The development and initial validation of the Fatigue Sensitivity Questionnaire.

Currently, there is poor understanding of fatigue and the possible psychological conditions that may underlie chronic fatigue. Although substantial work has been directed to better clinically address fatigue, no work has explored individual differences in expectations or perceptions of the negative consequences associated with fatigue-related symptoms. The goals of this study were to (a) develop and (b) validate a measure of expectations or perceptions of the negative consequences associated with fatigue-related symptoms (e.g. fatigue sensitivity) across two independent samples (N = 1,827; 73.1% female; Mage = 21.68; SD = 4.54) of young adults. Results supported a 10-item measure of fatigue sensitivity, entitled the Fatigue Sensitivity Questionnaire (FSQ). The FSQ demonstrated unidimensionality, excellent internal consistency, and strong convergent and discriminant validity. Overall, the 10-item scale offers a single score that can be employed to measure fatigue sensitivity. Clinically, the FSQ may be a brief, informative, and easily disseminated measure in better understanding and capturing expectations or perceptions about the negative consequences of fatigue. As a research tool, the use of the FSQ may provide broader understanding of vulnerability factors that may influence fatigue-related health outcomes. Future research is needed to test the validity of the FSQ in other samples.

Identifying the role of sociodemographic factors in major depressive disorder and suicidality among Spanish-speaking Latino patients in a federally qualified health center.

Rates of suicide and major depressive disorder (MDD) are currently at the highest point in the history of the United States (US). However, these rates are not distributed evenly among the population and Latinos show disproportionately high rates of both suicide and MDD. Yet, past research has infrequently explored factors related to suicide and MDD in primary care settings that serve as the major community portal for mental health among the Latino population. Thus, the current study investigated sociodemographic variables (marital status, nativity, education, employment, primary language, age, and gender) in terms of their relations with suicidal ideation, suicide risk, MDD, and MDD symptom severity among Latino primary care patients in a Federally Qualified Health Center (N = 634, M age = 39.46, SD = 11.46, 87.1% female). Results indicated that gender and Nativity were associated with suicidal ideation, older age was associated with suicide risk, and higher education and having a partner were negatively associated with MDD and depressive symptom severity. These results provide novel insight into the role of sociodemographic factors predicting suicide and MDD among Latinos in primary care, and suggest greater scientific and clinical attention can be focused on certain sociodemographic factors to offset mental health disparities among this group.

Anxiety sensitivity and rumination: Transdiagnostic factors involved in the relation between subjective social status and anxiety and depressive symptoms and disorders among economically disadvantaged Latinos in primary care.

Latinos face striking physical and mental health disparities. One factor associated with such disparities is subjective social status, reflecting subjective ratings of social standing. Yet there is presently a lack of empirical information about the mechanisms underlying relations between subjective social status and anxiety and depressive symptoms and disorders among Latinos in community medical services that serve as focal catchment areas for assessment and intervention programming. The present investigation examined the unique explanatory roles of 2 transdiagnostic factors, rumination and anxiety sensitivity, in the relation between subjective social status and depressive, suicidal, social anxiety, and anxious arousal symptoms as well as anxiety/depressive disorders, among Latinos seeking health services at a primary health care facility. Participants included 253 Latino adults with annual incomes of less than $30,000 (M age = 39.1, SD = 11.1). Results indicated that rumination and anxiety sensitivity each significantly (independently) mediated associations between subjective social status and all dependent variables except suicidal symptoms. For suicidal symptoms, only rumination was a mediator. The present findings suggest that rumination and anxiety sensitivity may represent mechanisms for associations between subjective social status and anxiety and depressive symptoms and disorders among economically disadvantaged Latinos in primary care settings. (PsycINFO Database Record

Understanding the Correlates between Care-Recipient Age and Caregiver Burden, Work-family Conflict, Job Satisfaction, and Turnover Intentions.

Although the caregiver literature has explored a wide array of different variables, there is a gap in research on how demographics of the care recipient affect their caregiver. Using data from a diverse sample of 1,007 unpaid caregivers, individuals were separated into four groups based on care recipient age; childcare, adultcare, eldercare, and those with care recipients from multiple age categories. Then, following previous literature, childcare was split into four groups based on the age of the youngest child cared for (0-2 years; 3-5 years; 6-12 years; and 13-17 years). Group differences were found in work-family conflict (time) and five types of caregiver burden. Specifically, time-dependence burden differed most between groups with caregivers of children (0-2 years) having the highest levels and caregivers of children (13-17) having the lowest levels. There were no differences found between groups for job satisfaction, turnover intentions, or family-work conflict. Additional differences were found when considering caregivers' gender. This research is an exploratory step in understanding how age of care recipient relates to different outcomes for caregivers. Implications are discussed.

Subjective social status and rumination in relation to anxiety and depressive symptoms and psychopathology among economically disadvantaged Latinos in primary care.

The present investigation examined the interactive effects of subjective social status and rumination in relation to anxiety/depressive symptoms and psychopathology among 276 Latinos (82% female; Mage = 39.2, SD = 11.1; 97.0% reported Spanish as first language) who attended a community-based primary health care clinic. Results indicated that the interaction between rumination and subjective social status was significantly associated with depression (B = -.04, t = -3.52, p < .001, 95% CI [-.06, -.02]), social anxiety (B = -.01, t = -3.84, p < .001, 95% CI [-.02, -.01]), and the number of mood and anxiety disorders (B = -.004, t = -2.80, p = .005, 95% CI [-.006, -.001]), after controlling for main effects of rumination and subjective social status. The form of the interactions suggested that the associations of rumination and the outcome variables were stronger for those with lower compared to higher subjective social status. For anxious arousal symptoms, however, there was not a statistically significant interaction. These findings underscore the potential importance of examining the interplay between rumination and subjective social status in regard to better understanding, and intervening to reduce, various forms of anxiety/depressive symptoms and disorders among Latinos in primary care settings. (PsycINFO Database Record

Financial strain and cognitive-based smoking processes: The explanatory role of depressive symptoms among adult daily smokers.

Little work has focused on the underlying mechanisms that may link financial strain and smoking processes. The current study tested the hypothesis that financial strain would exert an indirect effect on cognitive-based smoking processes via depressive symptoms. Three clinically significant dependent variables linked to the maintenance of smoking were evaluated: negative affect reduction motives, negative mood abstinence expectancies, and perceived barriers for quitting. Participants included 102 adult daily smokers (Mage=33.0years, SD=13.60; 35.3% female) recruited from the community to participate in a self-guided (unaided; no psychological or pharmacological intervention) smoking cessation study. Results indicated that depressive symptoms explain, in part, the relation between financial strain and smoking motives for negative affect reduction, negative mood abstinence expectancies, and perceived barriers for quitting. Results indicate that smoking interventions for individuals with high levels of financial strain may potentially benefit from the addition of therapeutic tactics aimed at reducing depression.

Anxiety sensitivity explains associations between anxious arousal symptoms and smoking abstinence expectancies, perceived barriers to cessation, and problems experienced during past quit attempts among low-income smokers.

Disproportionately more smokers report low-income and mental health problems relative to non-smokers. Low-income smokers may use smoking to alleviate negative emotional states resulting from exposure to multiple stressors. Yet, little work has been devoted to elucidating mechanisms that may explain the association between negative emotional states and smoking-related processes among low-income smokers. The present study sought to address this gap by examining anxiety sensitivity, a transdiagnostic factor related to both anxiety and smoking, as a potential mediator for the influence of anxiety symptoms on smoking-related processes, including threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. Participants included treatment-seeking daily cigarette smokers (n=101; 68.3% male; Mage=47.1; SD=10.2). Results indicated that anxiety symptoms exerted a significant indirect effect through anxiety sensitivity for threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. The present results provide empirical support that anxiety sensitivity may be an underlying mechanism that partially explains the relation between anxiety symptoms and smoking processes among low-income treatment-seeking smokers. Findings broaden current theoretical understanding of pathways through which anxiety symptoms contribute to maladaptive smoking processes and cognitions among socioeconomically disadvantaged smokers.

Synergistic effects of pain intensity and experiential avoidance in relation to anxiety symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting.

Latinos are subject to numerous health inequalities, including mental health disparity for anxiety and its disorders. In fact, there is strikingly little understanding of transdiagnostic risk factors for the onset and development of anxiety symptoms and disorders among Latinos. To build knowledge in this domain, the present investigation examined the interactive effects of experiential avoidance and pain intensity in relation to anxious arousal, social anxiety, and anxiety disorders among 361 Latino adults with annual incomes of less than $30,000 (87.5% female; Mage=38.8, SD=11.4, and 98.5% used Spanish as their first language) who attended a community-based primary healthcare clinic. As hypothesized, the interaction between experiential avoidance and pain intensity was significantly related to anxious arousal, social anxiety, and a number of anxiety disorders over and above the effects of other factors. The form of the significant interactions indicated that participants reporting co-occurring higher levels of experiential avoidance and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between experiential avoidance and pain intensity in regard to a relatively wide array of anxiety problems among Latinos in a primary care medical setting.

Pain severity and emotion dysregulation among Latinos in a community health care setting: relations to mental health.

BACKGROUND: Although pain severity is often related to poorer mental health and is one of the most common presenting complaints in community health care settings, there is little understanding of the pain experience in relation to anxiety/depressive symptoms and disorders among Latino populations in medical contexts. METHOD: To address this gap, the current study explored an interactive model of pain severity and emotion dysregulation in relation to anxiety/depressive symptoms and psychopathology among 274 Latinos who attended a community-based primary health care clinic [86.9% female; Mage=39.3 (SD=11.2); 96.0% indicated Spanish as their first language]. RESULTS: Results indicated a statistically significant interaction between pain severity and emotion dysregulation for suicidal symptoms, social anxiety symptoms and number of mood/anxiety disorders, such that more severe pain and greater levels of emotion dysregulation related to poorer mental health. Both pain severity and emotion dysregulation were significant predictors of depressive symptoms, but only pain severity was a significant predictor of anxious arousal symptoms. CONCLUSIONS: These novel findings suggest a clinically significant interplay between pain severity and emotion dysregulation among Latinos in. The results are discussed in relation to the need for new screening and intervention tactics that address interrelations between pain severity and emotional dysregulation among Latinos seeking treatment in community health-care-based settings.

Synergistic effects of pain intensity and anxiety sensitivity in relation to anxiety and depressive symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting.

The present investigation examined the interactive effects of anxiety sensitivity and pain intensity in relation to anxious arousal, social anxiety, and depressive symptoms and disorders among 203 Latino adults with an annual income of less than $30,000 (84.4% female; Mage=38.9, SD=11.3 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and pain intensity was significantly related to increased anxious arousal, social anxiety, and depressive symptoms as well as number of depressive/anxiety disorder diagnoses. The form of the significant interactions indicated that participants reporting co-occurring higher levels of anxiety sensitivity and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and depressive symptoms as well as higher levels of depressive and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and pain intensity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

Acculturative stress and experiential avoidance: relations to depression, suicide, and anxiety symptoms among minority college students.

Although college campuses represent strategic locations to address mental health disparity among minorities in the US, there has been strikingly little empirical work on risk processes for anxiety/depression among this population. The present investigation examined the interactive effects of acculturative stress and experiential avoidance in relation to anxiety and depressive symptoms among minority college students (n = 1,095; 78.1% female; Mage = 21.92, SD = 4.23; 15.1% African-American (non-Hispanic), 45.3% Hispanic, 32.5% Asian, and 7.1% other races/ethnicities. Results provided empirical evidence of an interaction between acculturative stress and experiential avoidance for suicidal, social anxiety, and anxious arousal symptoms among the studied sample. Inspection of the significant interactions revealed that acculturative stress was related to greater levels of suicidal symptoms, social anxiety, and anxious arousal among minority college students with higher, but not lower, levels of experiential avoidance. However, in contrast to prediction, there was no significant interaction for depressive symptoms. Together, these data provide novel empirical evidence for the clinically-relevant interplay between acculturative stress and experiential avoidance in regard to a relatively wide array of negative emotional states among minority college students.

Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care.

From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample.

Interactive Effect of Negative Affectivity and Rumination in Terms of Mental Health Among Latinos in Primary Care.

The present investigation examined the interactive effects of rumination and negative affectivity in relation to anxiety and depressive symptoms and psychopathology among 245 Latino adults (M age = 39.7, SD = 11.4; 86.9 % female; 97.6 % reported Spanish as their first language) attending a community-based primary healthcare clinic. As expected, there was a significant interaction between rumination and negative affectivity for depressive, suicidal, social anxiety, anxious arousal symptoms, number of mood and anxiety disorders, and disability among the primary care Latino sample. Inspection of the interaction forms indicated a high degree of conceptual similarity. Specifically, rumination was related to greater levels of suicidal symptoms, social anxiety, anxious arousal, number of mood and anxiety disorders, and disability among individuals with higher, but not lower, levels of negative affectivity. The form of the interaction for depressive symptoms was in line with this pattern, but more extreme; rumination was related to greater levels of depressive symptoms among individuals with both higher and lower levels of negative affectivity. Together, these data provide novel empirical evidence suggesting that there is clinically relevant interplay between rumination and negative affectivity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

Negative Affectivity and Problematic Alcohol Use Among Latinos in Primary Care: The Role of Emotion Dysregulation.

OBJECTIVE: Latinos are the largest and most rapidly growing racial/ethnic group in the United States. In Latino communities, alcohol is the most widely abused substance, yet there is little empirical understanding of the factors underlying problematic alcohol use among Latinos. The current study explored whether negative affectivity exerted an indirect effect via emotion dysregulation in relation to two alcohol-related outcomes. METHODS: Participants were 316 Latinos attending a community-based primary care facility (Mage = 39.3, SD = 11.3; 85.4% female; 95.3% first language Spanish), who completed a variety of self-report and interview measures. Mediation analyses evaluated the indirect effect of negative affectivity via emotion dysregulation on problematic drinking and symptoms of alcohol dependence. RESULTS: While there was no direct or total effect of negative affectivity on either alcohol-related outcome, negative affectivity was significantly associated with both problematic alcohol use and symptoms of dependence via emotion dysregulation. Effect sizes were in the medium range, K(2) = .09 and .10, respectively. Post-hoc multiple mediation analyses evaluated subfactors of emotion dysregulation as mediators of the negative affectivity-alcohol associations. These results suggested that difficulties engaging in goal-directed behavior might be particularly important in explaining the association between negative affectivity and problematic alcohol use/symptoms of dependence. Last, independent mediation analyses evaluated emotion dysregulation subfactors and found that limited access to effective emotion regulation strategies and difficulties engaging in goal-directed behavior were, independently, significant mediators for both outcomes. Nonacceptance of emotional responses may also mediate negative affectivity and problematic drinking. Surprisingly, impulse control difficulties was not a significant mediator in any model. CONCLUSIONS: These data provide novel insight that among Latinos in primary care, emotion dysregulation is a possible mechanism underlying the indirect relationship between negative affectivity and problematic alcohol use and symptoms of dependence. Results also highlight specific facets of emotion dysregulation as potential targets of intervention. Future research should be longitudinal in nature, be conducted among more representative samples, and utilize measures that will better assess the potential variability in these associations. Results of such work may inform the development of alcohol treatment interventions incorporating the use of adaptive emotion regulation among Latinos in primary care.

Examining an underlying mechanism between perceived stress and smoking cessation-related outcomes.

The mediational role of negative reinforcement smoking outcome expectancies in the relation between perceived stress and (1) perceived barriers to cessation, (2) severity of problematic symptoms during past quit attempts, and (3) smoking-specific experiential avoidance (AIS) was examined. Data were drawn from a baseline assessment of a larger clinical trial. Participants included 332 adult treatment-seeking smokers (47.3% female; Mage=38.45; SD=.50; age range: 18-65 years). Results indicated that perceived stress was indirectly related to perceived barriers to smoking cessation, severity of problematic symptoms during past quit attempts, and AIS through negative reinforcement outcome expectancies. These results were evident after accounting for the variance explained by gender, negative affectivity, and alternative outcome expectancies for smoking. The present findings suggest that smokers with greater perceived stress experience greater negative reinforcement smoking expectancies, which in turn, may be related to numerous processes involved in the maintenance of smoking.

Anxiety sensitivity and mindful attention in terms of anxiety and depressive symptoms and disorders among Latinos in primary care.

The present investigation examined the interactive effects of anxiety sensitivity and mindful attention in relation to anxiety and depressive symptoms and psychopathology among 145 adult Latinos (85.5% female; Mage=39.9, SD=10.8 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and mindful attention was significantly related to number of mood and anxiety disorders, social anxiety, and depressive symptoms. No significant interaction, however, was evident for panic (anxious arousal) symptoms. The form of the significant interaction indicated that Latinos reporting co-occurring higher levels of anxiety sensitivity and lower levels of mindful attention evinced the greatest levels of anxiety/depressive psychopathology, social anxiety, and depressive symptoms. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and mindful attention in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care.

The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; Mage=39.0, SD=10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.

Examining substance use and affective processes as multivariate risk factors associated with overweight body mass among treatment-seeking smokers.

Cigarette smoking and obesity are two major public health problems. However, factors related to the underlying risk for being overweight are not well established. Certain demographic, smoking, and psychological factors have been linked to overweight/obese body mass. The current study examined a multivariate risk model, stratified by gender, in order to better explicate the nature of overweight body mass among daily smokers. In a sample of treatment-seeking smokers (n = 395), among males and females, (1) older age, (2) stronger expectancies about the weight/appetite control effects of smoking, (3) greater smoking-based inflexibility/avoidance due to smoking-related sensations, and (4) less problematic alcohol use, were associated with being overweight. Additionally, among males, having a tobacco-related medical problem and higher tolerance for physical discomfort aided in the discriminant function model for classifying smokers as overweight. Together, numerous cognitive-affective vulnerabilities and smoking processes may be targetable and potentially inform weight-related prevention programs among smokers.