Links of communal coping to relationship and psychological health in type 2 diabetes: actor-partner interdependence models involving role, sex, and race.

BACKGROUND: Communal coping is one person's appraisal of a stressor as shared and collaboration with a partner to manage the problem. There is a burgeoning literature demonstrating the link of communal coping to good relationships and health among persons with chronic disease. PURPOSE: We examined links of communal coping to relationship and psychological functioning among couples in which one person was recently diagnosed with type 2 diabetes. We distinguished effects of own communal coping from partner communal coping on both patient and spouse relationship and psychological functioning, as well as whether communal coping effects were moderated by role (patient, spouse), sex (male, female), and race (White, Black). METHODS: Participants were 200 couples in which one person had been diagnosed with type 2 diabetes (46% Black, 45% female) within the last 5 years. Couples completed an in-person interview, participated in a discussion to address diabetes-related problems, and completed a postdiscussion questionnaire. RESULTS: Own communal coping and partner communal coping were related to good relationship and psychological functioning. Interactions with role, sex, and race suggested: (i) partner communal coping is more beneficial for patients than spouses; (ii) own communal coping is more beneficial for men, whereas partner communal coping is more beneficial for women; and (iii) White patients and Black spouses benefit more from own communal coping than Black patients and White spouses. CONCLUSION: These findings demonstrate the benefits of communal coping across an array of self-report and observed indices, but suggest there are differential benefits across role, sex, and race.

Sex, race, and the role of relationships in diabetes health: intersectionality matters.

Previous research has seldom used an intersectionality framework to consider how sex and race affect diabetes health, nor has it examined the role of sex and race in the well-established link between romantic relationship quality and health. This study targeted 200 adults with type 2 diabetes (46% Black; 45% female) and examined whether sex, race, and the interaction between sex and race predicted behavioral and psychological health, or moderated the link between relationship quality and health outcomes. Black women reported poorer diabetes self-care and lower self-efficacy compared to other groups. Relationship quality was associated with better self-care, increased self-efficacy, and lower depressive symptoms. The association between relationship quality and medication adherence was stronger for Black women, and the association between relationship quality and self-efficacy was stronger for both Black women and White men. Results suggest that Black women with diabetes experience more health disadvantages than other groups, but some of these disadvantages might be attenuated by supportive romantic relationships.

An examination of the communal coping process in recently diagnosed diabetes.

Communal coping, which involves a shared illness appraisal and engaging in collaboration when illness-related problems arise, is likely beneficial for individuals with type 2 diabetes. The purpose of this work was to examine the process by which communal coping may lead to such benefits. First, we hypothesized that illness-related interactions characterized by more communal coping would involve greater spouse support provision and greater patient receptivity to support. Second, we hypothesized that such interactions would lead to greater perceived problem resolution and more positive perceptions of the interaction. Third, we expected communal coping to predict changes in long-term diabetes outcomes-increased self-efficacy, improved self-care, and reduced diabetes distress-6 months later. Finally, we predicted that these long-term links would be partially explained by the immediate interaction outcomes. We tested these hypotheses in a sample of 123 persons with recently diagnosed type 2 diabetes and their spouses. Patient and spouse communal coping was observed in the laboratory during a diabetes stressor discussion, and patients reported outcomes immediately after the discussion and 6 months later. Results were largely consistent with hypotheses, but spouse communal coping was more consistently linked to support outcomes, and only patient communal coping was linked to changes in long-term outcomes. This work contributes to the literature indicating communal coping is beneficial for individuals with chronic illness and provides insight into the process by which communal coping exerts these effects.

Daily Communal Coping in Couples With Type 2 Diabetes: Links to Mood and Self-Care.

Background: Adjusting to the challenges of a chronic illness does not affect patients alone but also influences social network members-most notably spouses. One interpersonal framework of coping with a chronic illness is communal coping, described as when a problem is appraised as joint and the couple collaborates to manage the problem. Purpose: We sought to determine whether daily communal coping was linked to daily mood and self-care behavior and examined one potential mechanism that may explain these links: perceived emotional responsiveness. Methods: Patients who had been diagnosed with diabetes less than 5 years ago and their spouses (n = 123) completed a daily diary questionnaire that assessed communal coping and mood for 14 consecutive days. The patients also reported daily self-care behaviors. We used multilevel modeling to examine the links of communal coping to patient and spouse mood and patient self-care. Because both patients and spouses reported their mood, the actor-partner interdependence model (APIM) was employed to examine mood. Results: Multilevel APIM showed that actor communal coping was associated with lower depressed mood, higher happy mood, and lower angry mood and partner communal coping was linked to higher happy mood. Patient communal coping was related to better dietary and medication adherence, and spouse communal coping was linked to better medication adherence. Perceived emotional responsiveness partially mediated the relations of communal coping to mood but not to self-care behaviors. Conclusions: Communal coping on a daily basis may help both patients and spouses adjust psychologically to the illness as well as enhance patient self-care behaviors.

Featured Article: Trajectories of Glycemic Control Over Adolescence and Emerging Adulthood: An 11-Year Longitudinal Study of Youth With Type 1 Diabetes.

Objective: To identify trajectories of glycemic control over adolescence and emerging adulthood and to test whether demographic and psychosocial variables distinguished these trajectories. Methods: We enrolled 132 youth with type 1 diabetes when they were average age 12 and followed them for 11 years. We used group-based trajectory modeling to identify distinct patterns of glycemic control, and examined whether age 12 demographic and psychosocial variables distinguished the subsequent trajectories. Results: We identified 5 trajectories of glycemic control: stable on target, stable above target, volatile late peak, stable high, and inverted U. Parent social status and household structure distinguished the more problematic trajectories from the stable on target group. Friend conflict, psychological distress, unmitigated communion, and self-care behavior at age 12 distinguished problematic glycemic control trajectories from the stable on target group. Conclusions: These results can be used to identify youth who are at risk for deteriorating glycemic control over adolescence.

Relation of parent knowledge to glycemic control among emerging adults with type 1 diabetes: a mediational model.

The study goal was to examine the links of parent knowledge of children's behavior to diabetes outcomes and to test a mediational model that focused on psychological distress and self-care behavior. We recruited 132 adolescents (average age 12) and followed them to average age 23. At age 23 (n = 107), we conducted in-person interviews with these emerging adults to measure parent knowledge, psychological distress, self-care behavior and glycemic control. We used structural equation modeling to test our hypotheses with these cross-sectional data. Higher levels of parent knowledge were linked to better glycemic control, and this path was mediated by reduced psychological distress and enhanced self-care behavior. Parents remain an important influence in the lives of emerging adults with type 1 diabetes. When emerging adults have a relationship with their parents in which they share general information, psychological distress may be reduced which then facilitates self-care and, ultimately, glycemic control.

Implicit and Explicit Communal Coping in Couples with Recently Diagnosed Type 2 Diabetes.

When an individual in a close relationship is diagnosed with a chronic illness, coping can be the responsibility of the patient, or couple-members can cope communally. Communal coping reflects a shared appraisal of a stressor (our problem instead of my problem) and collaborative efforts to address the stressor. The current study examined whether patients' and partners' communal coping levels were associated with relational and health functioning among 70 couples in which one member was recently diagnosed with type 2 diabetes. We assessed explicit communal coping with self-reported "inclusion of the other in the self" in regard to diabetes management and implicit communal coping with first person plural pronoun usage during a diabetes discussion. We also assessed patient reports of support received from partners, patient and partner psychological distress, and patient self-care behavior. Results showed that patient explicit communal coping was related to better patient relationship quality and greater support receipt from partners. Patient and partner explicit communal coping also were related to reduced partner distress but not patient distress. Instead, partner implicit communal coping was related to reduced patient distress. Most noteworthy, partner implicit communal coping was related to better patient self-care behavior. These results suggest that communal coping may be beneficial for both relationships and health, but that the effects of explicit measures differ from those of implicit measures. Patients might benefit especially from partner communal coping efforts that are less obvious.

A Bayesian model of psychosis symptom trajectory in Alzheimer's disease.

OBJECTIVE: Psychosis, like other neuropsychiatric symptoms of dementia, has many features that make predictive modeling of its onset difficult. For example, psychosis onset is associated with both the absolute degree of cognitive impairment and the rate of cognitive decline. Moreover, psychotic symptoms, while more likely than not to persist over time within individuals, may remit and recur. To facilitate predictive modeling of psychosis for personalized clinical decision making, including evaluating the role of risk genes in its onset, we have developed a novel Bayesian model of the dual trajectories of cognition and psychosis symptoms. METHODS: Cognition was modeled as a four-parameter logistic curve with random effects for all four parameters and possible covariates for the rate and time of fall. Psychosis was modeled as a continuous-time hidden Markov model with a latent never-psychotic class and states for pre-psychotic, actively psychotic and remitted psychosis. Covariates can affect the probability of being in the never-psychotic class. Covariates and the level of cognition can affect the transition rates for the hidden Markov model. RESULTS: The model characteristics were confirmed using simulated data. Results from 434 AD patients show that a decline in cognition is associated with an increased rate of transition to the psychotic state. CONCLUSIONS: The model allows declining cognition as an input for psychosis prediction, while incorporating the full uncertainty of the interpolated cognition values. The techniques used can be used in future genetic studies of AD and are generalizable to the study of other neuropsychiatric symptoms in dementia.

Visual environment, attention allocation, and learning in young children: when too much of a good thing may be bad.

A large body of evidence supports the importance of focused attention for encoding and task performance. Yet young children with immature regulation of focused attention are often placed in elementary-school classrooms containing many displays that are not relevant to ongoing instruction. We investigated whether such displays can affect children's ability to maintain focused attention during instruction and to learn the lesson content. We placed kindergarten children in a laboratory classroom for six introductory science lessons, and we experimentally manipulated the visual environment in the classroom. Children were more distracted by the visual environment, spent more time off task, and demonstrated smaller learning gains when the walls were highly decorated than when the decorations were removed.

Individual differences in cue weights are stable across time: the case of Japanese stop lengths.

Speech categories are defined by multiple acoustic dimensions, and listeners give differential weighting to dimensions in phonetic categorization. The informativeness (predictive strength) of dimensions for categorization is considered an important factor in determining perceptual weighting. However, it is unknown how the perceptual system weighs acoustic dimensions with similar informativeness. This study investigates perceptual weighting of two acoustic dimensions with similar informativeness, exploiting the absolute and relative durations that are nearly equivalent in signaling Japanese singleton and geminate stop categories. In the perception experiments, listeners showed strong individual differences in their perceptual weighting of absolute and relative durations. Furthermore, these individual patterns were stable over repeated testing across as long as 2 months and were resistant to perturbation through short-term manipulation of speech input. Listeners own speech productions were not predictive of how they weighted relative and absolute duration. Despite the theoretical advantage of relative (as opposed to absolute) duration cues across contexts, relative cues are not utilized by all listeners. Moreover, examination of individual differences in cue weighting is a useful tool in exposing the complex relationship between perceptual cue weighting and language regularities.

Effect of Repeated Exposure to the Visual Environment on Young Children's Attention.

Prior research suggests that visual features of the classroom environment (e.g., charts and posters) are potential sources of distraction hindering children's ability to maintain attention to instructional activities and reducing learning gains in a laboratory classroom. However, prior research only examined short-term exposure to elements of classroom décor, and it remains unknown whether children habituate to the visual environment with repeated exposure. In study 1, we explored experimentally the possibility that children may habituate to the visual environment if the visual displays are static. We measured kindergarten children's patterns of attention allocation in a decorated classroom environment over a 2-week period and compared the percentage of time children spent off-task to a baseline condition in which the classroom environment was streamlined (i.e., charts, posters, and manipulatives were removed). The findings indicate that with more prolonged exposure to a static visual environment, partial habitation effects were observed: Attention to the environment declined at the end of the exposure period compared to the beginning of the study; however, the environment remained a significant source of off-task behavior even after 2 weeks of exposure. In study 2, we extend this work by conducting a longitudinal observation of six primary classrooms in which we measured children's patterns of attention allocation in real classrooms for 15 weeks to investigate whether increasing familiarity with the classroom décor would influence attention toward the visual environment. No evidence of habituation was observed in genuine classrooms in study 2. Potential implications for classroom design and future directions are discussed.

Menstrual effects on mood symptoms in treated women with bipolar disorder.

OBJECTIVES: Reports suggest women with bipolar disorder (BD) have high rates of perimenstrual mood worsening. In this prospective study, the authors compared healthy controls and depressed and euthymic BD patients on medications on mood levels, psychosocial function, and physical symptoms in the late luteal versus the early follicular phase. METHODS: At baseline, the lifetime diagnosis of bipolar I disorder or bipolar II disorder, current mood episode, and absence of premenstrual dysphoric disorder in controls were confirmed with the Structured Clinical Interview for DSM-IV Disorders. Subjects were assessed across three menstrual cycles during the late luteal and early follicular phases. Clinicians administered the Structured Interview Guide for the Hamilton Depression Rating Scale and the Mania Rating Scale to assess levels of depression and hypomania/mania, respectively. Subjects completed self-report ratings on psychosocial function and perceived stress and tracked daily mood and physical symptoms on the National Institute of Mental Health LifeChart and the Daily Rating Form. Ovulation was verified objectively with mid-cycle luteinizing hormone urine dipsticks and serum progesterone levels. RESULTS: The sample characteristics were similar among the three patient groups of healthy controls (n = 10), BD-euthymic (n = 6), and BD-depressed (n = 5). The two-way analysis of variance indicated a significant difference among the diagnostic groups on depression scores, psychosocial functioning, and levels of perceived stress. There was no significant difference for menstrual phase or the interaction of menstrual phase by diagnostic group. CONCLUSIONS: Mood symptom level, psychosocial functioning, perceived stress, and physical discomfort were unrelated to menstrual phase in patients with BD. Appropriate maintenance treatment may prevent menstrual related mood symptoms. Use of an objective marker of ovulation is critical for research involving menstrual related outcomes.

Seasonal effects on depression risk and suicidal symptoms in postpartum women.

BACKGROUND: Postpartum depression (PPD) is the most common complication of childbirth. Suicide is a leading cause of maternal death in the first postpartum year. Depressed mothers often have suicidal ideation (SI). Depression and suicidality may vary across the seasons. Previous studies of seasonality and PPD were relatively small or encumbered by study design constraints. We examined the possible relationship between seasonality, depression, and SI in 9,339 new mothers. METHODS: From 2006 to 2010, the investigators screened women within 4-6 weeks postpartum with the Edinburgh Postnatal Depression Scale (EPDS). We used spectral analysis to explore seasonal variation in risk for depression and suicidality. RESULTS: The study team screened 9,339 new mothers, of whom 1,316 (14%) women had positive depression scores (EPDS≥10) which suggest PPD risk; 294 (3%) women had SI (item 10≥1). A positive EPDS was associated significantly with SI. PPD risk varied significantly across 12-months-risk was highest in December. We detected no seasonal variation in SI. CONCLUSIONS: Effects of seasonal light variation may contribute to increased risk for depressive symptoms. Suicidality could be related to maternal depression but not seasonal variation.

Brief report: trajectories of glycemic control over early to middle adolescence.

OBJECTIVES: To identify distinct patterns of glycemic control over early to middle adolescence, and to determine whether psychosocial variables predicted those patterns. METHODS: We used trajectory analysis to examine glycemic control over 5 years among adolescents with type 1 diabetes who were of age 12 on average at study start (n = 132). Well-being, relationships, and self-care behavior were assessed with in-person interviews. Blood glucose testing was determined from blood glucose meters, and missed clinic appointments and glycosolated hemoglobin were obtained from medical records. RESULTS: We identified two distinct clusters of individuals, a stable good glycemic control group and a poorer deteriorating glycemic control group. Individuals in the deteriorating control group were characterized by higher peer conflict, more negative diabetes emotions, fewer blood glucose tests, and more missed clinic appointments. CONCLUSION: Psychosocial variables and behavioral markers of self-care may predict the course of glycemic control over early to middle adolescence.

Trajectories of cognitive decline in Alzheimer's disease.

BACKGROUND: Late-onset Alzheimer disease (LOAD) is a clinically heterogeneous complex disease defined by progressively disabling cognitive impairment. Psychotic symptoms which affect approximately one-half of LOAD subjects have been associated with more rapid cognitive decline. However, the variety of cognitive trajectories in LOAD, and their correlates, have not been well defined. We therefore used latent class modeling to characterize trajectories of cognitive and behavioral decline in a cohort of AD subjects. METHODS: 201 Caucasian subjects with possible or probable Alzheimer's disease (AD) were evaluated for cognitive and psychotic symptoms at regular intervals for up to 13.5 years. Cognitive symptoms were evaluated serially with the Mini-mental State Examination (MMSE), and psychotic symptoms were rated using the CERAD behavioral rating scale (CBRS). Analyses undertaken were latent class mixture models of quadratic trajectories including a random intercept with initial MMSE score, age, gender, education, and APOE 4 count modeled as concomitant variables. In a secondary analysis, psychosis status was also included. RESULTS: AD subjects showed six trajectories with significantly different courses and rates of cognitive decline. The concomitant variables included in the best latent class trajectory model were initial MMSE and age. Greater burden of psychotic symptoms increased the probability of following a trajectory of more rapid cognitive decline in all age and initial MMSE groups. APOE 4 was not associated with any trajectory. CONCLUSION: Trajectory modeling of longitudinal cognitive and behavioral data may provide enhanced resolution of phenotypic variation in AD.

Partner unmitigated communion moderates communal coping benefits in type 2 diabetes.

The study goal was to determine whether partner's level of unmitigated communion moderated the relation of partner communal coping to patient health. Couples in which one person was recently diagnosed with type 2 diabetes (n = 123) were interviewed separately and asked to discuss a diabetes-related problem. Communal coping behavior (from videotaped discussions) interacted with partner communal coping, such that partner communal coping was related to lower patient distress, higher patient self-efficacy, and higher patient medication adherence only when partners scored lower on unmitigated communion. The extent to which perceived emotional responsiveness and overprotective behavior mediated these relations was explored.

Psychosocial predictors of diabetes risk factors and complications: An 11-year follow-up.

OBJECTIVE: The goal of this study was to use the risk and resistance framework to examine whether a set of psychosocial variables measured at age 12 in youth with Type 1 diabetes would predict the emergence of diabetes risk and complication variables 11 years and 13 years later. METHOD: We interviewed youth with Type 1 diabetes when they were average age 12 and followed them for 11 years until they were average age 23 and then average age 25. At age 12, we measured personality traits (unmitigated communion, unmitigated agency), relationship variables (parent relationship quality, friend support, friend conflict), indicators of psychological well-being (depressive symptoms, bulimic symptoms, self-worth), and self-care behavior. We used these psychosocial variables assessed at age 12 to predict diabetes risk factors, glycemic control, and the emergence of diabetes complications at follow-up. RESULTS: Higher unmitigated agency, poor quality parent relationships, higher friend conflict, bulimic symptoms, and lower self-worth predicted one or more diabetes outcomes. When statistical controls for age 12 glycemic control were employed, unmitigated agency emerged as the most robust predictor of diabetes outcomes. CONCLUSION: Unmitigated agency, which involves an overly inflated view of the self and a cynical view of others, predicted poor diabetes outcomes over an 11-year and 13-year period. The processes by which unmitigated agency could influence health are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evidence of dysregulated peripheral oxytocin release among depressed women.

OBJECTIVE: Oxytocin is a hypothalamic neuropeptide that plays a key role in mammalian female reproductive function. Animal research indicates that central oxytocin facilitates adaptive social attachments and modulates stress and anxiety responses. Major depression is prevalent among postpubertal females, and is associated with perturbations in social attachments, dysregulation of the hypothalamic-pituitary-adrenal stress axis, and elevated levels of anxiety. Thus, depressed women may be at risk to display oxytocin dysregulation. The current study was developed to compare patterns of peripheral oxytocin release exhibited by depressed and nondepressed women. METHODS: Currently depressed (N = 17) and never-depressed (N = 17) women participated in a laboratory protocol designed to stimulate, measure, and compare peripheral oxytocin release in response to two tasks: an affiliation-focused Guided Imagery task and a Speech Stress task. Intermittent blood samples were drawn over the course of two, 1-hour sessions including 20-minute baseline, 10-minute task, and 30-minute recovery periods. RESULTS: The 10-minute laboratory tasks did not induce identifiable, acute changes in peripheral oxytocin. However, as compared with nondepressed controls, depressed women displayed greater variability in pulsatile oxytocin release over the course of both 1-hour sessions, and greater oxytocin concentrations during the 1-hour affiliation-focused imagery session. Oxytocin concentrations obtained during the imagery session were also associated with greater symptoms of depression, anxiety, and interpersonal dysfunction. CONCLUSIONS: Depressed women are more likely than controls to display a dysregulated pattern of peripheral oxytocin release. Further research is warranted to elucidate the clinical significance of peripheral oxytocin release in both depressed and nondepressed women.

Communally coping with diabetes: An observational investigation using the actor-partner interdependence model.

Communal coping is a form of interpersonal coping that involves a shared illness appraisal and collaborating to address illness-related issues. We hypothesized that communal coping among couples in which one person is recently diagnosed with Type 2 diabetes would be related to better diabetes problem-solving, better mood, greater relationship quality, and less psychological distress for both partners. Communal coping was coded from videotaped interactions in which 119 heterosexual couples discussed difficulties in managing diabetes. Actor-partner interdependence models were performed to isolate associations of actor communal coping and partner communal coping with outcomes, and examined whether the couple-member had diabetes and sex as moderator variables. We expected that communal coping would be more beneficial for women than men, and that partner communal coping would be more strongly linked to outcomes than actor communal coping. Results were largely consistent with hypotheses, suggesting that communal coping is beneficial to couples coping with diabetes. (PsycINFO Database Record

Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial.

OBJECTIVE: Patients with bipolar disorder have recurrent major depression, residual mood symptoms, and limited treatment options. Building on promising pilot data, the authors conducted a 6-week randomized double-blind placebo-controlled trial to investigate the efficacy of adjunctive bright light therapy at midday for bipolar depression. The aims were to determine remission rate, depression symptom level, and rate of mood polarity switch, as well as to explore sleep quality. METHOD: The study enrolled depressed adults with bipolar I or II disorder who were receiving stable dosages of antimanic medication (excluding patients with hypomania or mania, mixed symptoms, or rapid cycling). Patients were randomly assigned to treatment with either 7,000-lux bright white light or 50-lux dim red placebo light (N=23 for each group). Symptoms were assessed weekly with the Structured Interview Guide for the Hamilton Depression Scale With Atypical Depression Supplement (SIGH-ADS), the Mania Rating Scale, and the Pittsburgh Sleep Quality Index. Remission was defined as having a SIGH-ADS score of 8 or less. RESULTS: At baseline, both groups had moderate depression and no hypomanic or manic symptoms. Compared with the placebo light group, the group treated with bright white light experienced a significantly higher remission rate (68.2% compared with 22.2%; adjusted odds ratio=12.6) at weeks 4-6 and significantly lower depression scores (9.2 [SD=6.6] compared with 14.9 [SD=9.2]; adjusted ß=-5.91) at the endpoint visit. No mood polarity switches were observed. Sleep quality improved in both groups and did not differ significantly between them. CONCLUSIONS: The data from this study provide robust evidence that supports the efficacy of midday bright light therapy for bipolar depression.