Associations between Post-Intensive Care Syndrome Domains in Cardiac Arrest Survivors and Their Families One Month Post-Event.

Background: Post-intensive care syndrome (PICS) affects many critical care survivors and family members. Nevertheless, the relationship between PICS-relevant domains in cardiac arrest (CA) survivors and psychological distress in their family members (henceforth, PICS-F) remains underexplored. Methods: We enrolled consecutive CA patients admitted between 16 August 2021 and 28 June 2023 to an academic medical center, along with their close family members, in prospective studies. Survivors' PICS domains were: physical dependence (Physical Self-Maintenance Scale, PSMS), cognitive impairments (Modified Telephone Interview for Cognitive Status, TICS-M), and post-traumatic stress disorder (PTSS) symptoms (PTSD Checklist-PCL 5), as well as PICS-F (PCL-5 Total Score). Hierarchical multivariate linear regressions examined associations between PICS-F and survivors' PICS domains. Results: Of 74 dyads (n = 148), survivors had a mean (SD) age of 56 ± 16 years, with 61% being male and with a median hospital stay of 28 days. Family members (43% spouses) were slightly younger (52 ± 14 years), predominantly female (72%), and of minority race/ethnicity (62%). A high prevalence of PICS assessed 28.5 days (interquartile range 10-63) post-CA was observed in survivors (78% physical dependence, 54% cognitive impairment, 30% PTSS) and in family members (30% PTSS). Survivor PTSS was significantly associated with family member distress (ß = 0.3, p = 0.02), independent of physical dependence (ß = 0.0, p = 0.9), cognitive impairment (ß = -0.1, p = 0.5), family member characteristics, and duration of hospitalization. Conclusions: Both CA survivors and their family members showed substantial evidence of likely PICS. Survivor PTSS is notably associated with family member distress, highlighting the need for dyadic interventions to enhance psychosocial outcomes.

Prospective evaluation of the relationship between cognition and recovery outcomes after cardiac arrest.

PURPOSE: Cognitive function is often impaired for cardiac arrest (CA) survivors due to hypoxic-ischemic brain injury. Whether cognitive impairment at hospital discharge is associated with recovery defined as functional status and fatigue measured at 1-month post-discharge is not known. METHODS: Consecutive CA patients admitted at an academic center (May 14, 2021-June 23, 2023) were assessed for cognitive impairment (modified Telephone Interview for Cognitive Status, TICS-m < 33) and depressive symptoms (8-item Patient Health Questionnaire) at hospital discharge. Poor functional status (primary outcome; modified Rankin Scale, mRS > 3) and fatigue severity (patient-reported outcome; Modified Fatigue Impact Scale) were assessed 1-month post-discharge. Hierarchical regressions tested associations of cognitive function with outcomes. RESULTS: Of 112 participants (mean age 54.4 ± 14.8; 38% female; 43% White race, 20% Black race, 29% Hispanic ethnicity) completing discharge TICS-m, 63 (56%) had indicated cognitive impairment, and 68 (61%) had poor 1-month functional outcome. Worse discharge cognitive function was independently associated with a higher risk of poor 1-month functional outcome (OR = 0.88, 95% CI [0.79, 0.98], p = 0.02) after adjusting for age, education, sex, race, ethnicity, length of hospital stay, comorbidities, and depressive symptoms. Fatigue severity lacked significant associations with cognitive function, but was associated with depressive symptoms (B = 1.03 [0.00, 2.05], p = 0.04). CONCLUSION: Cognitive function at discharge after CA was significantly and independently associated with functional outcome 1 month after hospital discharge. Psychological distress contributed to fatigue severity. This highlights the need for screening and addressing cognitive and emotional problems pre-hospital discharge.

Linking measures to mechanisms of action in behavior change: A qualitative analysis of expert views.

RATIONALE: Testing mechanisms of action (MoAs) hypothesized to underlie behavior change can enhance intervention effectiveness. Rigorous measurement of putative mechanisms is critical to this effort, but measures are rarely validated with respect to target MoAs. OBJECTIVE: This study aimed to elucidate challenges of linking measures to putative MoAs and to identify priorities for future research. METHOD: This study was a systematic exploration of written comments by experts in behavioral intervention research and theories of behavior change (N = 20) capturing their opinions about a task querying whether self-report measures from the Science Of Behavior Change (SOBC) Measures Repository were related to a set of MoAs identified by the Human Behaviour Change Project (HBCP). RESULTS: Six themes were identified: 1) Study Value, 2) Measure Properties, 3) Mechanism Properties, 4) Miscellaneous Measure Concerns, 5) Conceptual Challenges, and 6) Approaches to Developing Measure-Mechanism Links. Experts noted challenges such as lack of measure validation, poor measure properties (e.g., double-barreled items), overly broad MoA definitions that limited their utility, lack of clarity around the term "related," and more. Nonetheless, experts expressed the importance of the exercise. Suggestions included developing and refining measures that are validate for assessing MoAs, clarifying and elaborating MoA definitions, and conducting further, more granular research. CONCLUSION: This systematic examination of expert comments highlights issues that need further investigation to advance behavioral science, specifically pertaining to identifying valid measures of MoAs in behavioral and process research. This study highlights the challenges and opportunities for future research on linking measures and MoA in behavioral science and subsequently enhancing the efficacy of behavioral interventions.

Feasibility of a remote heart rate variability biofeedback intervention for reducing anxiety in cardiac arrest survivors: A pilot trial.

Background: Heart rate variability biofeedback (HRVB) is a promising non-pharmacologic approach for reducing anxiety. This intervention's feasibility needs testing in psychologically distressed cardiac patients for whom heart-related anxiety is a core concern. To enhance scalability and convenience, remote delivery of HRVB also needs to be assessed. Accordingly, we evaluated the feasibility of remote HRVB in survivors of cardiac arrest (CA) with elevated CA-related psychological distress. Methods: The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. This single-arm feasibility trial assessed the percentage of eligible contacted patients who consented and engaged in the study and the self-reported acceptability, feasibility, appropriateness, and usability of the intervention. Exploratory analyses assessed pre-to-post changes in trait anxiety, negative affect, cardiac-related interoceptive fear, and resting-state HRV. Results: Of 12 eligible CA survivors contacted, 10 enrolled. All 10 patients completed the virtual study visits and the majority (>50 %) of prescribed training sessions. Ninety percent reported good scores for intervention acceptability and feasibility, and 80 % reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. There were no changes in negative affect, interoceptive fear, or resting state HRV. Conclusion: A remotely delivered HRVB intervention was acceptable, feasible, and useable for cardiac patients with CA-related psychological distress. A phase 2 randomized controlled trial evaluating the efficacy of HRVB on cardiac patients' psychological distress, health behaviors, and autonomic dysfunction may be warranted.

Home-based cognitive bias modification training for reducing maladaptive fear in patients with suspected acute coronary syndrome: a pilot randomized clinical trial.

BACKGROUND: Patients evaluated in an emergency department for suspected acute coronary syndromes (ACS; e.g., myocardial infarction) often experience a lingering fear of recurrence, which may adversely affect their mental health and adherence to recommended health behaviors. Cognitive bias modification training (CBMT) is an acceptable, easy-to-use intervention that reduces fear of recurrence in cancer patients, and reduces fear and anxiety in other populations, providing an alternative to psychotherapy or counseling-based approaches. Feasibility testing is needed to assess whether a cardiac-related version of CBMT is acceptable to patients with elevated threat perceptions related to their suspected ACS. METHODS: We developed a tablet-based CBMT intervention tailored to reduce cardiac-related fear of recurrence. In this double-blinded feasibility trial, patients with elevated threat perceptions related to a recent suspected ACS were randomized either to a 4-week, 8-session, tablet-delivered intervention (CBMT) group or to a sham attention control group. Feasibility outcomes included the proportion of eligible patients who enrolled, drop-out rate, intervention compliance rate, acceptability/pleasantness and usability ratings, and task engagement (i.e., accuracy, response time). RESULTS: Of 49 eligible patients with suspected ACS and elevated threat perceptions recruited from NewYork-Presbyterian Hospital, over half (53.1%) enrolled after receiving a description of study procedures. Of the 26 randomized patients (mean age 59.15 years, 50% women), 2 patients (7.7%) dropped out. Additionally, 4 (15.4%) enrolled patients were not able to complete the tablet tasks, either due to difficulties with the technology or an inability to process the visually presented linguistic information at a sufficient speed. Still, among patients who returned the tablets (19 returned/20 received; 95%), most completed all assigned tablet tasks (intervention or control; 10/19; 52.6%), reporting that the tablets were easy to use and that the tasks were pleasant to complete. CONCLUSION: Current findings suggest that cardiac-related CBMT is a promising and generally acceptable intervention for suspected ACS patients with cardiac-related threat perceptions which are akin to fear of recurrence. Nevertheless, challenges related to tablet usage indicate that the intervention user-experience should be further refined to optimize usability. TRIAL REGISTRATION: Registered at ClinicalTrials.gov on 2/25/2019; NCT03853213. Registered with the Open Science Framework on 11/20/2017; https://osf.io/k7g8c/ .

The relationship of shift work disorder with symptoms of depression, anxiety, and stress.

Shift workers commonly suffer from disturbed sleep, which is known to affect mental health in other populations. Shift work disorder (SWD) is characterized by complaints of insomnia and/or excessive daytime sleepiness temporally associated with working non-standard schedules that occur during the usual time for sleep. Few studies have explored the extent to which workers with vs. without SWD experience worse mental health. We administered the Shift Work Disorder Screening Questionnaire to 60 adults engaged in various shift work schedules to categorize workers as being at high or low risk for SWD. Mental health outcomes were measured using the Depression Anxiety Stress Scale-21 (DASS-21). Linear regression was performed for each DASS-21 subscale, adjusting for age, sex, shift type, sleep duration, and frequency of alcohol use. Most participants (55 %) were at high risk for SWD. High-risk participants had higher depressive symptoms than low-risk participants, B = 3.59, 95 % CI [0.54, 6.65], p = .02. The estimated value for those at high risk for SWD corresponded to clinically significant mild depressive symptoms, (M = 13.43), compared to those at low risk, (M = 9.84). High risk for SWD was marginally associated with increased stress symptoms, B = 2.48, 95 % CI [-0.06,5.02], p = .06. Our findings add to the body of evidence that SWD is associated with poor mental health outcomes. Providing interventions specific to the sleep impacts of SWD, including tailored cognitive behavioral therapy for insomnia, may improve shift workers' mental health.

Association between cardiac event-induced PTSD symptoms and daily intrusive thoughts about cardiac risk: An ecological momentary assessment study.

OBJECTIVE: Posttraumatic stress symptoms (PSS) due to acute cardiac events are common and may lead patients to avoid secondary prevention behaviors. However, patients' daily experience of cardiac event-induced PSS has not been studied after a potentially traumatic cardiac hospitalization. METHOD: In an observational cohort study, 108 mostly male patients with coronary heart disease were recruited after evaluation for suspected acute coronary syndrome (ACS). One month later, PSS were assessed via telephone-administered PTSD Checklist for DSM-5 (PCL-5). The exposure of interest was elevated (PCL-5 ≥ 20) vs. non-elevated PSS (PCL-5 ≤ 5). The occurrence and severity of cardiac-related intrusive thoughts were assessed 5 times daily for 2 weeks via electronic surveys on a wrist-worn device. RESULTS: Moderate-to-severe intrusive thoughts were experienced by 48.1% of patients but more commonly by elevated-PSS (n = 36; 66.7%) than non-elevated-PSS (n = 72; 38.9%) patients. After adjustment for demographic and clinical characteristics, elevated- vs. non-elevated-PSS patients had a 9-fold higher odds of experiencing a moderate-to-severe intrusive thought during each 2-h assessment interval (adjusted OR = 9.14, 95% CI [2.99, 27.92], p < .01). After adjustment, intrusive thoughts on a 0-to-6 point scale were over two times as intense for elevated-PSS vs. non-elevated-PSS patients. CONCLUSIONS: Intrusive thoughts about cardiac risk were common in patients recently evaluated for ACS, but much more prevalent and intense in those with elevated vs non-elevated PSS.

Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome.

OBJECTIVE: Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD: Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS: Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS: Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identifying multilevel predictors of trajectories of psychopathology and resilience among juvenile offenders: A machine learning approach.

Mental ill health is more common among juvenile offenders relative to adolescents in general. Little is known about individual differences in their long-term psychological adaptation and its predictors from multiple aspects of their life. This study aims to identify heterogeneous trajectories of probable psychiatric conditions and their predictors. Participants included 574 juvenile offenders who were first convicted for serious crimes and without detention history. The participants were assessed at 11 timepoints over seven years (2000-2010). Growth mixture modeling revealed the same three trajectories for both probable anxiety and probable depression: stable low trajectory (75.96%; 75.78%), stable high trajectory (15.16%; 10.98%), and recovery (8.89%, 13.24%). Least absolute shrinkage and selection operator (LASSO) logistic regression identified three multilevel predictors for memberships of different trajectories. Risk factors against stable low trajectory lay within personal (e.g., neuroticism), relationship (e.g., parental hostility), and contextual levels (e.g., chaotic neighborhood). Resilience factors for stable low trajectory included strong work orientation and low education level of father. Recovery was predicted by Black race, self-identity, high education level of father, and nonincarcerated sentencing. Our findings suggest that both psychopathology and psychological resilience could be predicted by multiple personal, relationship, and contextual factors in the social ecology of juvenile offenders.

An Experimental Therapeutics Focus on Novel Mechanistic Targets in Cognitive Behavioral Treatments: Introduction to the Special Section.

This article introduces the special section, "An Experimental Therapeutics Focus on Novel Mechanistic Targets in Cognitive Behavioral Treatments." The purpose of this special section is to highlight research that follows the recommended Science of Behavior Change (SOBC) developmental progression for an experimental medicine approach to identifying and testing mechanisms of behavior change. Emphasis was placed on the earlier stage "pipeline" of investigations of novel mechanisms for behavior change: mechanisms that are undergoing the initial stages of validation. In this series, seven empirical articles are presented and are followed by an article detailing a checklist for reporting mechanistic research studies in order to improve communication of findings in the field. The final article in this series discusses the history, current status, and future directions for the SOBC approach to mechanistic science as viewed by National Institute of Health program officials.

Improving the Rigor of Mechanistic Behavioral Science: The Introduction of the Checklist for Investigating Mechanisms in Behavior-Change Research (CLIMBR).

Diverse fields rely on the development of effective interventions to change human behaviors, such as following prescribed medical regimens, engaging in recommended levels of physical activity, getting vaccinations that promote individual and public health, and getting a healthy amount of sleep. Despite recent advancements in behavioral intervention development and behavior-change science, systematic progress is stalled by the lack of a systematic approach to identifying and targeting mechanisms of action that underlie successful behavior change. Further progress in behavioral intervention science requires that mechanisms be universally prespecified, measurable, and malleable. We developed the CheckList for Investigating Mechanisms in Behavior-change Research (CLIMBR) to guide basic and applied researchers in the planning and reporting of manipulations and interventions relevant to understanding the underlying active ingredients that do-or do not-drive successful change in behavioral outcomes. We report the rationale for creating CLIMBR and detail the processes of its development and refinement based on feedback from behavior-change experts and NIH officials. The final version of CLIMBR is included in full.

Linking measures to mechanisms of action: An expert opinion study.

OBJECTIVE: This study sought to integrate the NIH Science of Behaviour Change (SOBC) measures repository comprising measures of putative mechanisms with mechanisms of action (MoA) identified by the Human Behaviour-Change Project (HBCP). DESIGN: Participants were 30 international experts recruited from professional networks and societies. In three anonymous virtual rounds, experts established consensus on hypothesized links between 26 MoAs and 44 self-report measures. METHODS: In Round 1, experts completed a survey rating agreement with 84 pre-identified measure-MoA links and suggested new links. In Round 2, experts discussed 10 links in an online forum, including pre-identified links with <50% agreement and new links suggested by 20-50% of experts. In Round 3, experts completed a survey rating all links eligible for discussion in Round 2. RESULTS: Twenty-seven experts completed Round 1, 23 completed Round 2 and 18 completed Round 3. In Round 1, 82 of 84 pre-identified links reached >50% agreement and 14 new links were suggested by >50% of experts. In Round 2, experts discussed measure-MoA links and measurement quality. In Round 3, 71 of 96 links reached ≥50% agreement. A total of 167 links reached >50% expert agreement, 33 of which reached ≥90% agreement. CONCLUSION: By identifying putative mechanisms (HBCP) for the 44 self-report measures (SOBC), this study advances the cumulation of scientific results and interoperability of resources to facilitate process research.

Looking back and moving forward: dimensions of coping flexibility divergently predict long-term bereavement outcomes.

BACKGROUND AND OBJECTIVES: Bereavement is a serious public health concern. Some people suffer prolonged and debilitating functional impairment after the death of a loved one. Evidence suggests that flexibility in coping approaches predicts resilience after stressful life events, but its long-term effects after the unique experience of bereavement are unknown. Which strategies of coping flexibility predict better-or worse-adjustment over time for bereaved people and at what times? DESIGN AND METHODS: The present study used path analyses to investigate longitudinal effects of forward-focus and loss-focus coping strategies on symptoms of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder in a spousally bereaved adult sample (N = 248) at three time-points after the loss (∼3 months, ∼14 months, and ∼25 months). RESULTS: Forward-focus coping demonstrated adaptive utility overall, with sooner effects on PCBD than on depression. By contrast, loss-focus coping demonstrated a delayed-onset, maladaptive pattern. CONCLUSIONS: The findings contribute to the coping flexibility literature by suggesting that the adaptiveness or maladaptiveness of different coping strategies may depend on the context that requires coping. In particular, forward-focus coping may be substantially more advantageous than loss-focus coping in the context of bereavement. Implications, limitations, and future research directions are discussed.

Psychological Distress After Sudden Cardiac Arrest and Its Impact on Recovery.

PURPOSE OF REVIEW: To summarize the prevalence, correlates, and health consequences of poor mental health in the increasingly sizable population of survivors of Sudden cardiac arrest (CA) and to describe current intervention research in this area. RECENT FINDINGS: After CA many patients report high psychological distress, including depression, generalized anxiety, and posttraumatic stress. Emerging evidence suggests that distressed patients' attention may narrow such that anxious awareness of afferent cardiac signals e.g., changes in heart rate or blood pressure, becomes predominant and a cause for concerned, constant monitoring. This cardiac-specific anxiety followed by behavioral avoidance and physiological hyperreactivity may increase patients' already high risk of secondary cardiovascular disease and undermine their health-related quality of life (HRQoL). Unlike other cardiovascular diseases, no clinical practice guidelines exist for assessing or treating psychological sequelae of CA. Future research should identify modifiable psychological targets to reduce secondary cardiovascular disease risk and improve HRQoL.

Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition.

Stage models encourage a longitudinal perspective on the care of those with major depression: supporting vigilance to the risk for stage progression and the selection of interventions to address that risk. A central goal for this article is to evaluate the role of cognitive-behavior therapy (CBT) in addressing stage progression in the treatment of major depression. We summarize the evidence supporting depression-focused CBT for: (1) preventing depression onset, (2) treating syndromal depression, (3) treating residual symptoms, (4) preventing relapse, and (5) addressing pharmacologic treatment resistance. In addition, consistent with the goal of aiding prevention and intervention development by refining mechanistic treatment targets, we evaluate the role of two specific risk-factors for stage progression: insomnia and rumination. These risk factors have a feed-forward relationship with stress, both being amplified by stress and amplifying the negative consequences of stress. Moreover, each of these risk factors predict depression stage transmissions across multiple stages, and both are modifiable with treatment. Accordingly, insomnia and rumination appear to serve as excellent mechanistic targets for the prevention of depression stage progression. These findings are discussed in relation to current limitations and future research directions for targeting these risk factors and furthering the effective treatment of depression.

The association between race- and ethnicity-related stressors and sleep: the role of rumination and anxiety sensitivity.

STUDY OBJECTIVES: This study was designed to investigate the association between psychosocial factors and self-reported sleep duration and two indices of sleep quality in a racially and ethnically diverse sample of adults. We investigated the relations between both rumination and anxiety sensitivity with these self-reported sleep outcomes. We also examined rumination and anxiety sensitivity as moderators of three race- and ethnicity-related stressors: discrimination, acculturative stress, and socioeconomic status. METHODS: In a cross-sectional design, we assessed 1326 adults (ages 18-48 years) selected for self-reported racial and ethnic minority status. Regression analyses were used to examine the associations between demographic, social/environmental stressors, depression severity, rumination, and anxiety sensitivity and three sleep outcomes: sleep duration, sleep quality subscale, and global sleep quality. RESULTS: Our findings supported the hypothesized role of rumination as an amplification factor for the influence of race- and ethnicity-related stressors on sleep duration and quality. Rumination was associated with all three sleep outcomes (sleep duration, sleep quality subscale, and global sleep quality) and was a moderator of the associations between discrimination and all 3 sleep outcomes. Anxiety sensitivity was not consistently associated with these sleep outcomes. Depression symptoms did not account for these findings. CONCLUSIONS: If confirmed in longitudinal study, our findings introduce a potentially important treatment target-rumination-for addressing sleep disparities in prevention or intervention models. Rumination appears to amplify the negative sleep consequences of race- and ethnicity-related stressors and is a modifiable treatment target.

The Prospective Association of Patient Hospitalization with Spouse Depressive Symptoms and Self-Reported Heath.

After hospital discharge, patients experience a period of generalized risk for adverse mental and physical health outcomes (post-hospital syndrome [PHS]). Hospital stressors can explain these effects in patients (e.g., sleep disruption, deconditioning). Patients' partners also experience adverse outcomes following patient hospitalization, but mechanisms of these effects are unknown. The purpose of this study was to test whether greater times and nights of patient hospitalization (proxies for partner exposure to hospital stressors) are prospectively associated with greater increases in partner depression and in partner self-reported poor health. Participants were 7,490 married couples (11,208 individuals) enrolled in the Health and Retirement Study. Outcomes were prospective changes in depressive symptoms and self-reported poor health, and primary predictors were spouse hospitalization over the past two years (yes/no), spouse hospitalized ≥ two times (yes/no), and spouse spent ≥ eight nights in-hospital (yes/no). Covariates included age, gender, race, ethnicity, income, own hospitalization experiences during the past 12 months, and one's own and spouse comorbidities. Having a spouse who experienced two or more hospitalizations was associated with an increase in one's own depression over time, as was having a spouse who spent eight or more nights in-hospital. Spouse hospitalization was not associated with prospective changes in self-reported health. Results suggest that PHS mechanisms may account for adverse post-hospitalization outcomes in patients' partners.

Effect of cohabiting partners on the development of posttraumatic stress symptoms after emergency department visits for stroke and transient ischemic attack.

OBJECTIVE: Partners can be beneficial for patients experiencing stressful health events such as a stroke/transient ischemic attack (TIA). During such events, however, partners may exacerbate early distress. The present study tested whether having a cohabiting partner modified the association between patients' early perceptions of threat (e.g., feeling vulnerable, helpless) and longer-term posttraumatic stress symptoms (PTSS). METHODS: Participants (N = 328) were drawn from an observational cohort study of patients evaluated for stroke/TIA at an urban academic hospital between 2016 and 2019. Participants self-reported emergency department (ED) threat perceptions and PTSS secondary to the stroke/TIA at three days and one month post-event. RESULTS: Cohabiting partner status modified the association of ED threat with early PTSS. Patients with a cohabiting partner exhibited a positive association between ED threat and early PTSS, B = 0.12, p < .001; those without a cohabiting partner did not, B = 0.04, p = .067. A cohabiting partner was protective only for patients who initially reported low levels of ED threat, as patients with a cohabiting partner who reported low levels of ED threat also had lower early PTSS, B = -0.15, p = .016; at high levels of ED threat, a cohabiting partner was not protective, B = -0.02, p = .68. ED threat was associated with PTSS at one month, B = 0.42, p < .001, but cohabiting partner status did not modify the association. CONCLUSIONS: ED threat perceptions were positively associated with early PTSS only for patients with a cohabiting partner. For patients who do not initially experience a stroke/TIA event as threatening, cohabiting partners may help patients maintain psychological equanimity.

Learning to make smart choices in the context of risk: The roles of internal affective feedback and life events.

Autonomic arousal may facilitate beneficial decision-making when the link between choices and outcomes is uncertain. However, it is unknown whether greater risk-specific autonomic arousal is linearly associated with faster learning to avoid risky decisions. Furthermore, although the influence of stress on decision-making is well documented, it is unknown whether recent life stress might moderate the relationship between this internal affective feedback and decision-making. We report two studies using the Iowa Gambling Task with diverse community samples. Each study demonstrated a linear relationship between the level of autonomic arousal prior to risky decision-making and the rate of learning to avoid risk. Additionally, participants' recent life events conditionally moderated this association. Specifically, the relationship between risk-specific arousal and advantageous learning was strongest for participants who experienced relatively more positive and fewer negative life events in the previous four months. These findings suggest that autonomic arousal may generally inform decision-making, but less so when life circumstances are relatively poor.