canada ( n = 246; ages 25 to 87) wore a sleep watch for 14 consecutive days and completed mobile surveys 5×/day about sleep, stressfulness and pleasantness expectations, and physical symptoms. RESULTS: Multilevel models indicated that self-reported sleep quality and duration, but not efficiency, were associated with lower next-day expectations for stressors (Study 1) and stressfulness (Study 2). Self-reported sleep quality (Study 1) and all sleep indices (Study 2) predicted greater next-day expectations for positive events and pleasantness, respectively. For actigraphy-assessed sleep (Study 2), only longer-than-usual actigraphic sleep duration was associated with lower stressfulness expectations, whereas both sleep duration and efficiency were positively linked with daily pleasantness expectations. Only pleasantness expectations (Study 2)-but not daily stressfulness and event expectations (Study 1)-predicted end-of-day physical symptoms. CONCLUSION: Findings suggest the importance of sleep on expectations of next-day stress and positive experiences, of which may have implications for daily physical health.

Positive event diversity: Relationship with personality and well-being.

OBJECTIVE: Examining the personality and well-being correlates of positive event diversity. BACKGROUND: Past research has highlighted that personality traits are linked to the frequency of daily positive events. This study is the first to examine positive event diversity, the extent to which positive events are spread across multiple types of positive life domains, as well as its personality and well-being correlates. METHOD: We conducted parallel analyses of three daily diary datasets (Ns = 1919, 744, and 1392) that included evening assessment of daily positive events and affective well-being. The Big Five personality traits were assessed in baseline surveys. RESULTS: Positive Event Diversity was related to higher person-mean daily positive affect but not negative affect. Higher Extraversion, Agreeableness, Openness, and lower Neuroticism were correlated with more positive event diversity. These associations became nonsignificant when controlling for positive event frequency. Positive event frequency moderated the link between positive event diversity and person-mean affect, such that higher positive event diversity was associated with higher negative and lower positive affect for people who experienced more frequent positive events. CONCLUSIONS: No consistent evidence was found for personality as a moderator of the positive event diversity-well-being link across the three studies. Further, the well-being implications of positive event diversity may be better understood when interpreting them alongside indexes of positive event frequency.

Predictors of Complicated Grief During the COVID-19 Pandemic: A Cross-Classified Analysis.

The COVID-19 pandemic left many people grieving multiple deaths and at risk for developing symptoms of complicated grief (CG). The present study is a prospective examination of the role of neuroticism and social support in the development of CG symptoms. Findings from cross-classified multilevel models pointed to neuroticism as a risk factor for subsequent CG symptoms. Social support had a stress-buffering effect, emerging as a protective factor following the loss of a first degree relative. More recent loss and younger age of the deceased were both independently associated with heightened CG symptoms. Results from the present study provide insight into heterogeneity in CG symptom development at the between-person level, and variability in CG symptoms within individuals in response to different deaths. Findings could therefore aid in the identification of those at risk for the development of CG symptoms.

The American Psychosomatic Society Antiracism Task Force: Implementation, Activities, and Lessons Learned.

ABSTRACT: The American Psychosomatic Society (APS) is an international professional society that aims to advance the scientific study of biological, behavioral, and social factors in health among educators, clinicians, and researchers. In pledging to be an antiracist organization in 2020, APS formed the Antiracism Task Force to identify different manifestations of systemic racism within the society and to make recommendations for building a more inclusive and equitable professional organization. The goal of this paper was to be maximally transparent to membership about our activities and lessons learned, as well as offer a case study to other organizations striving toward antiracism. We describe the inaugural year of activities of the APS Antiracism Task Force, which included proposing amendments to the society's bylaws, collecting data on member attitudes toward diversity, and consulting on other member efforts to implement antiracism activities (e.g., increasing access to early career awards). In addition to reflecting on task force and society-specific factors that were facilitative in our first year, we describe future plans and potential challenges we may face as we support sustained commitment to APS's antiracism efforts.

Adherence to Recommended Preventive Behaviors During the COVID-19 Pandemic: The Role of Empathy and Perceived Health Threat.

BACKGROUND: Coping via empathic responding may play a role in preventive behavior engagement during the COVID-19 pandemic, and unlike trait empathy, is a potentially alterable target for changing health behavior. PURPOSE: Our goal was to examine the role of empathic responding in preventive behavior engagement during the COVID-19 pandemic, independent of trait empathy and perceived threat of COVID-19. METHODS: Participants (N = 2,841) completed a baseline survey early in the pandemic, and a follow-up survey approximately 2 weeks later (M = 13.50 days, SD = 5.61). Preventive health behaviors, including physical distancing and hygiene practices, were assessed at both timepoints. Hierarchical linear regression examined the contributions of trait empathy, perceived threat of COVID-19, and empathic responding at baseline to preventive behaviors at follow-up. RESULTS: Controlling for baseline levels of preventive behaviors and demographic covariates, trait empathy and threat of COVID-19 at baseline were each independently associated with preventive behaviors at follow-up. An interaction between perceived threat and empathic responding indicated that those perceiving high threat of COVID-19 at baseline tended to report engaging in preventive behaviors at follow-up regardless of their levels of empathic responding, whereas for those reporting low levels of perceived threat, higher levels of empathic responding were associated with higher engagement in preventive behavior. CONCLUSIONS: When perceived threat of COVID-19 was low, higher empathic responding was associated with increased engagement in preventive behaviors regardless of trait empathy, suggesting that empathic responding can serve as an actionable target for intervention to promote preventive behavior during the pandemic.

Personality differences in the occurrence and affective correlates of daily positive events.

OBJECTIVE: Previous research shows that Neuroticism predicts exposure and affective reactivity to daily stressors. Zautra and colleagues extended this work to daily positive events. Building on these frameworks, we examined the Big Five personality traits as predictors of the occurrence and affective correlates of daily positive events. METHOD: Participants in two national U.S. daily diary studies (NSDE 2: N = 1,919 and NSDE Refresher: N = 778; aged 25-84) reported daily positive events, emotions specific to the events, and daily affect for 8 consecutive days. RESULTS: In parallel analyses in both samples, Extraversion and in the NSDE Refresher sample only Openness (but not Neuroticism, Conscientiousness, or Agreeableness) predicted more frequent positive event occurrence. All Big Five traits were associated with one or more emotional experiences (e.g., calm, proud) during positive events. Neuroticism predicted greater event-related positive affect in the NSDE 2 sample, whereas Agreeableness was related to more event-related negative affect in the NSDE Refresher sample. CONCLUSIONS: The Big Five personality traits each provided unique information for predicting positive events in daily life. The discussion centers on potential explanations and implications for advancing the understanding of individual differences that contribute to engagement in positive experiences.

Pandemic stressors and depressive symptoms: Examining within- and between-person effects of neuroticism.

Experiencing stressors related to the COVID-19 pandemic such as health-related concern, social isolation, occupational disruption, financial insecurity, and resource scarcity can adversely impact mental health; however, the extent of the impact varies greatly between individuals. In this study, we examined the role of neuroticism as an individual-level risk factor that exacerbates the association between pandemic stressors and depressive symptoms. With repeated assessments of pandemic stressors and depressive symptoms collected from 3181 participants over the course of the pandemic, we used multilevel modeling to test if neuroticism moderated the association between pandemic stressors and depressive symptoms at both between- and within-person levels. At the between-person level, we found that participants who reported more pandemic stressors on average had higher levels of depressive symptoms and that this association was stronger among those high in neuroticism. At the within-person level, reporting more pandemic stressors relative to one's average on any given occasion was also associated with heightened depressive symptoms and this effect was similarly exacerbated by neuroticism. The findings point to pandemic stressor exposure and neuroticism as risk factors for depressive symptoms and, in demonstrating their synergistic impact, may help identify individuals at greatest risk for adverse psychological responses to the COVID-19 pandemic.

Emotional Vulnerability to Short Sleep Predicts Increases in Chronic Health Conditions Across 8 Years.

BACKGROUND: Sleep is a robust determinant of next-day emotions, but people vary in the extent that their emotions fluctuate on days following short sleep duration. These individual differences in day-to-day sleep and emotion dynamics may have long-term health implications. PURPOSE: To evaluate emotional vulnerability to short sleep (within-person associations between sleep duration and next-day emotions) as a risk factor for future chronic conditions. METHODS: Adults aged 33-84 (N = 1,426; 57% female) in the Midlife in the United States Study reported sleep duration and emotions by telephone for eight consecutive days. Chronic conditions were assessed via checklist at baseline and at a median follow-up of eight years (range: 5-10 years). Short sleep was examined in three ways: person-centered continuous variable, ≤6 hr, and <7 hr; long sleep was defined as ≥9 hr. RESULTS: Multilevel structural equation models revealed that people with greater negative emotions following nights of sleep ≤6 hr (vs. their negative emotions after longer sleep) had increased chronic conditions at follow-up, compared to people who were less emotionally vulnerable to short sleep (Est. = 1.04, SE = .51, p < .028). Smaller declines in positive emotions following ≤6 hr of sleep were marginally predictive of lower risk for chronic conditions (Est. = -.77, SE = .44, p = .054). Emotional vulnerability to <7, ≥9, and continuous sleep hours were not associated with subsequent chronic conditions. CONCLUSIONS: Emotional vulnerability to short sleep is a unique risk factor for the development of chronic conditions, independent of mean-level sleep duration and emotions.

Associations Between Everyday Discrimination and Sleep: Tests of Moderation by Ethnicity and Sense of Purpose.

BACKGROUND: Everyday discrimination holds pernicious effects across most aspects of health, including a pronounced stress response. However, work is needed on when discrimination predicts sleep outcomes, with respect to potential moderators of these associations. PURPOSE: The current study sought to advance the past literature by examining the associations between everyday discrimination and sleep outcomes in an ethnically diverse sample, allowing tests of moderation by ethnic group. We also examined the role of sense of purpose, a potential resilience factor, as another moderator. METHODS: Participants in the Hawaii Longitudinal Study of Personality and Health (n = 758; 52.8% female; mage: 60 years, sd = 2.03) completed assessments for everyday discrimination, sleep duration, daytime dysfunction due to sleep, sleep quality, and sense of purpose. RESULTS: In the full sample, everyday discrimination was negatively associated with sleep duration, sleep quality, and sense of purpose, while positively associated with daytime dysfunction due to sleep. The associations were similar in magnitude across ethnic groups (Native Hawaiian, White/Caucasian, Japanese/Japanese-American), and were not moderated by sense of purpose, a potential resilience factor. CONCLUSIONS: The ill-effects on health due to everyday discrimination may operate in part on its role in disrupting sleep, an issue that appears to similarly impact several groups. The current research extends these findings to underrepresented groups in the discrimination and sleep literature. Future research is needed to better disentangle the day-to-day associations between sleep and discrimination, and identify which sources of discrimination may be most problematic.

The Cycle of Daily Stress and Sleep: Sleep Measurement Matters.

BACKGROUND: Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress. PURPOSE: We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG). METHODS: Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]). RESULTS: Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (ß = -0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (ß = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity. CONCLUSIONS: Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary-not redundant-sleep measurement approaches.

Negative and positive affect as predictors of inflammation: Timing matters.

Very little research has assessed how measures of negative and positive affect (NA and PA) derived from assessments at multiple time points per day (e.g., via ecological momentary assessment [EMA]), as opposed to questionnaires that rely on recall over a longer period, are related to levels of peripheral inflammation. We examined how different indicators of NA and PA predicted concentrations of C-reactive protein (CRP) and seven peripheral inflammatory cytokines (IL-1ß, IL-6, TNF-α, IL-8, IL-4, IL-10, and IFN-γ) that were examined in the form of an inflammatory composite. A community-based sample of 220 adults (62% Black/African-American and 25% Hispanic/Latino; aged 25-65; 65% female) completed questionnaires at baseline (including recalled affect "over the past month") and then provided EMA reports 5x/day for 14 days. Blood was drawn from each participant after completion of EMA and used to determine plasma levels of CRP and cytokines. Analyses examined if indicators of affect predicted inflammation, controlling for age, gender, body mass index, education, health conditions, and statin use. Neither recalled NA or PA nor momentary NA or PA (aggregated across the 14 days of EMA) were significantly associated with the cytokine composite or CRP. Negative mood more proximal to the blood draw (i.e., aggregated momentary NA in week 2 of EMA) was associated with the cytokine composite but not CRP. Exploratory moderation analyses revealed that the cytokine composite was also associated with PA in week 2 for men only, and with recalled NA for those with lower education. Exploratory analyses around temporal dynamics suggested that the timing of NA measurement relative to the blood draw mattered: Specifically, there were stronger trends of association between momentary NA and inflammatory cytokines when NA was assessed closer in time to blood collection. Future investigation of the relevance of temporal proximity and other measurement details may improve understanding of how affect relates to inflammation.

Sense of Purpose Moderates the Associations Between Daily Stressors and Daily Well-being.

Background: Having a sense of purpose in life has been consistently demonstrated as a predictor of positive health outcomes, including less perceived stress, yet, little is known about the role of sense of purpose on stressful days. Purpose: The current study investigated the sense of purpose as a moderator of stressor-related changes in daily physical symptoms, positive affect, and negative affect. Methods: A subset of the Midlife in the United States study (n = 1949, mage: 56.4 years) reported their sense of purpose, along with up to eight daily assessments of stressors, affect, and physical symptoms. Multilevel models evaluated whether sense of purpose was associated with deviations in affect or physical symptom reporting on days when participants reported a stressor versus days when stressors did not occur. Results: Sense of purpose was associated with higher daily positive affect, lower daily negative affect, and fewer daily physical symptoms. Compared with individuals who reported lower levels of purpose, those reporting higher levels encountered the same number of daily stressors, yet showed less of an increase in negative affect and physical symptoms on stressor days than on stressor-free days. Purpose did not predict changes in positive affect in response to daily stressors. Conclusions: Findings provide evidence that a purposeful life may be characterized by lower negative affect and physical symptom reporting on stressful days.

Bidirectional, Temporal Associations of Sleep with Positive Events, Affect, and Stressors in Daily Life Across a Week.

BACKGROUND: Sleep is intricately tied to emotional well-being, yet little is known about the reciprocal links between sleep and psychosocial experiences in the context of daily life. PURPOSE: The aim of this study is to evaluate daily psychosocial experiences (positive and negative affect, positive events, and stressors) as predictors of same-night sleep quality and duration, in addition to the reversed associations of nightly sleep predicting next-day experiences. METHODS: Daily experiences and self-reported sleep were assessed via telephone interviews for eight consecutive evenings in two replicate samples of US employees (131 higher-income professionals and 181 lower-income hourly workers). Multilevel models evaluated within-person associations of daily experiences with sleep quality and duration. Analyses controlled for demographics, insomnia symptoms, the previous day's experiences and sleep measures, and additional day-level covariates. RESULTS: Daily positive experiences were associated with improved as well as disrupted subsequent sleep. Specifically, positive events at home predicted better sleep quality in both samples, whereas greater positive affect was associated with shorter sleep duration among the higher-income professionals. Negative affect and stressors were unrelated to subsequent sleep. Results for the reversed direction revealed that better sleep quality (and, to a lesser degree, longer sleep duration) predicted emotional well-being and lower odds of encountering stressors on the following day. CONCLUSIONS: Given the reciprocal relationships between sleep and daily experiences, efforts to improve well-being in daily life should reflect the importance of sleep.

Linking Daily Stress Processes and Laboratory-Based Heart Rate Variability in a National Sample of Midlife and Older Adults.

OBJECTIVE: This study evaluates the associations between people's trait-like patterns of stress in daily life (stressor frequency, perceived stressor severity, affective reactivity to stressors, and negative affect) and laboratory-assessed heart rate variability (HRV). METHODS: Data were collected from 909 participants aged 35 to 85 years in the Midlife in the United States Study. Participants reported negative affect and minor stressful events during telephone interviews on 8 consecutive evenings. On a separate occasion, HRV was measured from electrocardiograph recordings taken at rest during a laboratory-based psychophysiology protocol. Regression models were used to evaluate the associations between daily stress processes and three log-transformed HRV indices: standard deviation of R-R intervals (SDRR), root mean square of successive differences (RMSSD), and high-frequency power (high-frequency HRV [HF-HRV]). Analyses were adjusted for demographics, body mass index, comorbid conditions, medications, physical activity, and smoking. RESULTS: Stressor frequency was unrelated to HRV (r values ranging from -0.04 to -0.01, p values >.20). However, people with greater perceived stressor severity had lower resting SDRR (fully adjusted B [standard error {SE}] = -0.05 [0.02]), RMSSD (-0.08 [0.03]), and HF-HRV (-0.16 [0.07]). Individuals with more pronounced affective reactivity to stressors also had lower levels of all three HRV indices (SDRR: B [SE] = -0.28 [0.14]; RMSSD: -0.44 [0.19]; HF-HRV: -0.96 [0.37]). Furthermore, aggregated daily negative affect was linked to reduced RMSSD (B [SE] = -0.16 [0.08]) and HF-HRV (-0.35 [0.15]). CONCLUSIONS: In a national sample, individual differences in daily negative affect and responses to daily stressors were more strongly related to cardiovascular autonomic regulation than the frequency of such stressors.

Direction of Association Between Depressive Symptoms and Lifestyle Behaviors in Patients with Coronary Heart Disease: the Heart and Soul Study.

BACKGROUND: Emerging evidence indicates that the association between depression and subsequent cardiovascular events is largely mediated by health behaviors. However, it is unclear whether depression is the cause or the consequence of poor health behaviors. PURPOSE: The purpose of the present study is to examine prospective, bidirectional relationships of depressive symptoms with behavioral and lifestyle factors among patients with coronary heart disease. METHODS: Depressive symptoms and lifestyle behaviors (physical activity, medication adherence, body mass index, waist to hip ratio, sleep quality, and smoking status) were assessed at baseline and 5 years later among a prospective cohort of 667 patients with stable coronary heart disease. RESULTS: Greater depressive symptoms at baseline predicted poorer lifestyle behaviors 5 years later (less physical activity, lower medication adherence, higher body mass index, higher waist to hip ratio, worse sleep quality, and smoking). After adjustment for demographics, cardiac disease severity, comorbidity, and baseline lifestyle behaviors, depressive symptom severity remained predictive of subsequent worsening of physical activity (beta = -0.08; 95 % confidence interval (CI) = -0.16, -0.01; p = 0.03), medication adherence (beta = -0.16; 95 % CI = -0.24, -0.08; p < 0.001), and sleep quality (beta = -0.19; 95 % CI = -0.27, -0.11; p < 0.001). Baseline lifestyle behaviors also predicted 5-year change in depressive symptoms, although the associations were attenuated after adjustment for baseline depressive symptoms and covariates. CONCLUSIONS: Among patients with coronary heart disease, depressive symptoms were linked to a range of lifestyle risk factors and predicted further declines in physical activity, medication adherence, and sleep quality.

The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications.

Positive psychological aspects of well-being-including positive emotions, optimism, and life satisfaction-are increasingly considered to have protective roles for cardiovascular disease (CVD) and longevity. A rapidly-growing body of literature has linked positive well-being with better cardiovascular health, lower incidence of CVD in healthy populations, and reduced risk of adverse outcomes in patients with existing CVD. This review first examines evidence on the associations of positive well-being with CVD and mortality, focusing on recent epidemiological research as well as inconsistent findings. Next, an overview is provided of putative biological, behavioral, and stress-buffering mechanisms that may underlie the relationship between positive well-being and cardiovascular health. Key areas for future inquiry are discussed, in addition to emerging developments that capitalize on technological and methodological advancements. Promising initial results from randomized controlled trials suggest that efforts to target positive well-being may serve as valuable components of broader CVD management programs.

Positive Affect and Health Behaviors Across 5 Years in Patients With Coronary Heart Disease: The Heart and Soul Study.

OBJECTIVES: Positive psychological states are linked to superior health and longevity, possibly due to behavioral factors. We evaluated cross-sectional and 5-year associations between positive affect and health behaviors in patients with coronary heart disease (CHD). METHODS: Outpatients with CHD reported positive affect, physical activity, sleep quality, medication adherence, cigarette smoking, and alcohol use at baseline (n = 1022) and 5 years later (n = 662). Covariates in regression analyses included demographics, cardiac disease severity, and depressive symptoms. RESULTS: At baseline, higher positive affect (per 1 standard deviation) was associated with better health behaviors: physical activity (odds ratio [OR] = 1.52, 95% 95% confidence interval [CI] = 1.30-1.77, p < .001), sleep quality (OR = 1.24, 95% CI = 1.04-1.48, p = .015), medication adherence (OR = 1.46, 95% CI = 1.12-1.90, p = .005), and nonsmoking (OR = 1.29, 95% CI = 1.06-1.57, p = .012), but was unrelated to alcohol use. Baseline positive affect did not predict health behaviors at follow-up, accounting for baseline behaviors. However, increases in positive affect across 5 years co-occurred with improvements in physical activity (B = 0.023, standard error [SE] = 0.008, p = .002), sleep quality (B = 0.011, SE = 0.005, p = .039), and medication adherence (B = 0.014, SE = 0.004, p < .001), but not smoking status (OR = 1.07, 95% CI = 0.73-1.55, p = .74). CONCLUSIONS: Positive affect was associated with health behaviors among patients with CHD. Efforts to sustain or enhance positive affect may be promising for promoting better health behaviors.

Daily positive events and inflammation: findings from the National Study of Daily Experiences.

BACKGROUND: Inflammation is implicated in the development of chronic diseases and increases the risk of mortality. People who experience more daily stressors than others have higher levels of inflammation, but it is unknown whether daily positive events are linked to inflammation. OBJECTIVE: To examine the association of daily positive events with 3 inflammatory markers, interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen. METHOD: A cross-sectional sample of 969 adults aged 35-86 from the Midlife in the United States Study completed telephone interviews for 8 consecutive evenings. Participants reported positive experiences that occurred over the past 24h. Blood samples were obtained at a separate clinic visit and later assayed for inflammatory markers. Regression analyses evaluated the frequency of daily positive events (defined as the percent of study days with at least 1 positive event) as a predictor of each inflammatory marker. Covariates included information on demographics, physical health, depressive symptoms, dispositional and behavioral factors, and daily positive and negative affect. RESULTS: On average, participants experienced positive events on 73% of days (SD=27%). The frequency of daily positive events was associated with lower IL-6 (p<0.001) and CRP (p=0.02) in the overall sample, and lower fibrinogen among women (p=0.01). The association remained for IL-6 in the fully adjusted model, but was no longer significant for CRP and fibrinogen after controlling for household income and race. Effects were more pronounced for participants in the lowest quartile of positive event frequency than for those in the top 3 quartiles, suggesting that lack of positivity in daily life may be particularly consequential for inflammation. Furthermore, interpersonal positive events were more predictive of lower IL-6 overall and lower fibrinogen in women than non-interpersonal positive events. CONCLUSION: Daily positive events may serve a protective role against inflammation.

A comparison of cook-medley hostility subscales and mortality in patients with coronary heart disease: data from the heart and soul study.

OBJECTIVE: Hostility is associated with adverse outcomes in patients with coronary heart disease (CHD). However, assessment tools used to evaluate hostility in epidemiological studies vary widely. METHODS: We administered nine subscales of the Cook-Medley Hostility Scale (CMHS) to 656 outpatients with stable CHD between 2005 and 2007. We used Cox proportional hazards models to determine the association between each hostility subscales and all-cause mortality. We also performed an item analysis using logistic regression to determine the association between each CMHS item and all-cause mortality. RESULTS: There were 136 deaths during 1364 person-years of follow-up. Four of nine CMHS subscales were predictive of mortality in age-adjusted analyses, but only one subscale (the seven-item Williams subscale) was predictive of mortality in multivariable analyses. After adjustment for age, sex, education, smoking, history of heart failure, diabetes, and high-density lipoprotein, each standard deviation increase in the Williams subscale was associated with a 20% increased mortality rate (hazard ratio = 1.20, 95% confidence interval = 1.00-1.43, p = .046), and participants with hostility scores in the highest quartile were twice as likely to die as those in the lowest quartile (hazard ratio = 2.00, 95% confidence interval = 1.10-3.65, p = .023). CONCLUSIONS: Among nine variations of the CMHS that we evaluated, a seven-item version of the Williams subscale was the most strongly associated with mortality. Standardizing the assessment of hostility in future epidemiological studies may improve our understanding of the relationship between hostility and mortality in patients with CHD.

Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis.

BACKGROUND: Depression is a risk factor for nonadherence to HIV/AIDS treatment. PURPOSE: A meta-analysis was conducted to examine whether treatment of depression and psychological distress improves antiretroviral therapy adherence. METHODS: PubMed and PsycINFO databases were systematically searched for relevant articles. Studies that reported an association between depression treatment (or an intervention with a component addressing mental health) and antiretroviral adherence were included. RESULTS: Across 29 studies of 12,243 persons living with HIV/AIDS, treatment of depression and psychological distress improved antiretroviral adherence (p < 0.001). The odds of a person adhering were 83 % better if he/she was treated for depression. Greater improvements in adherence were found for samples with lower CD4 counts or more severe depression, for interventions specifically targeting depression (versus addressing mental health as a secondary objective), longer treatments, and observational studies. CONCLUSIONS: These findings support the need for detection and treatment of depression among persons living with HIV/AIDS.