Climate to COVID, global to local, policies to people: a biopsychosocial ecological framework for syndemic prevention and response in behavioral medicine.

Land development, pollution, and waste have affected natural environments, contributing to hurricanes, wildfires, and pandemic infectious diseases like COVID-19. Globalized corporate food systems that produce ultra-refined foods with low nutritional value contribute to both environmental conditions and health conditions like obesity and undernutrition. This has the greatest impact on communities already suffering from elevated health risks driven by economic inequities rooted in racism. These interacting environmental, health, and social conditions represent a syndemic. We outline practical suggestions to address this syndemic of environmental degradation, pandemic infectious disease, chronic disease, undernutrition, and inequity through research and practice at many levels, including individual behavior, local communities, and regional, national and global policy. Collaboration with communities is central to simultaneously tackling interconnected human and environmental health threats. For example, community-led groups have increased access to healthy food in response to pandemic conditions. Building on behavioral medicine's rich foundation of ecological models, communities have partnered with local researchers to address the needs of equitable public transport and reduction of greenhouse gas emissions through multilevel research and practice. Policymakers, researchers, practitioners, and community members should collaborate with each other and across disciplines to find lasting, multiduty solutions to improve physical, psychosocial, and planetary health.

Couples' Relationship Satisfaction and Its Association with Depression and Spouse Responses Within the Context of Chronic Pain Adjustment.

BACKGROUND: Chronic pain is one specific health condition where couple relationships have been directly linked to physical and psychological outcomes. Understanding how relationship satisfaction, couple dynamics, and pain adjustment interrelate is crucial for nurses who provide patient-centered care for patients with pain. AIMS: The current study was aimed at examining the associations of depressive symptoms and spouse response styles with relationship satisfaction in the context of West Haven-Yale Multidimensional Pain Inventory classifications. METHODS: Seventy-eight middle-aged outpatients with chronic pain (average pain duration of 8.98 years (SD = 9.51)) were recruited from a pain clinic in southeastern Michigan. Participants completed the Multidimensional Pain Inventory, from which pain adjustment classifications (adaptive, dysfunctional, interpersonally distressed) and spouse response styles were derived, the Dyadic Adjustment Scale to assess relationship satisfaction, and the Mood and Anxiety Symptom Questionnaire to assess depressive symptoms. RESULTS: Interpersonally distressed patients scored lower on relationship satisfaction than those classified as either adaptive or dysfunctional, F(2,66) = 6.38, p < .01. Significant inverse associations were found between punishing spouse response styles and relationship satisfaction for both interpersonally distressed and dysfunctional adjustment classifications: r = -.53, p < .05; r = -.57, p < .01, respectively. CONCLUSIONS: Overall, findings indicate that relationship satisfaction may be an area of concern among interpersonally distressed pain patients and that spouse response style may be a particularly important area of clinical attention.

Toward a Biopsychosocial Ecology of the Human Microbiome, Brain-Gut Axis, and Health.

OBJECTIVE: Rapidly expanding insights into the human microbiome and health suggest that Western medicine is poised for significant evolution, or perhaps revolution-this while medicine continues on a trajectory from reductionism to a biopsychosocial (BPS) paradigm recognizing biological, psychological, and social influences on health. The apparent sensitivity of the microbiota to perturbations across BPS domains suggests that a broad and inclusive framework is needed to develop applicable knowledge in this emerging area. We outline an ecological framework of the human microbiome by extending the BPS concept to better incorporate environmental and human factors as members of a global, dynamic set of systems that interact over time. METHODS: We conducted a selective literature review across disciplines to integrate microbiome research into a BPS framework. RESULTS: The microbiome can be understood in terms of ecological systems encompassing BPS domains at four levels: (a) immediate (molecular, genetic, and neural processes), (b) proximal (physiology, emotion, social integration), (c) intermediate (built environments, behaviors, societal practices), and (d) distal (physical environments, attitudes, and broad cultural, economic, and political factors). The microbiota and host are thus understood in terms of their immediate interactions and the more distal physical and social arenas in which they participate. CONCLUSIONS: A BPS ecological paradigm encourages replicable, generalizable, and interdisciplinary/transdisciplinary research and practices that take into account the vast influences on the human microbiome that may otherwise be overlooked or understood out of context. It also underscores the importance of sustainable bioenvironmental, psychological, and social systems that broadly support microbial, neural, and general health.

Pain catastrophizing differs between and within West Haven-Yale Multidimensonal Pain Inventory (MPI) pain adjustment classifications: theoretical and clinical implications from preliminary data.

OBJECTIVES: Pain catastrophizing is associated with multiple pain outcomes, and is differentially associated with the adaptive coping (AC), dysfunctional (DYS), and interpersonally distressed (ID) coping classifications of the West Haven-Yale Multidimensional Pain Inventory (MPI). We examined how catastrophizing, and the underlying components of magnification, rumination, and helplessness, may relate to MPI classifications and differentially relate to pain outcomes across classification groups to inform clinical treatment planning. MATERIALS AND METHODS: Sixty-nine adults (70% women) diagnosed with musculoskeletal pain were recruited from 2 pain clinics and completed self-report measures of pain severity, the MPI, Pain Catastrophizing Scale, and the Mood and Anxiety Symptom Questionnaire. RESULTS: Patients in the DYS and ID groups reported the greatest levels of rumination, helplessness, and overall catastrophizing, as well as the greatest depression, anxiety, and pain interference compared with the AC group. Catastrophizing related to average pain only in the DYS group (P<0.05), however, catastrophizing was associated with depression, anxiety, and interference (Ps<0.05) among those in the AC group, with a similar pattern observed among the ID group. DISCUSSION: Our findings suggest a continued need for targeting catastrophizing and negative affect among pain patients. However, our data suggest that even among relatively well-adjusted patients, there may be clinical utility in assessing catastrophic thinking given the associations of it with pain-related outcomes. The present findings additionally support the value of enlisting multiple theoretical perspectives such as the stress appraisal and attentional models in future research and clinical applications.

Hostility and social support explain physical activity beyond negative affect among young men, but not women, in college.

We examined social support as a moderator of cynical hostility in relation to physical activity and body mass index among college students (n = 859; M = 18.71 years (SD = 1.22); 60% women, 84% White). After controlling for negative affect in hierarchical linear regression models, greater hostility was associated with lesser physical activity among those with low social support, as expected. Greater hostility was also associated with greater physical activity among those high in social support, ps < .05. Effects were observed for men only. Hostility and social support were unrelated to body mass index, ps > .05. Young men with a hostile disposition and low social support may be at risk for a sedentary lifestyle for reasons other than negative affect.

Cardiovascular and psychological reactivity and recovery from harassment in a biracial sample of high and low hostile men and women.

BACKGROUND: This study emphasizes the importance of studying the emotional, motivational, and cognitive characteristics accompanying and the potential hemodynamic mechanisms underlying cardiovascular reactivity to and recovery from interpersonal conflict. PURPOSE: The relation of dispositional hostility to cardiovascular reactivity during a frustrating anagram task and post-task recovery was investigated. METHODS: The sample was composed of 99 healthy participants (age, 18-30 years; 53% women; 51% Caucasian; 49% African American)-half randomly assigned to a harassment condition. High and low hostility groups were created by a median split specific to sex and race subgroup score distributions on the Cook-Medley Hostility Scale. It was hypothesized that hostility would interact with harassment such that harassed, high hostile individuals would display the greatest cardiovascular and emotional reactivity and slowest recovery of the four groups. Participants completed a 10-min baseline, a 6-min anagram task, and a 5-min recovery period with blood pressure, heart rate, pre-ejection period, stroke index, cardiac index, and total peripheral resistance index measured. RESULTS: Harassed participants displayed significantly greater cardiovascular responses and lower positive affect to the task and slower systolic blood pressure (SBP) recovery than did nonharassed participants. The high hostile group, irrespective of harassment, showed blunted cardiovascular responses during the task and delayed SBP recovery than the low hostile group. CONCLUSION: Although the predicted interaction between hostility and harassment was not supported in the context of cardiovascular responses, such an interaction was observed in the context of blame attributions, whereby harassed hostile participants were found to blame others for their task performance than the other subgroups.

Nonlinear associations between chronic stress and cardiovascular reactivity and recovery.

A mixed literature on the influence of chronic and acute stress on cardiovascular reactivity (CVR) and recovery suggests a need for improved modeling of these associations. We examined these associations using both linear and nonlinear (quadratic) models. Data were collected on 129 healthy adults [59% female, ages 18-29 years]. Participants completed the Perceived Stress Scale (PSS) after engaging in a mental arithmetic and a stress recall task. Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were measured during rest, task, and recovery periods. Hierarchical ordinary least squares regression was used to examine the association of chronic stress to CVR and recovery with initial cardiovascular values and body mass index entered first as covariates. Hierarchical linear modeling (HLM) was also used for recovery. For reactivity, a quadratic relationship between PSS scores and DBP was observed in females such that those scoring at moderate levels of stress displayed lesser reactivity than those scoring either low or high. For recovery, a quadratic model was supported for SBP among females, with moderate levels of stress associated with greater recovery relative to either low or high levels. For females the quadratic model was also supported for SBP and DBP when examined using HLM. Quadratic modeling may better represent current theories of how chronic stress influences CVR and recovery. Our findings further suggest that these associations may be differentially evident by gender, perhaps due to gender differences in reported stress levels or gender-related task relevance.

Silent myocardial ischemia and cardiovascular responses to anger provocation in older adults.

To determine if older, asymptomatic individuals with no prior history of coronary heart disease with exercise-induced silent myocardial ischemia (SI) during graded exercise treadmill testing exhibit exaggerated cardiovascular reactivity to anger provocation, we compared 42 SI participants and 95 controls. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) changes from baseline to three tasks--anger recall, speech role-play, and mental arithmetic with harassment--were assessed. Compared to controls, SI displayed greater HR responses for the speech role-play task only. The SI group was significantly older, had higher levels of fasting glucose and triglycerides, and had lower HDL-cholesterol. In multiple regression analyses, after controlling for these differences, SI was significantly associated with greater HR responses to the speech role-play. In sum, the SI group significantly exaggerated HR responses to the speech role-play task, whereas SBP and DBP reactivity were comparable between groups. This suggests minimally enhanced cardiovascular reactivity among older SI patients that may nonetheless increase risk for cardiac events.

Diagnosis of hypertension and high blood pressure levels negatively affect cognitive function in older adults.

BACKGROUND: Hypertension is associated with diminished performance on tests of cognitive function. The degree to which those diagnosed with hypertension have controlled blood pressure (BP) levels may be a critical determinant of cognitive outcomes. Persons with hypertension and poorly controlled BP are likely to display the worst performance on cognitive tests. PURPOSE: The purpose is to examine potential interactive relations of hypertension diagnostic status and current BP levels to cognitive function. METHODS: Participants were 101 healthy older adults (ages 53-84, 62% male, 90% White, 29% diagnosed with hypertension) who engaged in biomedical and neuropsychological assessment. RESULTS: After statistical adjustment for age and education, persons with high BP performed more poorly than those with normal BP on the Visual Reproductions-Immediate and Delayed Recall and the Grooved Pegboard tests. Diagnosed hypertension was related to poorer performance on the Grooved Pegboard tests. An interaction of diagnosed hypertension and BP level revealed that those diagnosed with hypertension and also having poorly controlled BP levels performed least well on the Grooved Pegboard tests and the Trail Making Test-Part A. CONCLUSION: Irrespective of prior diagnostic status, individuals with high BP displayed compromised performance on tests of nonverbal memory, motor speed, and manual dexterity. However, as compared to the other groups, those diagnosed with hypertension and also having poorly controlled BP elevation were most vulnerable to difficulties on tests of perceptuo-motor speed, motor speed, and manual dexterity. These findings suggest the need for increased attention to preventative efforts with respect to BP assessment and control in older adults to help preserve cognitive function.

Stress-induced blood pressure reactivity and silent cerebrovascular disease.

BACKGROUND AND PURPOSE: Exaggerated blood pressure (BP) responses to mental stress, an index of autonomic dysregulation, have been related to enhanced risk for stroke. This study examined cross-sectional relations of stress-induced BP reactivity to silent cerebrovascular disease assessed by magnetic resonance imaging (MRI) in healthy older adults. METHODS: Sixty-seven nondemented, community-dwelling older adults (ages 55 to 81; 75% male) free of major medical, neurological, or psychiatric disease, engaged in: (1) clinical assessment of resting systolic and diastolic BP; (2) assessment of systolic and diastolic BP responses to 3 laboratory-based mental stressors; and (3) MRI. MRIs were rated for small silent infarcts (> or =3 mm), infarct-like lesions (<3 mm), and periventricular and deep white matter hyperintensities (WMH). RESULTS: After adjustment for age, gender, resting clinic BP, and fasting glucose levels, higher systolic BP reactivity was associated with an increased number of small silent infarcts (r2=0.14; P=0.004) and greater severity ratings of periventricular (r2=0.08; P<0.04) and deep WMH (r2=0.06; P<0.05). Higher diastolic BP reactivity was similarly associated with an increased number of small silent infarcts (r2=0.08; P<0.04), and greater severity ratings of periventricular (r2=0.08; P<0.04) and deep WMH (r2=0.11; P=0.009). CONCLUSIONS: These results indicate that greater stress-induced BP reactivity is associated with enhanced silent cerebrovascular disease on MRI in healthy asymptomatic older adults independent of resting BP levels. Exaggerated stress-induced BP reactivity warrants further examination as a potential biobehavioral risk factor for cerebrovascular disease.

Peripheral arterial disease and cognitive function.

OBJECTIVE: Peripheral arterial disease (PAD) is associated with comorbid atherosclerosis of the coronary and carotid arteries and is a significant risk factor for stroke. However, cognitive function in PAD patients before clinically evident stroke remains poorly characterized. Here we hypothesized that, on neuropsychological testing, PAD patients would perform more poorly than healthy control subjects, and persons with mild cardiovascular disease (essential hypertension), but better than stroke patients, thus reflecting a continuum of cognitive impairment associated with increased severity of vascular disease. METHOD: The cognitive performance of 38 PAD patients (mean ankle-brachial index=0.67, Fontaine Class II) was contrasted with that of 23 healthy normotensive controls, 20 essential hypertensives, and 26 anterior ischemic stroke patients on twelve neuropsychological tests. RESULTS: PAD patients performed significantly more poorly than hypertensives and normotensives, but better than stroke patients, on seven tests of nonverbal memory, concentration, executive function, perceptuo-motor speed, and manual dexterity. Hypertensives displayed poorer performance than normotensives on tests of nonverbal memory and manual dexterity. These findings were independent of age, education, and depression scores. Higher diastolic blood pressure and plasma glucose levels predicted poorer performance of select cognitive tests by PAD patients. Eight to 67% of PAD patients displayed impaired performance (< 5(th) percentile of normotensive controls) on the seven aforementioned cognitive tests. CONCLUSIONS: PAD patients exhibit diminished performance across a variety of domains of cognitive function. Findings also suggest a continuum of cognitive impairment associated with increasingly severe manifestations of cardiovascular disease, thus emphasizing the need for enhanced preventative measures to avert functional declines.

Relation of cognitive appraisal to cardiovascular reactivity, affect, and task engagement.

The relation of primary cognitive appraisals to cardiovascular reactivity, affect, task engagement, and perceived stress was examined in 56 men (ages 18-29). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, preejection period, stroke index, cardiac index, and total peripheral resistance were assessed at rest and during performance of a computerized mental arithmetic task. Extending on prior investigations, threat and challenge appraisals were assessed independently from one another and from secondary appraisals. Positive and negative affect, task engagement, and levels of perceived stress were also assessed. Results indicated that threat (R2 =.08, p =.01), challenge (R2 =.14, p =.003), and their interaction (R2 =.11, p =.006) independently predicted DBP reactivity; DBP responses were greatest among participants with a high threat/low challenge pattern of appraisal. Threat appraisals predicted greater negative affect (R2 =.32) and perceived stress (R2 =.48), whereas challenge appraisals were related to greater positive affect (R2 =.44) and task engagement (R2 =.40, ps <.0001). Greater positive affect was correlated with increased SBP and DBP reactivity, and greater levels of task engagement with increased DBP response (ps < or = .002). Results suggest that primary cognitive appraisals are more potent predictors of affect and task engagement than cardiovascular reactivity.