Perspectives on the non-replication of associations of "loneliness" with systolic blood pressure and HbAlc: Methodological and mental health considerations a commentary on Das (2018).

Das (2018) presents a critique of the loneliness literature in terms of design (viz., small samples and the existence of only one longitudinal study) and potentially flawed data analyses that do not take into account clustering factors such as where the participants live. With respect to loneliness, Das's analysis of two large longitudinal population studies showed neither evidence of a high prevalence nor associations with the cardiometabolic measures, thereby providing additional questions regarding the role of loneliness in the causal chain of health and well-being. If questions concerning what loneliness is and its causal role in the chain of biological, personological, social, and cultural health and well-being are not clearly elucidated, then misconceptions of the role of loneliness construct can arise. Although Das indicates that differences in the assessment of loneliness may contribute to the failure to replicate associations, other individual differences and methodological factors may confound interpretation of the causal role of loneliness; these points warrant further comment, which is the focus of this commentary.

Cognitive and affective factors predicting daily somatic complaints in college students.

Evidence suggests that cumulative somatic complaints predict health care utilization in college students. The symptom perception hypothesis and the response expectancy theory are 2 theories concerning the generation of somatic complaints. The symptom perception hypothesis suggests that negative affect influences daily somatic complaints, whereas the response expectancy theory surmises somatic complaint generation relates to response expectancies. Some evidence suggests that understanding the complex interplay of these factors may enhance prediction of daily somatic complaints. This study examines the combined effects of state negative affect, trait negative affect, and response expectancies in predicting daily somatic complaints. A total of 95 college students took part in a 2-part study composed of 1 in-lab session followed by completion of up to 7 daily diaries. Results show that state negative affect, trait negative affect, and response expectancies all uniquely predict daily somatic complaints. Our results support a cognitive-affective basis for somatic complaints and suggest future research integrating biopsychosocial factors may be useful in increasing our understanding. Furthermore, our results suggest potential intervention targets when counseling college students experiencing somatic complaints without physical origins. (PsycINFO Database Record

Arterial stiffness and cerebral hemodynamic pulsatility during cognitive engagement in younger and older adults.

This study examined central artery stiffness and hemodynamic pulsatility during cognitive engagement in younger and older adults. METHODS: Vascular-hemodynamic measures were completed in 19 younger (age 35±1yrs) and 20 older (age 69±2yrs) adults at rest and during a Stroop task. Aortic stiffness (carotid-femoral pulse wave velocity, PWV) and carotid pulse pressure (PP) were assessed using applanation tonometry. Carotid stiffness was assessed as a single-point PWV using Doppler Ultrasound. Middle cerebral artery (MCA) mean flow and flow pulsatility index (PI) were assessed using transcranial Doppler. Cognitive function was assessed as accuracy and reaction time from the Stroop task. RESULTS: Older adults had lower accuracy scores and longer reaction times on the Stroop task compared to younger adults (p<0.05). Both age groups had similar increases in MCA mean flow during Stroop (p<0.05). There were significant increases in aortic PWV, carotid PWV, carotid PP and MCA PI during Stroop in older but not younger adults (p<0.05). Carotid PP and MCA PI assessed during Stroop were statistical mediators of the association between age group and Stroop performance metrics (accuracy and reaction time, p<0.05), while aortic and carotid PWV were indirect statistical mediators of MCA PI through carotid PP (p<0.05). CONCLUSIONS: Older adults experience increases in large artery stiffness during cognitive engagement possibly preventing effective buffering of pulsatile hemodynamic energy entry into the cerebrovasculature. This is important as pulsatile flow during cognitive engagement, and not mean flow per se, was related to overall cognitive performance.

Carotid stiffness, extra-media thickness and visceral adiposity in young adults.

BACKGROUND AND AIMS: Carotid extra-media thickness (EMT) encompasses arterial adventitia and perivascular adipose tissue (PAT). Adventitial remodeling and PAT may contribute independently to functional (stiffness) and structural (remodeling) changes in artery wall properties. Visceral adiposity may contribute to PAT, thereby affecting artery stiffness. We investigated the relationships between carotid artery stiffness, EMT, and visceral adiposity in young, healthy individuals. METHODS: 135 healthy males (20 ± 2 yr, body mass index [BMI] 24.8 ± 3.3 kg/m2) underwent anthropometric and vascular measures on two separate days. Visceral adiposity was assessed using waist circumference and sagittal abdominal diameter (SAD). Brachial and carotid systolic, diastolic, and pulsatile (PP) blood pressures were assessed using an oscillometric cuff and applanation tonometry, respectively. Carotid intima-media thickness (IMT) and EMT were assessed using Doppler ultrasound. Carotid artery stiffness was calculated as ß-stiffness and calibrated to carotid pressures. RESULTS: Separate stepwise multiple regression models demonstrated that carotid PP (ß = 0.205) and EMT (ß = 0.267) accounted for 12.6% of variance in ß-stiffness, while carotid PP (ß = 0.195) and SAD (ß = 0.226) accounted for 10.5% of variance in EMT (p < 0.05). Mediation analyses revealed carotid PP partially mediated the relationship between a) EMT and ß-stiffness, and b) SAD and EMT (p < 0.05). CONCLUSIONS: Carotid PP and EMT, but not IMT, are related to carotid ß-stiffness. Carotid PP and visceral adiposity (SAD) are related to EMT. Carotid PP partially mediates the association between a) EMT and carotid ß-stiffness, and b) SAD and EMT. Our findings suggest visceral adiposity may detrimentally affect subclinical markers of cardiovascular disease risk (carotid PP, EMT) and contribute to artery stiffness.

The Role of Agonistic Striving in the Association Between Cortisol and High Blood Pressure.

OBJECTIVE: A social action theory of chronic stress proposes that agonistic striving (seeking to influence or control others) impairs cardiovascular health by magnifying the impact of high adversity-induced cortisol levels on blood pressure. We tested three predictions of social action theory: (1) the social action theory taxonomy of regulatory strivings characterizes young adults from high-adversity neighborhoods; (2) high cortisol levels predict high blood pressure more reliably in the subgroup with the agonistic striving profile than in subgroups with other profiles; (3) the association of higher cortisol and higher blood pressure with agonistic striving is not explained by negative affect (depressive symptoms/dysphoria, anger, hostility). METHODS: Participants were young adults (N = 198, mean [SD] age = 32 [3.4] years); 71% female; 65% black) from disadvantaged urban neighborhoods. Motive profiles (including agonistic strivings) were assessed using the Social Competence Interview. Cortisol levels were derived from saliva samples; blood pressure level was obtained during two days of ambulatory monitoring. Psychological measures of negative affect were assessed using questionnaires. RESULTS: The predicted taxonomy of regulatory strivings was replicated in this sample; the interaction between cortisol and motive profile was significant (F(2, 91) = 6.72, p = .002); analyses of simple effects disclosed that higher cortisol levels predicted higher ambulatory blood pressure only in individuals who exhibited agonistic striving. Depressive symptoms/dysphoria, trait anger, and hostility were not correlated with agonistic striving, cortisol, or blood pressure. CONCLUSIONS: Agonistic striving may represent a distinctive (and novel) social-cognitive mechanism of toxic stress and cardiovascular risk.

Composite cardiovascular risk scores and neuropsychological functioning: a meta-analytic review.

BACKGROUND: The ability for patients to understand their risk for disease is important to early intervention and effective treatment. The link between individual cardiovascular risk factors and cognition has been well-established. PURPOSE: This study investigated the relationship between cognition and a combination of these factors through a single composite risk score. METHODS: This study quantitatively summarized the strength of the association between composite cardiovascular risk scores and cognitive test performance using meta-analytic methods. RESULTS: One hundred and nine effect sizes were obtained from 19 studies employing 54,564 participants. Composite risk scores showed a significant association (r=-0.16) with cognitive test performance. Cognitive domain and age did not significantly modify this relationship. CONCLUSIONS: Composite cardiovascular risk scores can be useful indicators of future cognition. The development of a dementia risk score using similar risk factors could aid in the assessment and lifestyle interventions of persons at risk for dementia.

Sleep Duration and Waist Circumference in Adults: A Meta-Analysis.

BACKGROUND: Previous research has demonstrated a relation between insufficient sleep and overall obesity. Waist circumference (WC), a measure of central adiposity, has been demonstrated to improve prediction of health risk. However, recent research on the relation of insufficient sleep duration to WC in adults has yielded inconsistent findings. OBJECTIVES: To assess the magnitude and the consistency of the relation of insufficient sleep and WC. METHODS: A systematic search of Internet and research databases using Google Scholar, Medline, PubMed, and PsycINFO through July 2013 was conducted. All articles in English with adult human subjects that included measurements of WC and sleep duration were reviewed. A random effects meta-analysis and regression analyses were performed. Heterogeneity and publication bias were checked. Results are expressed as Pearson correlations (r; 95% confidence interval). RESULTS: Of 1,376 articles, 30 met inclusion criteria and 21 studies (22 samples for a total of 56,259 participants) provided sufficient data for meta-analysis. Results showed a significant negative relation between sleep duration and WC (r = -0.10, P < 0.0001) with significant heterogeneity related to sleep comparison method. Potential moderators of the relation between sleep duration and WC were not significant. Funnel plots showed no indication of publication bias. In addition, a fail-safe N calculation indicated that 418 studies with null effects would be necessary to bring the overall mean effect size to a trivial value of r = -0.005. CONCLUSIONS: Internationally, cross-sectional studies demonstrate a significant negative relation between sleep duration and waist circumference, indicating shorter sleep durations covary with central adiposity. Future research should include prospective studies.

Carotid artery stiffness and hemodynamic pulsatility during cognitive engagement in healthy adults: a pilot investigation.

BACKGROUND: The matching of vascular supply to neuronal metabolic demand during cognitive engagement is known as neurovascular coupling (NVC). Arterial stiffness is a prominent determinant of pulsatility in the systemic circulation and may thus indirectly impact NVC. In this pilot investigation, we explored changes in carotid artery stiffness and cerebrovascular hemodynamic pulsatiltiy during cognitive engagement in healthy adults. METHODS: Twenty-seven adults (age 39 ± 3 years, BMI 24 ± 1 kg/m(2)) underwent Doppler ultrasonography of the common carotid artery (CCA) combined with applanation tonometry to derive (i) CCA elastic modulus (Ep) and ß-stiffness index; (ii) CCA flow pulsatility index (PI); (iii) CCA pulse pressure, (iv) CCA augmentation index (AIx). Cerebral PI was assessed using transcranial Doppler at the middle cerebral artery (MCA). All measures were made at rest and during an incongruent Stroop task. RESULTS: CCA PI was reduced (1.75 ± 0.06 to 1.57 ± 0.06, P < 0.05) while MCA PI was unchanged (0.75 ± 0.02 to 0.75 ± 0.02, P > 0.05) during Stroop. Brachial pulse pressure increased during Stroop (43 ± 1 to 46 ± 1 mm Hg, P < 0.05) while CCA pulse pressure was unchanged (36 ± 1 to 35 ± 1 mm Hg, P > 0.05). Similarly, CCA Ep (54.5 ± 5.5 to 53.8 ± 4.9 kPa, P > 0.05) and ß-stiffness index (4.4 ± 0.4 to 4.2 ± 0.3 aU, P > 0.05) were unchanged. CCA AIx increased (1 ± 4 to 13 ± 4%, P < 0.05). CONCLUSION: Carotid pressure pulsatility is unaltered while carotid flow pulsatility is reduced during cognitive engagement. Carotid artery stiffness does not change suggesting that factors other than the dynamic elastic properties of the CCA buffer cerebrovascular hemodynamic pulsatility during cognitive engagement.

I just want my research credit: frequency of suboptimal effort in a non-clinical healthy undergraduate sample.

Although performance validity testing is becoming fairly routine in clinical settings, research protocols involving neuropsychological tests infrequently include assessments of performance validity. The current study utilized an embedded measure of effort over two administrations of CNS Vital Signs to determine the frequency of poor effort in non-clinical healthy undergraduate students participating in a research study for course credit. Results indicate that more than 1 in 10 college students participating in a cognitive test battery for research showed test scores consistent with inadequate effort, which was associated with poor performance on testing across many domains. This conclusion was supported by poor performance on many other subtests. Healthy college students with suboptimal effort (n = 11) had an overall score in the 15th percentile on average compared to the 48th percentile in the rest of the students (n = 66). Those who failed validity indicators on the baseline administration were more likely to fail validity indicators on the repeat administration. Those who were tested in the morning were also more likely to fail validity indicators. The current study provides evidence for the potential limitations of conducting research using neuropsychological tests with healthy college student volunteers in the absence of performance validity testing. Revised college-level cutoffs are proposed.

Do agonistic motives matter more than anger? Three studies of cardiovascular risk in adolescents.

OBJECTIVES: Three motivational profiles have been associated with recurring psychological stress in low-income youth and young adults: Striving to control others (agonistic striving), striving to control the self (transcendence striving), and not asserting control (dissipated striving). Agonistic striving has been associated with elevated ambulatory blood pressure during daily activities. Three studies tested the hypotheses that: (1) agonistic striving is associated with poor anger regulation, and (2) agonistic striving and poor anger regulation interactively elevate blood pressure. DESIGN: Motivational profiles, anger regulation, and ambulatory blood pressure were assessed in a multiethnic sample of 264 urban youth. MAIN OUTCOME MEASURES: (1) anger regulation/recovery during laboratory challenge; (2) anger/blood pressure during daily activities (48 hours). RESULTS AND CONCLUSION: Replication of the profiles in distant cities showed they occur with similar frequency across differences of region, race, and gender. Analyses controlling for body size, race, and gender revealed that individuals with the agonistic striving profile had higher ambulatory pressure, especially during social encounters. They became more openly angry and aggressive when challenged but did not exhibit difficulty regulating anger in the laboratory, nor did they feel angrier during monitoring. However, individuals with the agonistic striving profile who did display poor anger regulation in the lab had the highest blood pressure; deficient self-regulatory capability amplified the positive association between agonistic striving and cardiovascular risk in both genders and all ethnic groups. Although anger is thought to increase cardiovascular risk, present findings suggest that anger and elevated blood pressure are coeffects of agonistic struggles to control others.

Shame, guilt, and depressive symptoms: a meta-analytic review.

Recent theoretical and empirical work has facilitated the drawing of sharp conceptual distinctions between shame and guilt. A clear view of these distinctions has permitted development of a research literature aimed at evaluating the differential associations of shame and guilt with depressive symptoms. This study quantitatively summarized the magnitude of associations of shame and guilt with depressive symptoms. Two hundred forty-two effect sizes were obtained from 108 studies employing 22,411 participants. Shame showed significantly stronger associations with depressive symptoms (r = .43) than guilt (r = .28). However, the association of shame and depressive symptoms was statistically indistinguishable from the associations of 2 maladaptive variants of guilt and depressive symptoms (contextual-maladaptive guilt, involving exaggerated responsibility for uncontrollable events, r = .39; generalized guilt, involving "free-floating" guilt divorced from specific contexts, r = .42). Other factors also moderated the effects. External shame, which involves negative views of self as seen through the eyes of others, was associated with larger effect sizes (r = .56) than internal shame (r = .42), which involves negative views of self as seen through one's own eyes. Depressive symptom measures that invoked the term guilt yielded stronger associations between guilt and depressive symptoms (r = .33) than depressive symptom measures that did not (r = .21). Age, sex, and ethnicity (proportion of Whites to Asians) did not moderate the effects. Although these correlational data are ambiguous with respect to their causal interpretation, results suggest that shame should figure more prominently in understandings of the emotional underpinnings of depressive symptoms.

Alcohol consumption and prehypertension: an investigation of university youth.

Prehypertension and heavy alcohol consumption increase the risk for primary hypertension (PH), a major predictor of cardiovascular-related morbidity and mortality. Although undergraduate college students have exhibited prehypertensive blood pressure (BP) levels and more than 40% of undergraduates drink heavily, few researchers have examined both risk factors in the university context. In this study, the authors collected BP and self-reported quantity and frequency of alcohol consumption data from 211 undergraduates (95 women). Logistic regression analyses showed that prehypertensive undergraduates (ie, those with systolic BP > or = 120 mm Hg or diastolic BP > or = 85 mm Hg) were nearly 4 times more likely to consume alcohol levels associated with increased risk for developing PH. Additional research on alcohol and PH among adolescents and undergraduates is needed, with particular reference to mechanisms and reducing the risk for morbidity and mortality emanating from cardiovascular disease.

Suppressed anger, evaluative threat, and cardiovascular reactivity: a tripartite profile approach.

Despite decades of theory and research implicating suppressed anger in the development of cardiovascular disorders involving cardiovascular reactivity (CVR), to date the theoretical components of low anger expression, guilt feelings over agonistic reactions, and defensive strivings to avoid social disapproval have not been used conjointly to profile suppressed anger for the prediction of CVR. The purpose of this study, then, was to cluster analyze measures of anger expression, hostility guilt, and social defensiveness to create a suppressed anger profile (low anger expression, high hostility guilt, high social defensiveness) and a non-suppressed profile from a sample of college males. Social evaluative threat may be a potent stressor for people who defensively suppress anger expression. Thus, to examine the combined effects of suppressed anger and social evaluative threat, participants, prior to telling a story to a Thematic Apperception Card (TAT), were randomly assigned to either a high-threat (story will be compared to stories created by the mentally ill) or a low-threat condition (story used to study effects of talking on cardiovascular responses). Blood pressure (BP) and heart rate (HR) were monitored during a rest period and the subsequent TAT card period. As predicted, suppressed anger males in the high-threat condition showed the highest levels of diastolic BP and HR change from the rest period. The suppressed anger group's systolic BP reactivity was independent of threat manipulation. Research implications are discussed.

Defensive avoidance of disapproval: the relationship of a defensive style to physical and mental health.

This article presents an exploration of a clinically meaningful interpersonal style labeled here as defensive avoidance of disapproval (DAD), which involves a motivated inattention to physiological, affective, or cognitive reactions arising from stressful social transactions, thereby safeguarding a self-image of social competence. First, we discuss conceptual antecedents of DAD derived from post-Freudian theories of twentieth-century psychodynamic and interpersonally oriented clinicians. Second, we highlight measurement issues as they relate to DAD. Third, we review research on the association of DAD with psychophysiological stress reactivity and diminished health. Finally, DAD-related clinical implications are considered. Our discussion of DAD invites the (1) assessment of phenomenological "blind spots" regarding the physiological, affective, and cognitive components of disapproval-induced stress, (2) development of strategies to decrease premature therapy termination that may result from a defensive avoidance of social disapproval, and (3) cultivation of interventions to increase the high DAD patient's acknowledgement, rather than rejection, of the signs of social stress.

Depression, anxiety, and resting frontal EEG asymmetry: a meta-analytic review.

Emotion-related disturbances, such as depression and anxiety, have been linked to relative right-sided resting frontal electroencephalograph (EEG) asymmetry among adults and infants of afflicted mothers. However, a somewhat inconsistent pattern of findings has emerged. A meta-analysis was undertaken to (a) evaluate the magnitude of effects across EEG studies of resting frontal asymmetry and depression, anxiety, and comorbid depression and anxiety and (b) determine whether certain moderator variables could help reconcile inconsistent findings. Moderate effects of similar magnitude were obtained for the depression and anxiety studies, whereas a smaller effect emerged for comorbid studies. Three moderating variables predicted effect sizes: (a) Shorter EEG recording periods were associated with larger effects among adults, (b) different operationalizations of depression yielded effects of marginally different magnitudes, and (c) younger infant samples showed larger effects than older ones. The current data support a link between resting frontal EEG asymmetry and depression and anxiety and provide a partial account of inconsistent findings across studies.

Sociotropic cognition moderates stress-induced cardiovascular responsiveness in women through effects on total peripheral resistance, but not cardiac output.

Although cardiovascular disease (CVD) remains the leading cause of mortality in women, few studies have examined the role of psychosocial factors in its development. This study examined the moderating effects of sociotropic cognition (SC), a need for social acceptance and approval, on psychosocial stress-induced cardiovascular responsiveness (CVR) and affect reactivity in women. Sixty-eight normotensive, college-aged females were randomly assigned to a low or high social threat condition. Measures of systolic, diastolic and mean arterial blood pressures (SBP, DBP and MAP, respectively), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and negative affect were collected during rest, and under conditions of high vs. low interpersonal threat. A two-step hierarchical regression analysis was performed to predict all response variables (BPs, HR, CO, TPR and affect). Increases in SBP, DBP, MAP, TPR and negative affect were greater in the high threat than low threat condition. Changes in SBP, MAP and TPR positively covaried with SC under conditions of high interpersonal threat, but showed no significant covariation in the low threat condition. The data suggest that an excessive need for social acceptance may contribute to rises in BP through an increase in TPR, but not CO under conditions of high social threat.

Vigilance to a persisting personal threat: unmasking cardiovascular consequences in adolescents with the Social Competence Interview.

We report the first systematic study of hemodynamic responses to the Social Competence Interview, using the original Ewart protocol, which focuses attention on a persisting personal threat. Physiologic changes in 212 African American and Caucasian urban adolescents during the Social Competence Interview, mirror tracing, and reaction time tasks showed that the Social Competence Interview elicits a pronounced vasoconstrictive response pattern, with diminished cardiac activity, that is more typical of alert mental vigilance than of active coping. This pattern was observed in all race and gender subgroups. Results suggest that the Social Competence Interview may be a broadly useful procedure for investigating the role of threat-induced vigilance in cardiovascular and other diseases.

Agonistic interpersonal striving: social-cognitive mechanism of cardiovascular risk in youth?

The social competence model (SCM) of cardiovascular disease (CVD) risk identifies combinations of goal-oriented strivings, expressive behaviors, and social skill deficits that contribute to persisting interpersonal difficulties and chronic health-damaging stress in youth. SCM hypotheses were tested on 187 Black and White adolescents who completed the Social Competence Interview (SCI) and later underwent ambulatory blood pressure (ABP) monitoring. Cluster analyses of stress narratives assessed via SCI identified 3 predicted stress profiles: agonistic (interpersonally focused), transcendent (self-development focused), and avoidant. Group comparisons using social, hemodynamic, and ABP data supported the SCM hypothesis that youths who exhibit the agonistic striving profile display diminished social competence, negative social impact, and heightened cardiovascular responding during a stress interview, and elevated ABP during normal social interactions, thus suggesting higher risk of CVD.

Stress, glucocorticoids, and memory: a meta-analytic review.

Although a strong psychoneuroendocrine linkage exists between stress, glucocorticoids and memory, the relationship is not always straightforward. Eighty-eight effect sizes and 1642 participants from 28 studies were meta-analyzed for the effects of stress on memory performance and glucocorticoid activation. Analyses showed that stress was associated with glucocorticoid activation and declarative memory decline. In animal studies, predator stress affected memory performance more than physical stress. In human studies, males showed higher cortisol levels than females in response to stress. Further, the correlation between cortisol levels and memory deficits was stronger in studies using laboratory stressors than those examining long term effects of chronic exposure to rising basal levels of glucocorticoids and chronic life stressors. It was concluded that, although the relationship between stress, glucocorticoids, and memory loss was empirically supported, there were other factors, such as stress condition and gender, as well as individual differences within groups, that influenced the association between these variables, and warrant further examination.