Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients.

OBJECTIVE: The purpose of this study was to examine the interaction of daily concurrent positive interpersonal events (PIE) and negative interpersonal events (NIE) on the daily experience of negative affect and fatigue in a sample of men and women with rheumatoid arthritis. Two hypotheses were made. The blunting hypothesis predicted that NIE would nullify the beneficial influence of PIE on outcome measures, and the buffering hypothesis predicted that PIE would offset the adverse influence of NIE. DESIGN: Participants completed up to 30 consecutive daily diaries. Multilevel modeling was used to examine the day-to-day dependencies among study variables. MAIN OUTCOME MEASURES: The primary outcomes were daily negative affect and fatigue. RESULTS: In support of the blunting hypothesis, on days when NIE were diminished, PIE were associated with a greater reduction in fatigue. In contrast, consistent with the buffering hypothesis, on days when PIE were elevated, NIE were associated with a lesser increase in negative affect. CONCLUSION: The examination of concurrent PIE and NIE provides a unique perspective on the role of interpersonal events in affective and physiological outcomes, beyond that which can be gained from the examination of either type of event in isolation.

Lifetime depression and diabetes self-management in women with Type 2 diabetes: a case-control study.

AIMS: Little is known about the association between lifetime history of major depressive disorder (L-MDD) and diabetes self-management, particularly when depression is remitted. We examined the association between L-MDD and diabetes self-management in women with Type 2 diabetes who were not depressed at the time of assessment. METHODS: L-MDD was assessed with structured psychiatric interview. Participants completed paper-and-pencil measures of demographics, diabetes-related distress, self-care behaviours, healthcare utilization and diabetes self-efficacy. RESULTS: One-hundred and fifty-three women participated; 41% had L-MDD. Compared with their never-depressed counterparts, women with L-MDD had more diabetes distress, reported lower overall rates of self-monitoring of blood glucose (SMBG) and greater tendency to skip SMBG, had lower diet adherence and were less likely to have seen a primary care provider in the past year. Diabetes self-efficacy mediated the relationship between L-MDD and self-management. CONCLUSIONS: Interventions to promote self-management for patients with L-MDD may be warranted.

A common polymorphism in serotonin receptor 1B mRNA moderates regulation by miR-96 and associates with aggressive human behaviors.

Non-coding regulatory elements can transduce the human genome's response to environmental stimuli. Thus, there is a possibility that variation in non-coding regulatory elements may underlie some of the diversity in human behavior. However, this idea has remained largely untested due to the difficulty in accurately identifying regulatory elements in the 98% of the human genome that does not encode protein. The recent recognition that small trans-acting RNAs anneal to mRNA and regulate gene expression provides a means to identify and test such variants. Here, we show that microRNA-directed silencing of mRNA can be attenuated by a common human polymorphism. We have identified an element (A-element) within serotonin receptor 1B (HTR1B) mRNA that confers repression by miR-96. The repressive activity of this element is attenuated by a common human variant (G-element) that disrupts a nucleotide critical for its interaction with miR-96. Because deletion of the HTR1B gene leads to an aggressive phenotype in mice, we hypothesized an association between the A/G polymorphism and aggressive phenotypes in a sample of 359 college students. As predicted, individuals homozygous for the ancestral A-element reported more conduct-disorder behaviors than individuals with the G-element. Our studies suggest that such functional variants may be common and may help to refine the search for genes involved in complex behavioral disorders.

The idiographic study of inconsistent condom use behavior of persons living with HIV.

A pilot study was conducted to assess the feasibility of using, in a multiply disadvantaged population, an electronic daily diary to test hypotheses linking affective states to variability in psychosocial determinants of condom use. Twenty-one mostly non-Caucasian individuals reporting profound economic disadvantage, heavy alcohol use and HIV infection completed a 5-7 minute interactive voice response (IVR) telephone-based survey daily for three weeks. Potentially affect-related within-person variability was observed in HIV-preventive attitudes, intentions and self-efficacy. Surprisingly, in this sample, HIV-preventive attitudes, intentions and self-efficacy exhibited as much, or greater, variability within persons as compared to between persons. Positive affect was found to significantly co-vary with self-efficacy to practice safer sex B=0.20, t((199))=2.14, p=0.03. For each unit increase in daily positive affect, daily self-efficacy increased by 0.20. Results suggest that a daily diary methodology is both feasible in a high-risk population and may offer new insights into understanding unprotected sexual behavior.

History of major depressive disorder and diabetes outcomes in diet- and tablet-treated post-menopausal women: a case control study.

AIMS: Little is known about the long-term associations between remitted major depressive disorder (MDD) and clinical diabetes outcomes. This study investigated associations between a remote history of fully remitted MDD and (i) glycaemic control, (ii) diabetes symptoms, and (iii) physical and emotional functioning in post-menopausal women with Type 2 diabetes (T2DM). METHODS: Forty-four post-menopausal women with diet- or tablet-treated T2DM participated. Twenty-three had never experienced depression and 21 had a history of MDD. All participants had been free of MDD and antidepressant treatment for > or = 1 year. RESULTS: Compared with their never-depressed counterparts, women with a history of MDD had significantly higher HbA(1c) (7.0 vs. 6.5%), more diabetes symptoms, and worse emotional functioning, after controlling for confounding variables. Differences in HbA(1c) and diabetes symptoms were not accounted for by the higher current subclinical depressive symptoms observed in the previously depressed group. Differences in emotional functioning were accounted for by current subclinical depressive symptoms. CONCLUSIONS: Most health-care providers overlook fully remitted depression. However, previously depressed patients, who outnumber currently depressed patients, may still have poorer glycaemic control than never-depressed patients.

Pain and negative mood during rehabilitation after anterior cruciate ligament reconstruction: a daily process analysis.

Daily diary methods were used to examine changes in pain and negative mood over the first 6 weeks of rehabilitation after surgical reconstruction of the anterior cruciate ligament (ACL). Participants (58 men and 33 women) completed measures of personal factors (i.e., age, athletic identity, neuroticism, optimism) before surgery and indices of daily pain, negative mood, and stress for 42 days after surgery. Multilevel modeling revealed that, as would be expected, daily pain ratings decreased significantly over the course of the study and that the rate of decline in pain ratings decreased over time. Age and daily negative mood were positively associated with daily pain ratings. Daily negative mood also decreased significantly over the course of the study and was positively associated with neuroticism, daily pain, and daily stress. Athletic identity and optimism interacted with time since surgery in predicting daily negative mood such that participants with high levels of athletic identity and low levels of optimism reported greater decreases in daily negative mood over time. Overall, the findings reveal a pattern of improved psychological functioning over the early stages of post-operative ACL rehabilitation.

Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients.

OBJECTIVE: To examine how depressive symptoms, a history of depression, and cognitive functioning contribute to the prediction of rehabilitation efficiency in stroke patients. DESIGN: Consecutive admissions to an acute inpatient rehabilitation program were screened for cognitive functioning and level of depressive symptoms. History of depression was determined by family member interview. Functional status was evaluated at time of admission and discharge. Depressive symptoms, depression history, and cognitive functioning were examined as predictors of length of stay (LOS) and efficiency of utilization of rehabilitation services. SETTING: Acute inpatient rehabilitation hospital. PATIENTS: A total of 348 consecutive stroke admissions to an inpatient program were evaluated for depression and cognitive functioning, of whom 243 patients completed all aspects of the screening. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation progress, measured with the LOS efficiency measure (LOS-EFF) of the FIM instrument, and length of rehabilitation hospital stay. RESULTS: Patients with higher levels of depressive symptoms used rehabilitation services less efficiently than those with lower symptom levels but did not have longer LOSs. History of depression was associated with longer LOS and less efficient use of rehabilitation services. Cognitive impairment did not predict rehabilitation efficiency. CONCLUSIONS: The present study lends further support to the benefits of screening stroke patients at the time of rehabilitation admission for depression and history of depression. Identifying patients who have high levels of depressive symptoms and/or a previous depressive episode will allow more comprehensive assessment and rapid intervention.

Examinations of chronic pain and affect relationships: applications of a dynamic model of affect.

Two studies of the relationship between pain and negative affect are presented in this article: a study of weekly fluctuations in pain and negative affect among those with arthritis and a study of daily fluctuations in pain and negative affect for participants with fibromyalgia. The roles of positive affect and mood clarity (or the ability to distinguish between different emotions) in modifying the size of the relationship between pain and negative affect were examined in both studies as a means of testing the predictions of a dynamic model of affect regulation. In both studies, the presence of positive affect reduced the size of the relationship between pain and negative affect. Also, for arthritis participants with greater mood clarity, there was less overlap in ratings of negative and positive affective states.

Women's pursuit of personal goals in daily life with fibromyalgia: a value-expectancy analysis.

Eighty-nine women with fibromyalgia completed the Life Orientation Test, identified health and social goals, and answered questions from the Goal Systems Assessment Battery (P. Karoly & L. Ruehlman, 1995) about their valuation of, and self-efficiency in attaining, each goal. For 30 days, they responded to palm-top computer interviews about their pain and fatigue and rated their goal effort, goal progress, and pain- and fatigue-related goal barriers. Goal barriers increased and goal efforts and progress decreased on days with greater pain and fatigue; goals valued more highly were pursued more effortfully and successfully; more optimistic individuals were less likely to perceive goal barriers and, on days that were more fatiguing than usual, were less likely to reduce their effort and to retreat from progress in achieving their health goal; and more pessimistic individuals perceived greater goal barriers on days that were less painful than usual.

Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients.

The authors compared the internal consistency, 1-year temporal stability, and self-informant agreement of ratings of personality trait (NEO Five-Factor Inventory; NEO-FFI; P. T. Costa & R. R. McCrae, 1992) and personality disorder symptom severity (Structured Clinical Interview for DSM-III-R Personality Disorders Questionnaire; SCID-II-Q; R. L. Spitzer, J. B. W. Williams, M. Gibbon, & M. First, 1990) in 131 substance-dependent inpatients. Internal consistency coefficients were acceptable to very good for most NEO-FFI and SCID-II-Q scales, and temporal stability correlations were significant for all measures. Agreement between patient and informant ratings was more modest. Substance abuse and depression symptom severity moderated the temporal stability and self-informant agreement of several personality trait and disorder ratings. The authors did not find that the five factors were more reliable than the Axis II symptoms. Issues related to the reliability of personality assessment in multiply diagnosed patients are discussed.

History of affective disorder and the temporal trajectory of fatigue in rheumatoid arthritis.

This study examines whether the general level and rate of change of fatigue over time is different for those rheumatoid arthritis (RA) patients with and those without a history of affective disorder (AD). Four hundred fifteen RA patients from a national panel had yearly telephone interviews to obtain fatigue and distress reports, and a one-time semistructured assessment of the history of depression and generalized anxiety disorder Growth-curve analysis was used to capture variations in initial fatigue levels and changes in fatigue over 7 years for those with and without a history. RA patients with a history of major AD reported levels of fatigue that were 10% higher than those without a history in the 1st year of the study. Their fatigue reports remained elevated over 7 years. Further analysis showed that the effects of a history of AD on fatigue are fully mediated through current distress, although those with a history had a significantly smaller distress-fatigue slope. Thus, a history of AD leaves RA patients at risk for a 7-year trajectory of fatigue that is consistently higher than that of patients without a history. The elevation in fatigue reports is, at least in part, a function of enduring levels of distress.

Daily interpersonal experiences, context, and alcohol consumption: crying in your beer and toasting good times.

The authors explored a multidimensional view of drinking, whereby social and solitary drinking represent distinct behaviors associated with positive and negative experiences, respectively. Using daily diary methodology and multilevel analytic strategy, the authors examined, over 30 days, the within-person association of negative and positive experiences and alcohol consumption in different contexts and focused on interpersonal experiences. On days with more negative interpersonal experiences, participants engaged in more solitary drinking (i.e., drinking at home and alone), whereas on days with more positive interpersonal experiences they drank more in social contexts. The authors also demonstrated that individuals high on neuroticism drank more in solitary contexts on days with more negative interpersonal experiences, relative to those with lower neuroticism. These findings lend support to models linking daily drinking motivation and context-dependent drinking behavior.

The relationship of daily mood and stressful events to symptoms in juvenile rheumatic disease.

OBJECTIVES: The purpose of this study was 3-fold: 1) to assess the feasibility of a daily diary for use with children with juvenile rheumatic disease (JRD), 2) to describe daily variation in mood, stressful events, and symptoms in children with JRD, and 3) to examine the extent to which daily mood and daily stressful events predict daily symptoms in children with JRD. METHODS: Twelve children with JRD completed a daily booklet for 7 days. The daily booklet included measures of daily mood, daily stressful events, daily symptoms, and daily function. The children also completed a visual analog scale for pain and the Children's Depression Inventory. RESULTS: Subjects showed good compliance with scheduled completion and return of the daily diaries. Results indicated that children with JRD showed variability in daily mood, frequency of daily stressful events, and daily symptoms across days. Multilevel fixed effects models showed that more negative daily mood and more daily stressful events significantly predicted increased reports of fatigue, stiffness, and cutting back on daily activities. Negative daily mood also correlated with increases in daily reported pain. CONCLUSIONS: These results indicate that daily diary research is both feasible and potentially informative in children with JRD. Our data emphasize the need for further investigation into the role of daily mood and daily stressful events on disease course in JRD.

Positive and negative daily events, perceived stress, and alcohol use: a diary study.

Using daily diary methodology, the authors examined over 60 days the within-person associations among positive and negative daily experiences, perceptions of stress, desire to drink, and alcohol consumption in a sample of 83 regular drinkers. Multilevel regression analyses indicated that days on which individuals reported more positive and negative nonwork events were also days they reported higher levels of desire to drink and actual consumption. Days on which individuals reported more negative work events were also days they reported a greater desire to drink, and days on which individuals reported more positive and negative health events were also days they reported lower levels of desire to drink and actual consumption. Weak evidence was found for the mediating effects of perceived stress in these associations. Several of the within-person associations varied as a function of gender, neuroticism, and drinking to cope; no moderating effects were found for extraversion.

Personality and substance use disorders as predictors of criminality.

The study objective was to evaluate the relationship between a personality disorder (PD) diagnosis and criminal behavior among drug- and alcohol-dependent patients both retrospectively and prospectively. We examined 1-year pretreatment and 1-year post-treatment crime rates among 370 drug- and/or alcohol-dependent patients. Hierarchical logistic regression was used to examine the predictive value of DSM-III-R PD diagnoses after controlling for demographic features and type and severity of substance dependence. Patients with a diagnosis of antisocial PD (ASPD) were more likely to report having committed a variety of crimes, including violent crimes, during the pretreatment period. Individuals with more PD diagnoses or a diagnosis of borderline PD (BPD) or schizoid PD also reported a greater number of pretreatment violent crimes. In addition, the number of PD diagnoses was correlated with the number of crimes against property. During the pretreatment period, significant interactions were also found between PD measures and substance use in relation to both property crimes and violation of parole or probation. During the posttreatment period, a diagnosis of BPD predicted the commission of violent crimes. In contrast, a cluster A PD predicted a lower frequency of crimes against property. ASPD did not predict criminality during the 1-year follow-up period. In conclusion, a PD diagnosis, particularly ASPD, was associated with a variety of criminal behaviors during the 1-year period preceding substance abuse treatment. Following treatment, PD diagnosis had limited value in the prediction of criminal behavior. Possible explanations for these findings are discussed.

Mood and alcohol consumption: an experience sampling test of the self-medication hypothesis.

In this investigation the authors applied the experience sampling method to prospectively test the self-medication hypothesis. In vivo reports gathered in the context of daily life demonstrated that nervousness was the only negative mood state to predict increases in alcohol consumption later in the course of the day. Further examination of this within-person relationship demonstrated that men were more likely to consume alcohol when nervous than were women, but this association was unrelated to family history of alcoholism, problem drinking patterns, or trait anxiety and depression. Consistent with the self-medication hypothesis, cross-sectional analyses also confirmed that alcohol consumption was generally associated with lower levels of nervousness; this effect varied by several demographic and clinical variables. These findings are discussed in terms of the diversity of reasons for alcohol consumption and their potential for explaining problem drinking.

A daily process approach to coping. Linking theory, research, and practice.

For decades, coping researchers have used between-person designs to address inherently within-person questions derived from theory and clinical practice. The authors describe recent developments in the use of within-person, process-oriented methods that examine individuals intensively over time. Ongoing studies of stress and alcohol consumption, the effects of depression on adaptational processes, and the temporal dynamics of coping with chronic pain demonstrate that by tracking rapidly fluctuating processes such as mood and coping close to their real-time occurrence, daily process designs offer unique insights into conceptually and clinically challenging questions. Such designs also provide new opportunities to examine the purported mechanisms of therapeutic interventions. Despite its demands on participants and investigators, daily process research offers fresh opportunities to link psychological theory, research, and practice.

Stress and alcohol use: a daily process examination of the stressor-vulnerability model.

The authors used a daily diary methodology to examine over 60 days how the within-person associations among event stress, alcohol consumption, and desire to drink varied as a function of gender, positive and negative alcohol-outcome expectancies, and avoidant coping in a sample of 88 regular drinkers. Multilevel regression analyses indicated that men who more strongly anticipated positive outcomes or a sense of carelessness from drinking drank relatively more on stressful days compared with low-stress days. Similar results were found predicting desire to drink. Men who anticipated greater impairment from drinking drank relatively less on stressful days. In general, these effects did not hold for women. Little evidence was found for the predicted effects for avoidant coping style, and some results showed that avoidant coping style buffered the exacerbating effects of careless unconcern expectancies.

Mood states associated with transitory changes in asthma symptoms and peak expiratory flow.

OBJECTIVE: This study examined the within-person relations between transitory changes in mood, asthma symptoms, and peak expiratory flow rate (PEFR). METHODS: Thrice-daily for 21 consecutive days, 48 adults with moderate to severe asthma entered information in palm-top computers about their mood and asthma symptoms. A multidimensional model of mood, ie, the mood circumplex, informed the assessment of mood arousal and mood pleasantness. At each observation, participants also recorded their PEFR with peak flow meters that stored blinded data. Albuterol doses were also monitored electronically. Before and after the 21-day study, spirometric measures of airways obstruction were taken under controlled conditions. RESULTS: Random effects regression models revealed a significant, but weak, within-person relation between symptoms and PEFR. Changes in mood vectors with an arousal component were significantly related to PEFR changes, whereas changes in mood vectors with a pleasantness component tracked changes in asthma symptom reports, even after adjustment for contemporaneous PEFR and after controlling for time of day and albuterol dosing. Comparison of spirometric assessments with unsupervised PEFR suggested that part of the relation between mood arousal and PEFR may be attributable to the "effort-dependence" of peak flow self-monitoring. CONCLUSIONS: Different dimensions of mood were associated with transitory changes in asthma symptoms and PEFR. This may be one reason why individuals with asthma misperceive the severity of their symptoms in relation to underlying airways obstruction.

Co-occurrence of Axis I and Axis II disorders in substance abusers.

OBJECTIVE: This study examined the co-occurrence of anxiety/mood and personality disorders (PDs) in substance abusers, the impact of anxiety/ mood disorders on the symptom profiles of PDs, and the impact of anxiety/mood disorders and PDs on pre-treatment status. METHOD: Current anxiety/mood disorders and PDs and pre-treatment status were assessed using semi-structured interviews in 370 treated substance abusers. RESULTS: Anxiety/mood disorders and PDs frequently co-occurred, with the overall pattern of associations being non-specific. The strongest associations were of social phobia with avoidant and schizotypal PD, and of major depression with borderline PD. However, symptom profiles of PDs were not associated with anxiety/mood disorders. Finally, anxiety/mood disorders and PDs were both independently and differentially associated with poor pre-treatment characteristics. CONCLUSION: The findings suggest the clinical importance of obtaining both Axis I and Axis II diagnoses in treated substance abusers, and highlight the distinctiveness of the Axis I and Axis II disorders.