Parental Relationships, Patient-Centered Communication With Healthcare Providers, and Diabetes Management Across Emerging Adulthood.

OBJECTIVE: To examine whether yearly fluctuations in acceptance from and disclosure to parents were associated with fluctuations in perceptions of patient-centered communication (PCC) with the healthcare provider and whether fluctuations in PCC were associated with self-efficacy, type 1 diabetes self-care, and HbA1c across four annual assessments during early emerging adulthood (EA). METHODS: A total of 228 high school seniors (M age = 17.76 years at time 1) reported on mothers' and fathers' acceptance and diabetes-related disclosure to parents, diabetes self-care, and PCC once per year for 4 years. HbA1c was collected from assay kits. RESULTS: Multilevel models revealed within-person associations such that in years when individuals reported greater maternal acceptance than their average, they reported higher PCC. In addition, between-person differences indicated that individuals who reported more maternal acceptance on average relative to others also perceived greater PCC. Similar associations were found for EAs' reports of fathers. No significant effects were found for disclosure to either mother or father. Yearly fluctuations in PCC were associated with self-efficacy such that in years when perceived PCC was higher, self-efficacy was higher. Between person-effects were found for self-efficacy, self-care, and HbA1c such that individuals who reported more PCC on average relative to others reported higher self-efficacy, better self-care, and lower HbA1c. CONCLUSIONS: Aspects of EA's relationships with parents fluctuate with perceptions of PCC with healthcare providers. Perceived PCC with the healthcare provider may be important in higher self-efficacy, diabetes self-care, and lower HbA1c across the early EA years.

Diabetes support from romantic partners during early emerging adulthood.

We examined support for type 1 diabetes in casual versus committed romantic relationships and links to blood glucose, self-care, and affect in 101 young adults (Mage 18.8). Individuals provided survey and daily measures of support and blood glucose and affect during a 14-day diary period. Survey data indicated individuals viewed partners as helpful, with partners in committed relationships rated more helpful than those in casual relationships. Daily assessments indicated partners were seen as only moderately helpful. Individuals in committed relationships discussed diabetes with partners on more diary days than those in casual relationships. When individuals in any relationship type experienced more helpful partner support than their average, they reported higher positive and lower negative affect. However, those in casual relationships also experienced more negative affect and higher mean blood glucose the next day. Results suggest tradeoffs between immediate benefits and subsequent costs of partner support to adults in casual relationships.

The developmental precursors of blunted cardiovascular responses to stress.

Blunted cardiovascular responses to stress have been associated with both mental and physical health concerns. This multi-method, longitudinal study examined the role of chronic social-developmental stress from adolescence onward as a precursor to these blunted stress responses. Using a diverse community sample of 184 adolescents followed from age 13 to 29 along with friends and romantic partners, this study found that high levels of parental psychological control at age 13 directly predicted a blunted heart rate response and indirectly predicted blunted respiratory sinus arrhythmia (RSA) reactivity under stress. Heart rate effects were mediated via indicators of a developing passive response style, including observational measures of withdrawal during conflict with friends and romantic partners, social disengagement, and coping with stressors by using denial. RSA effects were mediated via withdrawal during conflict with romantic partners and coping by using denial. The current findings are interpreted as suggesting a mechanism by which a key social/developmental stressor in adolescence may alter relational and ultimately physiological patterns of stress responding into adulthood.

The Role of Self-regulation Failures and Self-care in the Link Between Daily Sleep Quality and Blood Glucose Among Adults with Type 1 Diabetes.

BACKGROUND: Sleep, a process that restores the body's ability to self-regulate, may be one important factor affecting self-care behaviors and blood glucose (BG) levels. The link between sleep quality, self-care behaviors, and BG levels may occur by sleep-altering daily self-regulatory failures. PURPOSE: This study examined whether the relation between sleep quality and self-care behaviors occurred through self-regulation failures and whether the relation between sleep quality and BG levels occurred through self-regulation failures and self-care behaviors sequentially. METHODS: One hundred and ninety-nine adults with type 1 diabetes (T1D) completed an online questionnaire for 14 days in which they reported sleep quality, self-regulation failures, and self-care behaviors. BG levels were gathered from glucometers. Analyses involved multilevel mediation models and focused on daily within-person and between-person variability of sleep quality. RESULTS: Better daily sleep quality was associated with higher self-care behaviors at both within-person and between-person levels, and self-regulation failures mediated the association between daily sleep quality and daily self-care behaviors at both within-person and between-person levels. Better daily sleep quality was associated with better BG levels at the within-person level and self-regulation behaviors and self-care behaviors sequentially mediated the association between daily sleep quality and daily BG levels at the within-person level. CONCLUSION: This study provides a process account of the importance of daily sleep quality of adults with T1D, as well as one potential mechanism-self-regulation-that may explain the effect of sleep quality on diabetes outcomes.

The benefits of daily exercise on blood glucose levels and affect among adults with type 1 diabetes.

The purpose of this study was to investigate the concurrent and lagged effects of daily exercise on daily blood glucose level and affect among persons with type 1 diabetes (T1D). 199 persons with T1D (Mage = 46.82) completed a 14-day diary in which they reported on their engagement in moderate to vigorous exercise for 30 min and positive and negative affect. Daily blood glucose (BG) was gathered through study-provided glucometers. Multilevel modeling examined the effects of daily variability in (within-person effects) and average levels of (between-person effects) daily exercise on BG and affect. On days when persons with T1D reported they exercised moderately to vigorously for 30 min, they had lower mean BG, higher risk for low BG, lower negative affect, and higher positive affect on the same day as well as lower mean BG on the following day. Engaging in daily exercise is important in managing daily blood glucose and affect among persons with T1D, but can be complicated by hypoglycemia.

Strained Bedfellows: An Actor-Partner Analysis of Spousal Attachment Insecurity and Sleep Quality.

Background: The quality of interpersonal ties-especially closer relationships-appears to be associated with physical health outcomes. Sleep is one pathway through which relationships and health appear to be linked, but this has been inadequately investigated in the context of dyadic attachment. Purpose: The present study examined links between relationship-specific attachment anxiety (which can involve preoccupation with one's partner, negative relationship cognitions, and fear of abandonment) and avoidance (e.g., low emotional investment or intimacy) and sleep quality. Methods: Attachment, assessed using the Experience in Close Relationship (ECR), was used to predict Pittsburgh Sleep Quality Inventory (PSQI)-assessed sleep quality in 92 married heterosexual couples via actor-partner interdependence models. Depression was examined as a potential mediator of this association. Results: Consistent with hypotheses, actors' anxious attachment predicted diminished quality of their own sleep, whereas actors' avoidant attachment was unrelated to their own sleep quality. Results further suggested that couples in which both spouses were higher in attachment anxiety experience better sleep quality (b = -0.74, SE = 0.28, p = .0082, 95% CI [-1.287, -0.196]). Conversely, couples in which both spouses were higher in attachment avoidance showed poorer sleep quality (b = 0.56, SE = 0.23, p = .0188, 95% CI [0.095, 1.016]). These effects were found to be independent of marital satisfaction and depression. Some evidence was also consistent with mediation of links between attachment and sleep quality via depression. Conclusions: Results suggest adult romantic attachment and sleep are associated in complex ways, highlighting the importance of dyadic approaches to the study of relationships, sleep, and health.

Sleep Quality and Inflammation in Married Heterosexual Couples: an Actor-Partner Analysis.

BACKGROUND: Subjective sleep quality is a predictor of important health outcomes, but little work has examined the social context of sleep that might inform theoretical models and intervention approaches. The present study tested actor-partner models of sleep quality and its links to inflammatory markers. METHOD: Participants were 84 middle-age to older adult heterosexual married couples who completed the Pittsburgh Sleep Quality Index and had blood drawn for determination of CRP and IL-6 levels. RESULTS: Main results indicated that only actor levels of poor global sleep quality predicted higher CRP levels. No actor × partner or gender × actor/partner interactions were significant. These results were also not moderated by relationship quality. Secondary analyses, focused on the different components of sleep quality, revealed marginally significant evidence for partner's poor sleep (i.e., sleep disturbances, sleep latency) on one's own inflammatory outcomes. CONCLUSION: These results suggest the promise of modeling sleep quality as a dyadic process that can impact inflammation and potentially related health outcomes.

A multivariate dynamic systems model for psychotherapy with more than one client.

The dynamics of the give and take between therapist and client(s) is frequently of interest to therapy process researchers. Characterizing the ways that therapists respond to clients and clients respond to therapists can be challenging in therapeutic encounters involving a single therapist and a single client. The complexity of this challenge increases as the number of people involved in a therapeutic encounter increases not only because there are more people responding to one another but also because the patterns of responding can become more complex. This manuscript demonstrates how dyadic cross-lagged panel models can be extended to psychotherapeutic encounters involving 3 people and used to test processes that exist between dyadic subsets of the larger group as well as the group as one cohesive unit. Three hundred seventy-nine talk turns of fundamental frequency from a couple therapy session were modeled using 3 dyadic cross-lagged panel models, and each individual's respiratory sinus arrhythmia (RSA) was treated as a moderator. Although the regression coefficients for each dyadic subset (e.g., therapist-husband) were nonsignificant, an eigenvalue/eigenvector decomposition of the regression coefficients from the 3 dyadic cross-lagged panel models suggests that interdependence exists at the level of the whole group (i.e., therapist-husband-wife) rather than between pairs of individuals within the group (e.g., husband-wife). Further, an interaction involving husband's RSA suggested that interdependence involving the husband ceased when the husband displayed greater regulatory effort. This combination of statistical methods allows for clearly distinguishing between dyadic therapeutic processes and group-level therapeutic processes. (PsycINFO Database Record

Observed dyadic collaboration among couples coping with type 1 diabetes.

Previous research linking collaboration to relationship and health outcomes has relied almost exclusively on individual self-report and failed to take into consideration the dyadic nature of collaboration. We enrolled couples (n = 193) in which one person had Type 1 diabetes (52% female; 91% non-Hispanic white) into the study and asked them to discuss a diabetes-related issue of high concern for 8 min. These videotaped interactions were coded for dyadic collaboration. Mood was measured before and after the discussion. After the discussion, patients and partners reported support provided and received during the discussion. Results showed that observed dyadic collaboration was related to improvements in mood and greater support exchanges for both patients and partners when self-reported collaboration was statistically controlled. Gender moderated the effects on partners, such that benefits of dyadic collaboration were stronger for women than men. Future research may benefit from including collaborative elements into couple-focused interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Daily stress spillover and crossover in couples coping with type 1 diabetes.

In the context of a chronic illness such as Type 1 diabetes (T1D), managing general stressors may be linked to diabetes-specific stressors for persons with T1D, an intraindividual contagion phenomenon (i.e., spillover). Among those with romantic partners, stress may also be associated with the partner's stress (i.e., crossover). These intraindividual and interpersonal processes may be further strengthened or weakened in the presence of individual (e.g., sleep satisfaction) and interpersonal (e.g., relationship satisfaction) factors. This study examined spillover and crossover effects between daily general and diabetes-specific stressors and whether sleep satisfaction and relationship satisfaction moderated spillover and crossover effects among couples in which one person had T1D. Persons with T1D (n = 199; Mage = 46.82, 52.3% female) and their romantic partners (n = 199; Mage = 46.41, 47.2% female) reported general stressors and sleep satisfaction, and persons with T1D reported diabetes-specific stressors on 14 consecutive days. Both couple members completed a survey that assessed relationship satisfaction. Multilevel models revealed significant within-person and between-person stress spillover and crossover effects. When examining the moderating role of sleep satisfaction, however, persons with T1D with better sleep satisfaction did not experience spillover between one domain and the other. Furthermore, partners with higher relationship satisfaction did not experience crossover between the persons with T1D-specific stressors and their general stressors. These findings support the conceptualization of the link between general and diabetes-specific stressors as both an intraindividual and a dyadic process among couples coping with T1D. In addition, better sleep satisfaction can prevent spillover effects, and relationship satisfaction can prevent stress crossover effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Enemies and friends in high-tech places: the development and validation of the Online Social Experiences Measure.

BACKGROUND: Interpersonal positivity and negativity are separable dimensions both recognized as having important effects on health. Though online social interactions and research examining them are increasingly common, no validated instrument has heretofore been developed to examine social support and social negativity specifically in online contexts. The present studies describe the development and validation of the Online Social Experiences Measure (OSEM) to allow for assessment of online social positivity and negativity simultaneously. METHODS AND RESULTS: In Study I, responses to a potential item pool were collected from participants (N = 557), who were then subdivided into two groups for the purposes of cross-validation via exploratory and confirmatory factor analyses. Results suggested the emergence of two factors: online social support (OSEM+ subscale) and online social negativity (OSEM- subscale). Across Studies I and II (N = 139), the OSEM showed good convergent and discriminant validity, and both subscales had high internal consistency. Study II included an ambulatory cardiovascular assessment and found the OSEM- subscale to be predictive of elevated diastolic blood pressure and heart rate. The OSEM+ subscale was predictive of more favorable cardiovascular readings for some types of participants (e.g. those with a greater number of online-only social ties). CONCLUSIONS: Overall, results suggest online social positivity and negativity may have implications for physical health, and that the OSEM may be a useful tool in understanding online social processes.

(Too) Anxious to help? Social support provider anxiety and cardiovascular function.

Provider factors, such as anxiety, may be important in understanding effects of received social support (SS), which are less consistently positive than those of perceived SS. Due to the dyadic nature of support, anxiety on the part of the provider was predicted to influence the effectiveness of received SS. This laboratory study examined effects of SS provider anxiety within unacquainted dyads on cardiovascular reactivity during acute stress. 148 participants were assigned to support roles, and each dyad was randomized to low or high provider anxiety. Results include that SS provider anxiety resulted in greater blood pressure reactivity and less recovery toward baseline diastolic blood pressure within the dyad. Overall, it appears provider anxiety contributes to less effective SS for recipients and that health costs may accompany providing and receiving support under nonoptimal conditions.

Social support, social integration, and inflammatory cytokines: A meta-analysis.

OBJECTIVE: Social support and social integration have been linked to lower rates of morbidity and mortality. However, the biological mechanisms responsible for such links need greater attention to advance theory and unique intervention opportunities. The main aim of this article was to conduct a meta-analytic review of the association between social support-social integration and inflammatory cytokines (e.g., interleukin-6, C-reactive protein) and test several proposed moderators from prior qualitative reviews. METHOD: A literature search was conducted using the ancestry approach and with databases PsycINFO, Medline, and EMBASE by crossing the exact keywords social support or social integration with inflammation. The review identified 41 studies with a total of 73,037 participants. RESULTS: The omnibus meta-analysis showed that social support-social integration were significantly related to lower levels of inflammation (Zr = -.073). These results were not moderated by the operationalization of social relationships or the type of population, cytokine, and design. CONCLUSIONS: These data suggest that inflammation is at least one important biological mechanism linking social support and social integration to the development and course of disease. Future work should continue to build on this review and address next-generation questions regarding antecedent processes, mechanisms, and other potential moderators. (PsycINFO Database Record

Social support and sleep: A meta-analysis.

OBJECTIVE: While the implications of social support are increasingly well understood, no meta-analytic review to date has examined the intersection of the social support and sleep literatures. The aims of this meta-analysis were primarily to review the association between social support and sleep and additionally to test several proposed moderators from prior work. METHOD: Using a literature search and the ancestry approach, the review identified 61 studies with a total of 105,437 participants. RESULTS: Random-effects modeling showed that greater social support was significantly related to improved sleep outcomes (Zr = -.152). These results were not moderated by the operationalization of support, study design, or chronic conditions. CONCLUSIONS: These data indicate a robust association between social support and favorable sleep outcomes. (PsycINFO Database Record

The quality of social networks predicts age-related changes in cardiovascular reactivity to stress.

Although existing life span models suggest that positivity in relationships should benefit the health of older adults, much less is known about how relationships that contain both positive and negative aspects (i.e., ambivalent ties) might influence age-associated cardiovascular risk. Given the increased interpersonal stress associated with ambivalent ties, the SAVI model would predict that older adults might be more negatively influenced given age-related changes in physiological flexibility. In this study, the quality of an individual's social network (i.e., supportive, ambivalent, aversive) was used to predict cardiovascular reactivity during laboratory stress across a 10-month follow-up period in 108 participants between the ages 30 to 70. Results revealed evidence that the number of ambivalent network ties predicted greater increases in diastolic blood pressure reactivity. Importantly, there was an Age × Ambivalent Ties interaction in which the number of ambivalent ties was related to greater increases in systolic blood pressure reactivity primarily in older adults. These data are discussed in terms of the health implications of social networks across the life span. (PsycINFO Database Record