Online acceptance and commitment therapy as treatment for loneliness among older adults: Report of a pilot study.

BACKGROUND: Loneliness has been linked to cognitive decline, cardiovascular risk, and risk of mortality among older adults. Creative approaches are needed to increase access for older adults to evidence-based intervention programs. One possible approach is acceptance and commitment therapy (ACT). The aim of this study was to pilot test a novel ACT-based online intervention to decrease loneliness in older adults living in the community. METHODS: A self-paced online ACT program consisting of eight interactive modules designed to teach participants skills to address common contributors to loneliness was evaluated. It was delivered to a sample of 529 men and women, aged 65 or over, who were assessed pre-intervention, postintervention, and at a one-month follow-up, with a short 10-item version of the UCLA Loneliness Scale. RESULTS: For participants who completed all eight modules of the intervention, average levels of loneliness significantly decreased from pre- to posttreatment, b = -0.013, t (385) = -4.69, p < 0.001 (Cohen's d = 0.30). The improvement in loneliness was maintained at the one-month follow-up assessment. These improvements were particularly robust for individuals who were lonely at outset (Cohen's d = 0.73). The change in loneliness among these individuals was significantly greater than that observed in members of a "hold-out" group of lonely individuals that did not participate in the intervention (Cohen's d = 0.24). CONCLUSIONS: This pilot investigation suggests the feasibility of this program for decreasing loneliness in older adults. Future controlled investigations with long-term follow-up assessments are needed to confirm the effectiveness and sustained benefits of the program.

Dealing with loss in the face of disasters and crises: Integrating interpersonal theories of couple adaptation and functioning.

The COVID-19 pandemic has highlighted the significant and varied losses that couples can experience during times of global and regional disasters and crises. What factors determine how couples navigate their close relationships during times of loss? In this paper, we elaborate and extend on one of the most influential frameworks in relationship science-the Vulnerability Stress Adaptation Model (VSAM, Karney and Bradbury, 1995)-to enhance the model's power to explain relationships during loss-themed disasters/crises. We do so by elaborating on attachment theory and integrating interdependence theory (emphasizing partner similarities and differences). Our elaboration and extension to the VSAM provides a comprehensive framework to guide future research and inform practice and policy in supporting relationships during and beyond loss-themed disasters/crises.

The effect of physical activity on the association between perceived racial discrimination and depression in African Americans.

BACKGROUND: The purpose of this cross-sectional study was to examine the effect of physical activity (PA) on the relationship between perceived racial discrimination and major depressive disorder (MDD) in African Americans. METHODS: 645 African Americans (mean age 45 years) were interviewed on their perceived racial discrimination, PA, and past 12-month MDD. Participants were categorized into tertiles (lower, middle, upper) of racial discrimination as well as "active" or "inactive" groups based on the US PA guidelines. Odds ratios and 95% confidence intervals (CIs) were calculated for MDD prevalence across discrimination tertiles stratified by PA group after adjusting for potential confounders. RESULTS: The upper (higher) discrimination group had 2.99 (95% CIs 1.03-8.67) increased odds of MDD compared with the lower group after adjusting for potential confounders. The stratified analysis indicated that the increased odds of MDD in the upper discrimination group were observed only among the inactive group (5.19 [1.08-24.87]) after adjusting for age and sex. The association between discrimination and MDD was not significant among active participants. LIMITATIONS: Limitations include generalizability since participants were predominantly women and recruited solely from Iowa or Georgia; the low number of MDD cases in some groups; and that causation cannot be inferred from this cross-sectional study. CONCLUSION: Not meeting the PA guidelines may be associated with higher depression among African Americans experiencing higher levels of perceived racial discrimination.

The Impact of Distal Influences and Proximal Resources on the Mental Health of African American Older Adults: Findings From the Georgia Centenarian Study.

BACKGROUND AND OBJECTIVES: Over the years, a large amount of research has been devoted to the investigation of factors that led to mental health outcomes in older adults. For African American older adults, their lived experiences place them at high risk for mental health problems. The purpose of this study was to examine the impact of early life influences (i.e., education, childhood life events, and childhood financial well-being) and present psychosocial resources (i.e., individual, financial, and social) on current mental health outcomes in a sample of African American older adults in their 60s, 80s, and 100s. RESEARCH DESIGN AND METHODS: Using data from the Georgia Centenarian Study, 125 participants were interviewed about their mental health, resources, and early life influences. RESULTS: A structural equation model was tested and resulted in a good fit. Results indicated that the more social resources African American older adults had available, the lower the number of depressive symptoms they reported. African Americans with higher levels of financial well-being during childhood reported higher self-rated mental health. Older adults had higher levels of financial resources. Level of education showed a positive relationship with financial resources. Indirect effects of distal influences on health outcomes via current resources were not found. DISCUSSION AND IMPLICATIONS: The findings are of direct practical relevance and can be used to more readily identify older African Americans who may be susceptible to poorer mental health outcomes based upon the impact of their unique distal and proximal psychosocial resources.

Perceived relationship support moderates the association of contextual stress with inflammation among African Americans.

We followed 402 African American young adults from ages 24 to 29, a period of emerging committed relationships, to examine the association of contextual stress (CS), for example, experiences of financial strain, victimization, and racial discrimination, with inflammation, and to test predictions that greater perceived relationship warmth and support (PRWS) at age 29 would moderate the association between earlier CS and inflammation, using a multiplex assessment of cytokines to construct an index of the ratio between predominantly proinflammatory cytokines versus predominantly anti-inflammatory cytokines. CS experienced at age 24 was associated with greater inflammation at age 29 in the full sample (b = .112, p = .004). PRWS at age 29 moderated the association of earlier CS with inflammation (b = -.114, p = .011), but there was no significant main effect of PRWS (b = -.053, p = .265). Finally, using an internal moderator approach, we compared the association of CS with inflammation among those not in a committed relationship to those in more or less supportive relationships, showing a significant and stronger association of CS with inflammation for those with low PRWS (-1 SD; b = .182, p < .001), a weaker and nonsignificant association of CS with inflammation among those with higher PRWS (+1 SD; b = -.002, p = .975), and an intermediate and nonsignificant association of CS with inflammation among those with no committed romantic relationship (b = .077, p = .227). Results were robust to number of cytokines included in the inflammation index. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Family health and income: A two-sample replication.

The current study examined psychological and family health predictors of change over time in household income, using data from longitudinal studies of African American (N = 889, 93.5% female) and Mexican origin (N = 674, 100% female) families. Participants self-reported their household income, as well as their emotional, personality, and cognitive resources. Participant behavioral and physical resources were coded from observed family interactions. Although income did not predict change in any personal resources, all five classes of personal resources (i.e., emotional, personality, cognitive, behavioral, physical) predicted change in income across a 10-year span (Study 1) and a 6-year span (Study 2). Income is potentially caused by these personal resources, or both income and these personal resources share a common cause. The dominant approach of assuming income causes personal and family health needs stronger support. (PsycINFO Database Record

Neighborhood racial discrimination and the development of major depression.

This study examined the impact of neighborhood racial discrimination on the development of major depressive disorder (MDD) in a sample of African American women. Participants were 499 women from Georgia and Iowa with no history of MDD who were followed for 9 to 11 years. Several neighborhood characteristics (community social disorder, community cohesion, and community racism) and individual characteristics (negative life events, financial strain, personal outlook, religious involvement, relationship quality, negative affectivity, and individual experiences of racism) were employed as predictors of whether or not the women met criteria for MDD during this period of time. In a multilevel logistic regression analysis, neighborhood-level discrimination as well as individual-level variables including the number of negative life events, financial strain, and negative affectivity were found to be significant predictors of developing MDD. Analyses of cross-level interactions indicated that the effects of neighborhood-level discrimination were moderated by the quality of individuals' relationships, such that better relationships with others served to lessen the effect of neighborhood discrimination on depression. Implications of these findings for understanding the negative effects of racial discrimination are discussed. (PsycINFO Database Record

Moderation of the effects of discrimination-induced affective responses on health outcomes.

OBJECTIVE: The goal of the study was to examine differential mediation of long-term effects of discrimination on health behaviour and health status by internalising (anxiety and depression) and externalising (hostility and anger), and to explore moderation of these effects, specifically, by the presence of support networks and coping tendencies. DESIGN: The current analyses employed structural equation modelling of five waves of data from Black female participants of the Family and Community Health Study over 11 years (M age 37-48). MAIN OUTCOMES MEASURES: The main outcome variables were health status and alcohol use (frequency and problematic consumption). RESULTS: Perceived racial discrimination was associated with increases in internalising and externalising. In addition, internalising reactions to discrimination were associated with deterioration in health status and increases in problematic drinking; externalising reactions were associated with increases in frequency of drinking. These relations were attenuated by availability of support networks, and exacerbated by use of avoidance coping. CONCLUSION: The current study (a) replicated previous research suggesting that two different types of affective reactions mediate the relations between perceived racial discrimination and physical health status vs. health-impairing behaviours: internalising and externalising, and (b) revealed moderation of these effects by coping mechanisms.

United and Divided by Stress: How Stressors Differentially Influence Social Support in African American Couples Over Time.

The factors that allow people to be good support providers in relationships are not fully understood. We examined how support providers' stressful experiences (financial strain and racial discrimination) differentially influence their supportiveness, using longitudinal data from two samples of African American couples. Among couples that provided observational data ( N = 163 couples), providers who experienced high chronic financial strain behaved less supportively toward their partners, while those who experienced frequent racial discrimination behaved more supportively over a 2-year period. In a second sample of 213 couples over a 3-year period, support providers who experienced financial strain were perceived by their partners as slightly less supportive, while providers who experienced frequent racial discrimination were perceived by their partners as more supportive. Findings suggest that supportiveness in relationships may be differentially shaped by the specific stresses and strains that partners face.

Autonomy promotion, responsiveness, and emotion regulation promote effective social support in times of stress.

Adult attachment theory provides guidance for providing optimal social support in intimate relationships. According to attachment theory, facilitating autonomy (secure base support) sometimes is more important than providing nurturance (safe haven support). In addition, it is important that couples celebrate one another's triumphs and successes (another form of secure base support). A key construct that explains the development of attachment is responsiveness to the individual's needs. Support that is delivered in a responsive manner (i.e., that leads the individual to feel understood, validated, and cared for) is more likely to enhance the relationship and less likely to damage self-esteem than assistance that is not responsive. A responsive exchange is more likely if emotion dysregulation can be prevented. Attachment theory offers explanations for why people vary in their effectiveness at emotion regulation. Appropriate emotion regulation is more likely if disclosures of current difficulties can be made in a way that is not defensive or accusatory, an ability that varies as a function of attachment orientation. Attachment theory also offers guidance regarding the optimal forms of social support for specific individuals. All these insights from adult attachment theory can be integrated into interventions to help couples become more effective support providers.

Black Women's Recommendations for Developing Effective Type 2 Diabetes Programming.

The purpose of this study was to learn from 29 Black women how to develop effective Type 2 diabetes programming. Three focus groups were held in Des Moines, Iowa, during fall 2012. Results highlighted themes related to diabetes knowledge, diabetes management and prevention, physical activity, diet, and diabetes management programming. Opinions were shared as to whether family members should be included in programs for supporting those diagnosed with diabetes. These results provided guidance and ideas to scholars and health care professionals aiming to improve effectiveness of diabetes programs for Black women and families.

An index of the ratio of inflammatory to antiviral cell types mediates the effects of social adversity and age on chronic illness.

BACKGROUND: It is assumed that both social stress and chronological age increase the risk of chronic illness, in part, through their effect on systemic inflammation. Unfortunately, observational studies usually employ single-marker measures of inflammation (e.g., Interleukin-6, C-reactive protein) that preclude strong tests for mediational effects. OBJECTIVE: The present study investigated the extent to which the effects of socioeconomic disadvantage and age on onset of chronic illness is mediated by dominance of the innate (inflammatory) over the acquired (antiviral) components of the immune system. METHODS: We assessed inflammation using the ratio of inflammatory to antiviral cell types (ITACT Ratio). This approach provided a stronger test of evolutionary arguments regarding the effect of social stress on chronic inflammation than is the case with cytokine measures, and afforded an opportunity to replicate findings obtained utilizing mRNA. We used structural equation modeling and longitudinal data from a sample of 100 middle-age African American women to perform our analyses. RESULTS: Dominance of inflammatory over antiviral cell activity was associated with each of the eight illnesses included in our chronic illness measure. Both socioeconomic disadvantage and age were also associated with inflammatory dominance. Pursuant to the central focus of the study, the effects of socioeconomic adversity and age on increased illness were mediated by our measure of inflammatory dominance. The indirect effect of these variables through inflammatory cell profile was significant, with neither socioeconomic disadvantage nor age showing a significant association with illness once the impact of inflammatory cell profile was taken into account. CONCLUSIONS: First, the analysis provides preliminary validation of a new measure of inflammation that is calculated based on the ratio of inflammatory to antiviral white blood cells. Second, our results support the hypothesis that socioeconomic disadvantage and chronological age increase risk for chronic illness in part through their effect on inflammatory processes.

Methylation of the oxytocin receptor gene mediates the effect of adversity on negative schemas and depression.

Building upon various lines of research, we posited that methylation of the oxytocin receptor gene (OXTR) would mediate the effect of adult adversity on increased commitment to negative schemas and in turn the development of depression. We tested our model using structural equation modeling and longitudinal data from a sample of 100 middle-aged, African American women. The results provided strong support for the model. Analysis of the 12 CpG sites available for the promoter region of the OXTR gene identified four factors. One of these factors was related to the study variables, whereas the others were not. This factor mediated the effect of adult adversity on schemas relating to pessimism and distrust, and these schemas, in turn, mediated the impact of OXTR methylation on depression. All indirect effects were statistically significant, and they remained significant after controlling for childhood trauma, age, romantic relationship status, individual differences in cell types, and average level of genome-wide methylation. These finding suggest that epigenetic regulation of the oxytocin system may be a mechanism whereby the negative cognitions central to depression become biologically embedded.

A Longitudinal Study of Racial Discrimination and Risk for Death Ideation in African American Youth.

Although multiple studies have found that African Americans commonly experience racial discrimination, available studies have yet to examine how perceived racism might be related to suicide vulnerability in African American youth. The purpose of this study was to examine a framework for how perceived racial discrimination contributes to symptoms of depression and anxiety as well as subsequent suicide ideation and morbid ideation. Data were obtained from 722 African American youth at mean age 10.56 years (SD = 0.64); a second wave of data was obtained 2 years later. Results revealed both a direct effect and mediated effects of perceived racism on later suicide and morbid ideation. For boys and girls, the effect of perceived racism was mediated by symptoms of depression. However, the association was mediated by anxiety for girls, but not for boys in the current sample. Implications for future research and interventions are discussed.

Anxiety Mediates Perceived Discrimination and Health in African-American Women.

OBJECTIVE: We examined the mediational role of symptoms of anxiety in accounting for the association of discrimination and chronic health conditions among African-American women. METHODS: Participants were 646 African-American women who completed self-report measures of perceived racial discrimination, symptoms of anxiety, and diagnosed chronic health problems. RESULTS: We examined the mediation hypothesis using a path analytic procedure. Mediational analyses indicated that, above and beyond symptoms of depression, age, and education status, anxiety symptoms were associated with both racial discrimination (ß = .03, SE = .01, p < .001) and chronic health problems (ß = .33, SE = .09, p < .001) and significantly mediated the discrimination-health association (ß = -.01, SE = .01, p = .16). CONCLUSIONS: These findings highlight the potentially vital role of symptoms of anxiety in the process that occurs from an individual's perception of discrimination to reported chronic health outcomes. Future research expanding our understanding of the interconnection of psychosocial stressors, discrimination, and their biological sequelae is needed.

Economic hardship and biological weathering: The epigenetics of aging in a U.S. sample of black women.

BACKGROUND: Past research has linked low socio-economic status (SES) to inflammation, metabolic dysregulation, and various chronic and age-related diseases such as type 2 diabetes, coronary heart disease, stroke, and dementia. These studies suggest that the challenges and adversities associated with low SES may result in premature aging and increased risk of morbidity and mortality. OBJECTIVE: Building upon this research, the present study investigates various avenues whereby low income might accelerate biological aging. METHODS: Structural equation modeling and longitudinal data from a sample of 100 Black, middle-aged women residing in the United States was used to investigate the effect of income on a recently developed epigenetic measure of biological aging. This measure can be used as a "biological clock" to assess, at any point during adulthood, the extent to which an individual is experiencing accelerated or decelerated biological aging. RESULTS: Low income displayed a robust association with accelerated aging that was unaffected after controlling for other SES-related factors such as education, marital status, and childhood adversity. Further, our analyses indicated that the association between income and biological aging was not explained by health-related behaviors such as diet, exercise, smoking, alcohol consumption, or having health insurance. Rather, in large measure, it was financial pressure (difficulty paying bills, buying necessities, or meeting daily expenses) that accounted for the association between low income and accelerated aging. CONCLUSIONS: These findings support the view that chronic financial pressures associated with low income exert a weathering effect that results in premature aging.

Stress, relationship satisfaction, and health among African American women: Genetic moderation of effects.

We examined whether romantic relationship satisfaction would serve as a link between early and later stressors which in turn would influence the thyroid function index (TFI), an indicator of physiological stress response. Using the framework of genetic susceptibility theory combined with hypotheses derived from the vulnerability-stress-adaptation and stress-generation models, we tested whether the hypothesized mediational model would be conditioned by 5-HTTLPR genotype, with greater effects and stronger evidence of mediation among carriers of the "s" allele. In a sample of African American women in romantic relationships (n = 270), we found that 5-HTTLPR moderated each stage of the hypothesized mediational model in a "for better or for worse" manner. That is genetic polymorphisms function to exacerbate not only the detrimental impact of negative environments (i.e., "for worse effects") but also the beneficial impact of positive environments (i.e., "for better effects"). The effect of early stress on relationship satisfaction was greater among carriers of the "short" allele than among those who did not carry the short allele, and was significantly different in both the "for better" and "for worse" direction. Likewise, the effect of relationship satisfaction on later stressors was moderated in a "for better "or "for worse" manner. Finally, impact on physiological stress, indexed using TFI level, indicated that the impact of later stressors on TFI level was greater in the presence of the short allele, and also followed a "for better" or "for worse" pattern. As expected, the proposed mediational model provided a better fit for "s" allele carriers.

Methylomic Aging as a Window onto the Influence of Lifestyle: Tobacco and Alcohol Use Alter the Rate of Biological Aging.

OBJECTIVES: To examine the effect of the relationship between alcohol and cigarette consumption on biological aging using deoxyribonucleic acid methylation-based indices. DESIGN: Hierarchical linear regression modeling followed by fitting of higher-order effects. SETTING: Longitudinal studies of aging and the effect of psychosocial stress. PARTICIPANTS: Participants in two ethnically informative cohorts (n = 656 white, n = 180 black). MEASUREMENTS: Deviation of biological age from chronological age as a result of smoking and alcohol consumption. RESULTS: Greater cigarette consumption was associated with accelerated biological aging, with strong effects evident at even low levels of exposure. In contrast, alcohol consumption was associated with a mixed effect on biological aging and pronounced nonlinear effects. At low and heavy levels of alcohol consumption, there was accelerated biological aging, whereas at intermediate levels of consumption there was a relative decelerating effect. The decelerating effects of alcohol were particularly notable at loci for which methylation increased with age. CONCLUSION: These data support prior epidemiological studies indicating that moderate alcohol use is associated with healthy aging, but we urge caution in interpreting these results. Conversely, smoking has strong negative effects at all levels of consumption. These results also support the use of methylomic indices as a tool for assessing the impact of lifestyle on aging.

Ethnicity and Smoking-Associated DNA Methylation Changes at HIV Co-Receptor GPR15.

Smoking is associated with poorer health outcomes for both African and European Americans. In order to better understand whether ethnic-specific genetic variation may underlie some of these differences, we compared the smoking-associated genome-wide methylation signatures of African Americans with those of European Americans, and followed up this analysis with a focused examination of the most ethnically divergent locus, cg19859270, at the GPR15 gene. We examined the association of methylation at this locus to the rs2230344 SNP and GPR15 gene and protein expression. Consistent with prior analyses, AHRR residue cg05575921 was the most differentially methylated residue in both African Americans and European Americans. However, the second most differentially methylated locus in African Americans, cg19859270, was only modestly differentially methylated in European Americans. Interrogation of the methylation status of this CpG residue found in GPR15, a chemokine receptor involved in HIV pathogenesis, showed a significant interaction of ethnicity with smoking as well as a marginal effect of genotype at rs2230344, a neighboring non-synonymous SNP, but only among African Americans. Gene and protein expression analyses showed that demethylation at cg19859270 was associated with an increase in both mRNA and protein levels. Since GPR15 is involved in the early stages of viral replication for some HIV-1 and HIV-2 isolates, and the prevalence of HIV is increased in African Americans and smokers, these data support a possible role for GPR15 in the ethnically dependent differential prevalence of HIV.