A sequential multiple assignment randomized trial of symptom management for cancer survivors during treatment and their informal caregivers.

CONTEXT: Many cancer survivors and their informal caregivers experience multiple symptoms during the survivor's treatment. OBJECTIVE: Test relative effectiveness and optimal sequencing of two evidence-based interventions for symptom management. METHODS: In this sequential multiple assignment randomized trial (SMART), survivors of solid tumors with elevated depression or anxiety and their caregivers as dyads were initially randomized after baseline assessment in a 3:1 ratio to the Symptom Management and Survivorship Handbook (SMSH, N = 277 dyads) intervention or SMSH plus 8 weeks of telephone interpersonal counseling (TIPC, N = 97 dyads). After 4 weeks, survivors who were not responding (no improvement or worsening score on depression and/or anxiety item) to SMSH only and their caregivers were re-randomized to continue with SMSH alone (N = 44 dyads) to give it more time or to SMSH + TIPC (N = 44 dyads). Mixed effects and generalized linear models compared severity of depression, anxiety, and a summed index of 16 other symptoms over weeks 1-13 and week 17 between randomized groups and among three dynamic treatment regimes (DTRs). Dyads received SMSH only for 12 weeks (DTR1); SMSH for 12 weeks with 8 weeks of TIPC added from week 1 (DTR2); and SMSH for 4 weeks followed by the combined SMSH + TIPC for 8 weeks if no response at 4 weeks (DTR3). RESULTS: Survivors randomized initially to SMSH alone had significantly lower anxiety over weeks 1-13 compared to those randomized to the combined SMSH + TIPC. In comparing DTRs, survivor's anxiety was significantly lower at week 13 for DTR1 compared to DTR2 with no other main effects for survivors or caregivers. Exploratory moderation analyses indicated a potential benefit of adding TIPC for caregivers of non-responders with elevated baseline symptoms. CONCLUSION: SMSH + TIPC did not result in better symptom outcomes at week 17 than SMSH alone. Lower intensity SMSH may improve depression and anxiety symptoms for most survivors and their caregivers. TRIAL REGISTRATION: Clinicaltrails.gov ID number, NCT03743415; approved and posted on 11/16/2018.

Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers.

CONTEXT: Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. OBJECTIVES: Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. METHODS: Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. RESULTS: Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. CONCLUSION: Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.

Social Isolation Mediates the Effects of Negative Emotionality and Resilience on Drinking to Cope and Drinking Alone.

Objective: The purpose of this research was to test an extension of the incentive motivation model of alcohol by examining effects of personality traits on drinking motives and contexts, as mediated by social isolation. Methods: Participants were 1269 adults who resided in the United States (n = 618) or United Kingdom (n = 651) and completed an online questionnaire measuring the traits of negative emotionality and resilience, along with social isolation, drinking motives (coping, social) and drinking contexts (alone, at a party, at a bar/club). Six months later, 70% of the participants returned to complete a similar online questionnaire. Results: Path analysis was used to test the hypothesized models and revealed that negative emotionality had a prospective indirect effect on drinking to cope and drinking alone through increased social isolation over the 6-month period of observation. In contrast, the trait of resilience had a prospective indirect effect on reductions in the drinking to cope motive and reductions in drinking alone, through decreased social isolation. Conclusion: The findings suggest that personality traits that contribute to social isolation may be risk factors for dysfunctional drinking motives and contexts.

Autonomy and overparenting: Are parents of emerging adults being responsive?

Recognizing the various negative consequences of overparenting for the child such as poor mental health and relationship quality and delayed transition to full adulthood, this study examined to what extent parents of emerging adults were being responsive and tailoring their parenting practices to meet their child's characteristics, such as need for autonomy and trait autonomy. Survey data from 256 parent-emerging adult child dyads were used for analyses. The results showed that parent-reported overparenting was not associated with child-reported autonomy features. Nevertheless, parents engaged in lower levels of tangible assistance and higher levels of advice/affect management if they perceived their child as high in autonomy need or trait autonomy. Collectively, these findings suggest that parents might practice overparenting out of their own desires and needs rather than taking into account their child's developmental needs and traits. Practical recommendations for family therapists are offered.

Connected Community Classification (C3): Development, Validation, and Geospatial Application for Population Health Promotion and Equity.

CONTEXT: Social determinants of health (SDOH) impact population health. Leveraging community-level strengths related to SDOH through a social infrastructure perspective can optimize health behaviors and health outcomes to promote health equity. OBJECTIVE: Our aims were to develop, validate, and apply the Connected Community Classification (C3) as comprehensive community-level measure of protective SDOH and structural factors in the Four Corners states region of the United States. DESIGN: C3 was developed using an iterative principal component analysis of publicly available data mapped to 5 SDOH domains. Regional clustering of C3 by zip code tabulation area (ZCTA) was identified using spatial autocorrelation methods. MAIN OUTCOMES: In adjusted spatial autoregressive models, we analyzed the association of C3 with high-risk health behaviors and chronic disease prevalence using publicly available data for population-level estimates of fruit and vegetable intake, physical activity, obesity, smoking, alcohol use, coronary heart disease (CHD), diabetes, and cancer. RESULTS: C3 was found to be reliable and valid; a C3 value of 10 indicates communities with greater connection (high), while a value of 1 indicates communities with greater separation (low) to social infrastructure. Lower connection, as measured by C3, was significantly inversely associated with lower fruit and vegetable intake, lower physical activity, and higher rates of obesity, smoking, CHD, diabetes, and cancer. C3 was significantly positively associated with heavy alcohol use. CONCLUSIONS: These findings demonstrate that communities connected to social infrastructure have better population health outcomes. C3 captures protective community attributes and can be used in future applications to assist health researchers, practitioners, nonprofits, and policymakers to advance social connection and health equity in geographically diverse underserved regions.

Loneliness, Spirituality, and Health-Related Quality of Life in Hispanic English-Speaking Cancer Caregivers: A Qualitative Approach.

Hispanic caregivers experiencing higher caregiving burden than their non-Hispanic cohorts, due in part to contextual factors, such as barriers to accessing health care, challenging employment environments, low education and income, immigration issues, and minority stress. Spirituality may serve as a coping strategy for Hispanic caregivers that influences health-related quality of life (HRQoL), possibly by modifying loneliness associated with caregiving. We explored these concepts using semi-structured interviews (N = 10 Hispanic caregivers). Participants shared perceptions of loneliness, spirituality, and how these factors related to HRQoL. Five themes emerged: caregiver experience, coping strategies, loneliness, religion and spirituality to gain strength. Findings suggested that spirituality and religion improved HRQoL partially by reducing loneliness. Future programs to improve HRQoL in Hispanic English-speaking cancer caregivers should address spirituality.

Social Determinants of Health and Symptom Burden During Cancer Treatment.

BACKGROUND: Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety). OBJECTIVES: The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors. METHODS: This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies-Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic. RESULTS: Non-Hispanic White survivors ( n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors ( n = 168) and non-Hispanic survivors of other races ( n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races. DISCUSSION: These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.

Exploring the Role of Marianismo and Loneliness in Latinas' Physical and Mental Well-Being.

The goal of this study is to better understand the role of social relationships and traditional gender norms in Latina health. Utilizing Hawkley and Cacioppo's theoretical model of loneliness and health as a framework, loneliness is proposed as a key component in the relationship between the Latina gender norm of marianismo and health. Participants were 178 female adults who identified as Latina (N = 97) or non-Latina White (N = 81), ranging in age from 19-88, who completed measures of loneliness, marianismo, depression, overall health, and health practices. Results indicate that being Latina was associated with family pillar marianismo, which includes characteristics centered on women's roles as the core of the family, that was associated with lower loneliness, and lower loneliness was subsequently associated with better overall health, lower depression, and beneficial health practices. However, being Latina had no association with silencing self to maintain harmony marianismo, that in turn had no association with loneliness, or health outcomes. These results suggest that elements of marianismo can play a protective role in Latina health and well-being, particularly when Latinas endorse the positive aspects of the gender norm that place women at the center of their families. Results also help explain the Latino health paradox by providing more specificity in the links between Latina ethnicity and positive health outcomes.

Parent-Child Relationships and the Health of Incarcerated Mothers: Exploring the Mediating Role of Loneliness.

The current study utilizes Hawkley, Cacioppo, and colleagues' model of loneliness and health to examine the influence of parent-child relationships on the health of incarcerated women. Participants were 121 incarcerated female adults who have at least one child, and who completed a questionnaire with measures of parental involvement, parent-child closeness, loneliness, overall health, physical functioning, depression, and anxiety. Results reveal that among incarcerated women, perceptions of close and involved relationships with their children were associated with less loneliness, and less loneliness was associated with better overall health and physical functioning, as well as lower depression and anxiety. Findings highlight the importance of including loneliness in studies that examine the impact of parent-child relationships on health, especially for this vulnerable population, and suggest that it is worthwhile to engage in efforts to help incarcerated women maintain close and involved relationships with their children through high-quality communication.

When goodbyes matter: The conditional relationship between final conversations and symptoms of depression.

An online survey of 528 people who lost someone close to them in the last 5 years was used to test associations between having final conversations (FCs) and depression. The direct effect was nonsignificant, but there were two significant moderation effects. Time since bereavement moderated the FC-depression relationship; there was a negative relationship between FCs and depression shortly following bereavement, but no relationship after more time had passed. The age of the deceased also moderated this relationship; there was a negative relationship between FCs and depression when the deceased was older, but no relationship when the deceased was younger.

Social determinants of health, psychological distress, and caregiver burden among informal cancer caregivers of cancer survivors during treatment.

OBJECTIVE: This study compared three ethnic/racial groups of informal cancer caregivers on social determinants of health and tested social determinants of health as predictors of psychological distress and caregiver burden. METHODS: This study was a secondary analysis of baseline data of a sequential multiple assignment randomized trial (SMART) testing symptom management interventions with caregiver-survivor dyads. Caregivers completed baseline measures of social determinants of health (SDoH), functional limitations, psychological distress, and caregiver burden. Hispanic, non-Hispanic White, and non-Hispanic other races caregivers were compared on these variables. Multivariate tests of associations between SDoH and caregiver burden and psychological distress were conducted in structural equation modeling with caregiver burden and psychological distress as latent variables. RESULTS: Hispanic caregivers reported significantly higher caregiver burden, specifically for finances, family, and schedules. Caregiver burden was significantly predicted by having income barely or not meeting needs, being female, socially isolated, married, Hispanic, and having poor physical functioning. Significant predictors of caregivers' psychological distress: being female, being socially isolated, and having poor physical functioning. CONCLUSION: Hispanic caregivers experience significant challenges associated with caregiver burden, especially if they are female, socially isolated, and have poor physical functioning. Assessment of these SDoH is important in caregiver health to provide supportive care during caregiving. CLINICAL TRIAL REGISTRATION NUMBER: NCT03743415 www.clinicaltrials.gov.

Depression among Underserved Rural and Urban Caregivers of Latinas with Breast Cancer.

Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.

Exploring the relationship between loneliness, spirituality, and health-related quality of life in Hispanic cancer caregivers.

Caregivers of cancer patients find it challenging to perform their roles and to meet the demands of caregiving. Spirituality has been investigated as a potential coping strategy employed by caregivers, yet spirituality and related practices vary among cultural groups. In this study, we investigated the relationship between spirituality and health-related quality of life (HRQOL) and evaluated mediation effects of loneliness on this relationship. The sample was 234 lower socioeconomic status (SES) Hispanic caregivers of breast cancer survivors using existing data from the Support for Latinas with Breast Cancer and Their Intimate and Family Partners study, funded by the American Cancer Society (Badger, PI). A cross-sectional analysis was conducted at baseline, using self-reported spirituality, loneliness, and HRQOL data collected from 2012 to 2017. The exposures and outcomes were assessed using the Spiritual Well-Being Scale, the Social Isolation-Short Form 8a PROMIS Item Bank v2.0 scale, and the Global Health Scale PROMIS v.1.0/1.1 scale. Descriptive and mediation analyses using the Preacher and Hayes' approach were conducted to estimate the direct effect of spirituality on HRQOL and the indirect effect of spirituality through mediation of loneliness in relation to HRQOL. A positive association between spirituality and HRQOL was found, whereas loneliness was inversely associated with HRQOL (b = - .18, SE = .03, p < .0001). Age did not function as a moderator of the spirituality-HRQOL association in any of the models tested, but in the model testing mediation, loneliness was shown to mediate the association between spirituality and HRQOL (b = - .17, p < .0001). These results suggest that spirituality may be beneficial to HRQOL in caregivers of Hispanic breast cancer survivors, due in part to reduced loneliness among more spiritual caregivers.

Use of scheduled and unscheduled health services by cancer survivors and their caregivers.

PURPOSE: The purpose was to determine predictors of scheduled and unscheduled health services use by cancer survivors undergoing treatment and their informal caregivers. METHODS: English- or Spanish-speaking adult cancer survivors undergoing chemotherapy or targeted therapy for a solid tumor cancer identified a caregiver (N = 380 dyads). Health services use over 2 months was self-reported by survivors and caregivers. Logistic regression models were used to relate the likelihood of service use (hospitalizations, emergency department [ED] or urgent care visits, primary care, specialty care) to social determinants of health (age, sex, ethnicity, level of education, availability of health insurance), and number of comorbid conditions. Co-habitation with the other member of the dyad and other member's health services use were considered as additional explanatory variables. RESULTS: Number of comorbid conditions was predictive of the likelihood of scheduled health services use, both primary care and specialty care among caregivers, and primary care among survivors. Greater probability of specialty care use was associated with a higher level of education among survivors. Younger age and availability of health insurance were associated with greater unscheduled health services use (hospitalizations among survivors and urgent care or ED visits among caregivers). Unscheduled health services use of one member of the dyad was predictive of use by the other. CONCLUSIONS: These findings inform efforts to optimize health care use by encouraging greater use of scheduled and less use of unscheduled health services. These educational efforts need to be directed especially at younger survivors and caregivers.

Family Connections and the Latino Health Paradox: Exploring the Mediating Role of Loneliness in the Relationships Between the Latina/o Cultural Value of Familism and Health.

This study aims to understand Latina/o health from a social relationships perspective. Specifically, a major goal of the study is to explain how despite disadvantages (e.g., lower income and less education), Latinas/os in some cases have superior health compared to non-Latina/o whites, a phenomenon known as the Latino Health Paradox. Based on the central role of familial relationships in Latina/o culture, and utilizing Hawkley and Cacioppo's theoretical model of loneliness and health as a foundation for the study, the premise underlying this research is that the Latina/o cultural value of familism has a beneficial impact on health via reduced loneliness. Participants were 255 adults who identified as Latina/o (N = 139) or non-Latina/o white (N = 116), ranging in age from 19-88. Results indicate that being Latina/o predicted strong endorsement of familism, that predicted lower loneliness, and lower loneliness subsequently predicted better overall health, mental health, and health practices. These results suggest that the cultural value of familism provides health-related benefits for Latinas/os, which contributes to understanding the Latino health paradox. Results also underscore the value of including loneliness in studies examining the impact of cultural values on health, as only loneliness had statistically significant direct associations with all three health outcomes.

Neighborhood Disadvantage and Mental Health: Test of a Parallel Mediation Model through Social Support and Negative Emotionality.

According to the life stress model, stressful circumstances occur in the context of social, psychological, and environmental features that can function as either resources or aggravating factors, each of which are associated with well-being. This research was designed to test indirect effects of living in disadvantaged neighborhoods on mental health, through reduced social support and increased negative emotionality. This model was tested with data from a national sample of 1050 adults residing in the United States. Participants completed measures of social support, negative emotionality, depression, loneliness, stress, and alcohol consumption. These scores were merged with data from the 2015 American Community Survey to assess indicators of neighborhood disadvantage at the zip code level. The test of a parallel mediation model with structural equation modeling indicated that neighborhood disadvantage did not have direct effects on either psychological distress or alcohol consumption. However, neighborhood disadvantage was associated with greater negative emotionality, and through negative emotionality, exhibited indirect effects on psychological distress and alcohol consumption. These results are consistent with elements of the life stress model that specify various psychosocial traits as maladaptive in the context of stressful environments.

Supportive health education reduces health care utilization and costs in Latinas with breast cancer and their caregivers.

PURPOSE: To compare costs and relative cost savings from reductions in unscheduled health services use for two 8-week psychosocial interventions (telephone interpersonal counseling [TIPC], supportive health education [SHE]) delivered by telephone to Latinas with breast cancer and their informal caregivers. Cost information is required before adopting supportive care interventions as part of routine care. There is limited information on costs of producing supportive care interventions or their impact on service use. METHODS: Latinas and their caregivers were randomized to either TIPC or SHE. At baseline and month 4, hospitalizations and urgent care and emergency department (ED) visits in the previous month were recorded. These were compared by trial arm for 181 survivors and 169 caregivers using logistic regression, adjusting for age and health services use at baseline. RESULTS: Total cost per 100 survivors was $28,695 for SHE and $27,399 for TIPC. Urgent care and ED visits were reduced for survivors in SHE versus TIPC (odds ratio (OR) = 0.31, 95% confidence interval (CI) [0.12, 0.88], p = .03). For hospitalizations, OR for SHE versus TIPC was 0.59, 95% CI [0.26, 1.37], p = .07. There were no differences between trial arms for caregiver health services use. Cost savings for SHE versus TIPC from reductions in health services use per 100 survivors ranged from $800 for urgent care to $17,000 for ED visits and $13,000 for hospitalizations. CONCLUSIONS: Based on this evidence, SHE can be a cost-saving supportive care solution that benefits not only survivors and caregivers, but also oncology practices reimbursed through episodes of care.

Social support and healthcare utilization of caregivers of Latinas with breast cancer.

BACKGROUND: Family caregivers experience significant health consequences related to caregiving, including higher mortality rates. Latino caregivers may have additional challenges related to social determinants of health. Gender and social support are key factors to consider in the context of chronic illnesses and healthcare use in caregivers of Latinos diagnosed with cancer. PURPOSE: The purpose of this study was to examine the moderating effect of gender and social support on the relationship between chronic illnesses and healthcare utilization in caregivers of Latina breast cancer survivors. METHODS: This was a secondary analysis of family caregivers from an experimental study with breast cancer survivors and their designated family caregivers. Participants completed telephone surveys about demographics, presence of chronic illnesses, frequency of emergency department, urgent care, and hospital visits, social support, and acculturation. Data were analyzed for direct and moderated relationships. RESULTS: There was a significant relationship between number of chronic illnesses and healthcare utilization, informational support, and social isolation. Income and acculturation were not related to chronic illnesses or healthcare utilization. Gender did not moderate the relationship between chronic illnesses and healthcare utilization. Informational support was a marginal moderator of the relationship between chronic illnesses and healthcare utilization alone and with acculturation and income included as covariates. CONCLUSIONS: Clinicians should consider the influence of informational support and social isolation on chronic illnesses and healthcare use in caregivers of Latina breast cancer survivors, specifically, how these factors may influence navigation of the healthcare system.

Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis.

Problem identification: Loneliness is common after cancer, contributing to poor outcomes. Interventions to modify loneliness are needed. This systematic review describes the current literature regarding loneliness interventions in cancer survivors.Literature search: Databases including: Ovid/MEDLINE; The Cochrane Central Register of Controlled Trials (CENTRAL); Elsevier/Embase; Clarivate/Web of Science (Core Collection), EBSCO/PsycINFO, EBSCO/CINAHL were used to perform a systematic review of literature using PRISMA guidelines. Second, risk of bias, meta-analysis and a narrative synthesis approach was completed to synthesize findings from multiple studies.Data evaluation/synthesis: Six thousand five hundred three studies were initially evaluated; eight studies met inclusion criteria. Findings indicate a paucity of interventions, generally of lower quality. Interventions were feasible and acceptable; those interventions with cultural modifications were more likely to demonstrate effectiveness.Conclusions: There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted.Implications for psychosocial oncology: Current studies suggest the psychosocial symptom of loneliness is modifiable among adult cancer survivors. Few interventions have been tested and shown to be effectiveness in cancer survivors in the U.S. and none have been tailored for older adult survivors, by patient gender/sex and few for specific race/ethnic groups. Results from this systematic review: a narrative synthesis and meta-analysis can inform future interventions targeting loneliness in this growing, yet vulnerable, adult cancer survivor population.

Longitudinal effects of U.S. students' reentry shock on psychological health after returning home during the COVID-19 global pandemic.

Guided by the stress process model (Pearlin, Mullan, Semple, & Skaff, 1990; Pearlin, 1999), the purpose of this longitudinal investigation was to examine the extent to which the stressor of premature forced reentry from studying abroad during the COVID-19 pandemic (e.g., reentry shock, reacculturative stress) was predictive of stress-related compromised mental health (i.e., perceived stress and loneliness) into the subsequent academic year. A total of 133 college students from different U.S. universities completed a short online questionnaire as soon as they came back from their study abroad experience (T1) and approximately six months after (T2), when they were resuming their Fall 2020 academic semester. Consistent with the stress process model, secondary stressors associated with reacculturation were predictive, concurrently and longitudinally, of mental health outcomes, especially loneliness, indicating that students who had the hardest time returning home unexpectedly were at the highest risk for worsened mental health over the following months. These findings reveal that reacculturation following unplanned termination of a study abroad experience is not an event as much as it is a process that unfolds over a period of months, as would be understood from the perspective of the stress process model.