Search

Spousal bereavement is associated with elevated risk of morbidity and mortality. Several well-regarded multidisciplinary research teams have investigated the biopsychosocial processes underlying why widows and widowers are at elevated physical-health risk. Here, we review research from multiple investigators showing that, on average, widows and widowers exhibit maladaptive patterns of autonomic, neuroendocrine, and immune activity compared with matched comparison subjects. Widows and widowers also exhibit poorer health behaviors than they did before their spouse's death, and the considerable variation in postloss psychological-adjustment trajectories among widows and widowers likely corresponds to physical-health risk trajectories. Yet there is little biobehavioral research on patterns of change in physical-health risk after the death of a spouse. We summarize recently published work demonstrating how attachment theory can characterize and predict individual differences in physical-health biomarkers, highlighting the need for a biopsychosocial approach to understanding and characterizing postloss trajectory patterns. We conclude by discussing the possibility that this line of inquiry could help researchers, and ultimately providers, identify adjustment trajectories earlier and thus deliver appropriate interventions when they are most needed. [ABSTRACT FROM AUTHOR]

Background: Low childhood socioeconomic status (SES) is reliably associated with poor adult health. Social environments early in life and physiological stress responses are theorized to underlie this link; however, the role of attachment orientations is relatively unknown.Purpose: In this study, we examined whether attachment orientations (i.e., attachment anxiety and attachment avoidance) and self-reported stress were mediators of the association between childhood SES and self-reported health in adulthood. Furthermore, we examined whether parasympathetic nervous system functioning was a moderator of associations between attachment orientations and self-reported stress.Methods: Participants (N = 213) provided self-reports of childhood SES, attachment orientations, general stress, and self-rated health. Respiratory sinus arrhythmia (RSA) was measured at rest, as well as during an acute social stressor.Results: Low childhood SES was associated with poor self-reported health via the serial pathway from attachment anxiety to general stress. Moreover, attachment avoidance was associated with self-reported health via general stress, but only among those with high stress-induced RSA. Findings were independent of participant age, sex, race, body mass index, baseline RSA, and adult SES.Conclusions: Attachment theory is useful for understanding why those from low SES backgrounds are at greater risk of negative health outcomes in adulthood. Findings extend our knowledge of how interpersonal relationships in childhood can shape emotional and physical health outcomes in adulthood. [ABSTRACT FROM AUTHOR]

Highlights • Inflammatory markers can distinguish bereaved spouses higher on grief severity compared with bereaved spouses with lower grief severity. • Even in a population high on depressive symptoms, there is a positive relationship between depression and inflammation. • Similar to the general population, inflammation is an important marker of elevated levels of depression among bereaved spouses. Abstract Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation. [ABSTRACT FROM AUTHOR]

The loss of a spouse is a highly stressful event that puts people at excess risk of mortality. Excess mortality among those who are widowed is highest in the first six months after the death of a spouse and decreases over time. Heart disease accounts for the largest proportion of these deaths. The psychological stress associated with stressful life events can enhance inflammation and lower heart rate variability (HRV). Both lower HRV and higher inflammation are risk factors for cardiovascular morbidity and mortality. Thirty-two recently bereaved individuals (Mean = 89.68 days since death, SD = 17.09) and 33 age-matched comparisons completed a blood draw, EKG, and self-report questionnaires. In both adjusted and unadjusted models, spousal bereavement was associated with enhanced pro-inflammatory cytokine production by in vitro lipolysaccharide-stimulated peripheral blood leukocytes. Moreover, spousal bereavement was associated with lower HRV in comparison to the comparison group. This study is the first to demonstrate that bereavement is associated with a more pronounced ex vivo cytokine production and lower HRV in a population that exclusively consisted of widows and widowers. These findings add to the growing literature revealing the mechanisms that underlie bereavement-related cardiovascular problems. Future longitudinal studies are needed to determine the temporal relation between these risks. Understanding the biological mechanisms that underlie this stressful life event could allow researchers to create therapeutic targets for interventions to reduce or prevent the toll of a “broken heart.” [ABSTRACT FROM AUTHOR]

Cancer research within the fields of psychoneuroendocrinology and psychoneuroimmunology has made substantial progress in understanding how psychological factors impact cancer. Although the pathways by which stress “gets under the skin” to impact cancer incidence, progression, and quality of life are not yet fully understood, the answers to key questions about how stressful life events and the negative emotions they generate can impact cancer initiation, progression, and survivorship have advanced quite dramatically. In this review, we summarize the state of the science in a way that is accessible to a broad audience. We then discuss future directions in cancer research, with a focus on ways psychological science can contribute to the next generation of cancer care. [ABSTRACT FROM AUTHOR]

Self-rated health (SRH) is a reliable predictor of health outcomes including morbidity and mortality. Immune dysregulation is one hypothesized mechanism underlying the association between SRH and health outcomes. Indeed, poorer SRH is associated with greater inflammation. The association between SRH and reactivation of latent herpesviruses is unknown, representing an important gap in the literature given that reactivation of latent herpesviruses leads to enhanced inflammation. The present study addressed this important gap in the literature by examining associations between SRH, inflammation (i.e., peripheral cytokines in the blood), and reactivation of latent herpesviruses among a sample of 1208 individuals participating in the Texas City Stress and Health Study. Participants completed a self-report measure of SRH and a blood draw. Results indicated that higher SRH was associated with lower reactivation of latent herpesviruses and inflammation. Moreover, reactivation of latent herpesviruses partially mediated the association between SRH and inflammation. Accordingly, findings add to our growing understanding of the association between SRH and immune dysfunction. [ABSTRACT FROM AUTHOR]

Being diagnosed and treated for breast cancer is emotionally and physically challenging. Breast cancer is the most commonly diagnosed cancer and the second leading cause of death for women in the United States. Accordingly, women with a breast cancer history are the largest group of female cancer survivors. Psychological stress substantially augments adverse autonomic, endocrine, and immune discharge, including enhanced production of proinflammatory cytokines. Importantly, inflammation is a key biological mechanism underlying the symptom cluster of pain, depression, fatigue, and sleep disturbances; there is also good evidence that inflammation contributes to breast cancer recurrence. Stress may exert direct effects on psychological and physiological risk processes. In this review, we take a biobehavioral approach to understanding predictors and mechanisms underlying somatic symptoms in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Childhood maltreatment increases the risk of depression, especially after experiencing a stressful life event, such as bereavement. Employing emotion regulation strategies can mitigate the impact childhood maltreatment has on depression later in life following the loss of a spouse. We evaluated how cognitive reappraisal and expressive suppression moderated the impact of childhood maltreatment and depressive symptoms following spousal bereavement. We examined 130 bereaved individuals 3 months after the death of a spouse, 4 months after the death of a spouse, and 6 months after the death of a spouse. We utilized a mixed model approach to test the interaction between childhood maltreatment and cognitive reappraisal and between childhood maltreatment and expressive suppression to predict depressive symptoms across 3 time points. Cognitive reappraisal moderated the relationship between childhood maltreatment and depressive symptoms (b = − 0.17, p =.003); expressive suppression did not (b = 0.06, p =.452). Participants who used less cognitive reappraisal had a positive relationship between childhood maltreatment and depressive symptoms (b = 3.27, p <.001);participants who used more cognitive reappraisal did not (b = 1.09, p =.065). Childhood maltreatment interacted with cognitive reappraisal, but not expressive suppression, to predict depressive symptoms following spousal bereavement. This study reveals how emotion regulation strategies can be utilized as a tool to buffer the impact of childhood maltreatment on mental health following a stressor later in life, which can serve as a target for future interventions for individuals experiencing a stressful life event. [ABSTRACT FROM AUTHOR]

Loneliness is strongly linked to poor health. Recent research suggests that appetite dysregulation provides one potential pathway through which loneliness and other forms of social disconnection influence health. Obesity may alter the link between loneliness and appetite-relevant hormones, one unexplored possibility. We examined the relationships between loneliness and both postmeal ghrelin and hunger, and tested whether these links differed for people with a higher versus lower body mass index (BMI; kg/m 2 ). During this double-blind randomized crossover study, women ( N = 42) ate a high saturated fat meal at the beginning of one full-day visit and a high oleic sunflower oil meal at the beginning of the other. Loneliness was assessed once with a commonly used loneliness questionnaire. Ghrelin was sampled before the meal and postmeal at 2 and 7 h. Self-reported hunger was measured before the meal, immediately postmeal, and then 2, 4, and 7 h later. Lonelier women had larger postprandial ghrelin and hunger increases compared with less lonely women, but only among participants with a lower BMI. Loneliness and postprandial ghrelin and hunger were unrelated among participants with a higher BMI. These effects were consistent across both meals. These data suggest that ghrelin, an important appetite-regulation hormone, and hunger may link loneliness to weight gain and its corresponding negative health effects among non-obese people. [ABSTRACT FROM AUTHOR]

Attachment theory provides a framework for understanding individual differences in chronic interpersonal stress. Attachment anxiety, a type of relationship insecurity characterized by worry about rejection and abandonment, is a chronic interpersonal stressor. Stress impacts cellular immunity, including herpesvirus reactivation. We investigated whether attachment anxiety was related to the expression of a latent herpesvirus, Epstein–Barr virus (EBV), when individuals were being tested for breast or colon cancer and approximately 1 year later. Participants ( N = 183) completed a standard attachment questionnaire and provided blood to assess EBV viral capsid antigen (VCA) IgG antibody titers. Individuals with more attachment anxiety had higher EBV VCA IgG antibody titers than those with less attachment anxiety. The strength of the association between attachment anxiety and antibody titers was the same at both assessments. This study is the first to show an association between latent herpesvirus reactivation and attachment anxiety. Because elevated herpesvirus antibody titers reflect poorer cellular immune system control over the latent virus, these data suggest that high attachment anxiety is associated with cellular immune dysregulation. [ABSTRACT FROM AUTHOR]

The origins of modern psychology are deeply rooted in the notion that stressful early-life experiences negatively impact people’s mental health. Emerging work in the field of health psychology suggests that early-life stress also impacts physical well-being. Indeed, those who experienced severe early-life stress as children are more at risk for cardiovascular disease, type 2 diabetes, and cancer compared with those who did not have those early-life experiences. Recent work in the field of psychoneuroimmunology suggests that inflammation may be one mechanism underlying these associations. In this article, we provide a brief overview of the literature on early-life stress and inflammation and how psychological, autonomic, neuroendocrine, and epigenetic responses to the early environment lead to potentiated inflammation in adulthood. We conclude by highlighting the need for health-promotion and disease-prevention programs that are designed to reduce the frequency and severity of early-life stress. [ABSTRACT FROM PUBLISHER]

Objective Breast cancer is the most frequent malignant tumor among women in the industrialized world. The vast majority of these tumors can now be successfully treated. A subset of breast cancer survivors report quality of life (QOL) difficulties well after treatment is completed. The current study examined how individual differences in attachment style and self-regulatory capacity (as indexed by respiratory sinus arrhythmia (RSA)) were associated QOL among post-treatment breast cancer survivors. Methods Women who had completed treatment for stage 0-IIIA breast cancer within the past 2 years participated in the study ( N = 96). RSA was assessed using electrocardiography data that was continuously measured non-invasively for 10 min. Attachment orientation was measured using a modified version of the Experiences in Close Relationships Scale and overall QOL by the Functional Assessment of Cancer Therapy-Breast scale. Results Breast cancer survivors with more attachment anxiety reported poorer QOL than those with less attachment anxiety. Women who were more avoidantly attached also reported poorer QOL compared with those who were less avoidantly attached. Furthermore, attachment avoidance interacted with RSA to predict QOL such that those with higher attachment avoidance were only vulnerable to poorer QOL if they also had lower self-regulatory capacity, as indexed by lower RSA. Conclusion A better understanding of how attachment style and RSA contribute to breast cancer survivors QOL will help identify people at risk for QOL problems after treatment completion. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary: Growing evidence suggests that lower subjective social status (SSS), which reflects where a person positions himself on a social ladder in relation to others, is independently related to poor health. People who rate themselves lower in status also experience more frequent stressors and report higher stress than those who rate themselves higher in status, and chronic stress can enhance an individual's response to subsequent stressors. To address whether SSS predicted stress-induced interleukin-6 (IL-6) changes, we assessed 138 healthy adults at rest and following the Trier Social Stress Test (TSST). Participants completed the TSST at two study visits, separated by 4 months. People who placed themselves lower on the social ladder had larger IL-6 responses from baseline to 45min post-stressor (p =0.01) and from baseline to 2h post-stressor (p =0.03) than those who placed themselves higher on the social ladder. Based on a ratio of subjective threat and coping ratings of the stress task, participants who viewed themselves as lower in status also tended to rate the speech task as more threatening and less manageable than those who viewed themselves as higher in status (p =0.05). These data suggest that people with lower perceived status experience greater physiological and psychological burden from brief stressors compared to those with higher perceived status. Accordingly, responses to stressors may be a possible mechanistic link among SSS, stress, and health. [Copyright &y& Elsevier]

Summary: Objective: The pain, depression, and fatigue symptom cluster is an important health concern. Loneliness is a common risk factor for these symptoms. Little is known about the physiological mechanisms linking loneliness to the symptom cluster; immune dysregulation is a promising candidate. Latent herpesvirus reactivation, which is reflected by elevated herpesvirus antibody titers, provides a window into immune dysregulation. Cytomegalovirus (CMV) and Epstein–Barr virus (EBV) are two common herpesviruses. Methods: Participants were 200 breast cancer survivors who were 2 months to 3 years post-treatment at the time of the study. They completed questionnaires and provided a blood sample that was assayed for CMV and EBV antibody titers. Results: Lonelier participants experienced more pain, depression, and fatigue than those who felt more socially connected. Lonelier participants also had higher CMV antibody titers which, in turn, were associated with higher levels of the pain, depression, and fatigue symptom cluster. Contrary to expectations, EBV antibody titers were not associated with either loneliness or the symptom cluster. Conclusions: The pain, depression, and fatigue symptom cluster is a notable clinical problem, especially among cancer survivors. Accordingly, understanding the risk factors for these symptoms is important. The current study suggests that loneliness enhances risk for immune dysregulation and the pain, depression, and fatigue symptom cluster. The present data also provide a glimpse into the pathways through which loneliness may impact health. [ABSTRACT FROM AUTHOR]

Objective A cancer diagnosis provokes significant levels of emotional distress, with intrusive thoughts being the most common manifestation among breast cancer survivors. Cancer-related intrusive thoughts can take the form of emotional memories, flashbacks, nightmares, and intrusive images. Emotional arousal after a severe life stressor prolongs adrenergic activation, which in turn may increase risk for post-traumatic symptomatology. However, antihypertensive beta-blockers block adrenergic activation and are known to reduce traumatic memories and related psychological distress. Thus, the current study examined the association between beta-blocker use and the severity of cancer-related intrusive thoughts and related symptoms following a cancer diagnosis. Methods The 174 breast and 36 female colorectal cancer patients who had recently undergone diagnostic screening or biopsy included 39 beta-blocker users and 171 non-users. Prior to any cancer treatment including surgery, participants completed questionnaires that included the Impact of Events Scale and the Center for Epidemiological Studies Depression Scale. Analyses controlled for age, education, cancer stage, cancer type, days since diagnosis, marital status, depression, and comorbidities. Results Although the high rates of cancer-related distress in this sample were similar to those of other studies with recently diagnosed patients, beta-blocker users endorsed 32% fewer cancer-related intrusive thoughts than non-users. Conclusions Recently diagnosed cancer patients using beta-blockers reported less cancer-related psychological distress. These results suggest that beta-blocker use may benefit cancer patients' psychological adjustment following diagnosis, and provide a promising direction for future investigations on the pharmacological benefits of beta-blockers for cancer-related distress. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-α) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1β) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-α in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health. [ABSTRACT FROM PUBLISHER]

Abstract: Depression is a risk factor for morbidity and mortality, and immune dysregulation may be partially responsible for this link. Proinflammatory cytokines such as interleukin 6 (IL-6) are reliable predictors of quality of life, morbidity, and many causes of mortality. The current study evaluated relationships between depressive symptoms, as assessed by the CES-D, and stress-induced inflammation. The participants, 138 healthy adults, were evaluated at rest, and after a standardized laboratory speech and mental arithmetic stressor. Compared with individuals with fewer depressive symptoms, those with more depressive symptoms produced more IL-6 in response to the stressor, as well as significantly higher levels of IL-6 both 45min and 2h after the stressor. These findings add to our emerging understanding of the complex interactions among stress, depression, and immune dysregulation, and provide one potential pathway to explain relationships between depressive symptoms and disease. [Copyright &y& Elsevier]

Abstract: There is considerable evidence that stressful early life events influence a variety of physical health problems later in life. Childhood adversity has been linked to elevated rates of morbidity and mortality from a number of chronic diseases. Immune dysregulation may be one potential pathway that explains this link. In this mini-review, we summarize human studies demonstrating that severe early life stressors have lasting immune consequences. We propose a model outlining potential biobehavioral pathways that explain how early life stressors leave people vulnerable to these maladaptive outcomes. Finally, we suggest ideas for future work to test different aspects of this model. [Copyright &y& Elsevier]

The current study outlined the timing of romantic attachment formation and its implications for relationship stability. People came to prefer their romantic partners for proximity and as a safe haven roughly 4 months after commitment; it took over 2 years to prefer them as their primary secure base. More anxiously attached people preferred their partner for proximity earlier than less anxiously attached people; more avoidantly attached people reported less preference for their romantic partner for all attachment components at the time of initial commitment compared to less avoidantly attached people. Those who more quickly represented their romantic partner as a secure base were less likely to subsequently break up; accordingly, normative attachment development may be prognostic for relationship stability. [ABSTRACT FROM AUTHOR]

Normal aging is marked by dysregulated immune function or immunosenescence. However, there is considerable variation in the degree to which adults are susceptible or resilient to immune dysregulation and disease. Stress is an important factor that can further alter the aging immune system. In this chapter, we review research that shows how stress can enhance age-related immune dysregulation in a variety of clinically relevant ways. We then explore what factors promote resilience to the negative immunological consequences of stress and aging. Finally, we take a lifespan perspective to examine evidence to suggest that some of the most important factors that augment or assuage an older adult's capacity for resilience to age and stress-related immune dysregulation develop long before he or she reaches older adulthood. [ABSTRACT FROM AUTHOR]

The present study tested whether individual differences in autonomie nervous system functioning interact with environmental risk factors to predict adolescents' psychosocial functioning. The authors assessed skin conductance and respiratory sinus arrhythmia at rest and during laboratory Stressors in 110 14-year-olds. Subsequently, adolescents and their mothers provided both questionnaire and daily diary data (over 10 days) on emotional and interpersonal functioning. The authors found stronger associations between environmental risk factors (having a single-mother household or a mother with high internalizing problems) and psychosocial outcomes (externalizing problems, daily negative affect, and daily interaction quality) among youths with specific patterns of tonic and stress-induced sympathetic and parasympathetic nervous system activity, but the pattern of moderating effects differed between boys and girls. The findings support the notion that individual differences in autonomie functioning index variation in youth's susceptibility to environmental risk factors. [ABSTRACT FROM AUTHOR]

In the present study we examined how husbands' and wives' intrusive thoughts of prostate cancer (i.e., thinking about it when not meaning to) and avoidance (i.e., efforts to not think about cancer) related to their own and each other's average negative affect over a subsequent 14-day period. We examined whether congruence or similarity in intrusion about illness, but not avoidance, would be associated with less negative affect as this response to cancer could potentially facilitate adjustment. Fifty-nine husbands and wives completed measures of intrusion and avoidance after the diagnosis of prostate cancer and reported on their daily negative affect for 14 days. Using the actor-partner interdependence model, both patients and their wives who had high levels of intrusive thoughts experienced less negative affect when the other member of the couple also experienced high levels of intrusive thoughts. Those who had higher levels of avoidance had spouses who had higher levels of negative affect regardless of their own levels of avoidance. Congruence in responses to cancer may be adaptive for intrusion but not avoidance because the use of intrusive thoughts by both husbands and wives can allow couples to process the diagnosis of cancer, facilitating psychological adjustment, whereas avoidance does not. The current investigation adds to our understanding of how people within a marital dyad affect each other as they adjust to a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To identify how child maltreatment is associated with quality of life (QOL) among breast cancer survivors. Patients and methods: One hundred and thirty two women who had completed treatment for stage 0-IIIA breast cancer within the past 2years (except for tamoxifen/aromatase inhibitors) and were at least 2months post surgery, radiation, or chemotherapy completed questionnaires including the Childhood Trauma Questionnaire, the Impact of Events Scale, the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) and the Fact-B breast cancer quality of life questionnaire. Results: Women who were abused or neglected as children reported more cancer-related psychological distress, more fatigue and poorer physical, emotional, functional and breast cancer-specific well-being after treatment. These relations were partially explained by the fact that breast cancer survivors reported receiving less support as adults. Conclusion: The findings suggest that child maltreatment is an important predictor of QOL among breast cancer survivors. One reason why this association exists is because those who are maltreated as children report less support as adults. A better understanding of how child maltreatment contributes to breast cancer survivor QOL will help in tailoring and, therefore, enhancing the efficacy of interventions aimed at improving QOL. [Copyright &y& Elsevier]

We tested associations among empathic responsiveness, attachment style, and vagal tone (a physiologic index of emotion regulation) in 103 mother-adolescent dyads. Dyads discussed positive and negative topics and then separately reviewed a videotape of the interaction and rated their own and the other person's affect at one-minute intervals. We used multilevel modeling to analyze the association between one's rating of the other person's affect and the other person's affect (empathic sensitivity), and the association between one's rating of the other person's affect and one's own affect (perceived concordance). Adolescents' empathic responsiveness was predicted by attachment style, vagal tone, and interactions between them. Adolescents with the greatest empathic responsiveness had low levels of attachment insecurity and high levels of vagal tone. [ABSTRACT FROM AUTHOR]

Abstract: Fatigue is a notable clinical problem in cancer survivors, and understanding its pathophysiology is important. The current study sought to determine biomarkers of fatigue that exist before cancer treatment. Relationships between the expression of latent Epstein–Barr virus (EBV) and cytomegalovirus (CMV) and fatigue were examined in 158 women newly diagnosed with breast cancer or awaiting a positive diagnostic result. Higher CMV antibody titers, but not EBV antibody titers, were associated with a greater likelihood of being fatigued. Associations between fatigue and higher CMV antibody titers remained after controlling for alcohol use, smoking, comorbidities, depressive symptoms, age, BMI, cancer stage, and sleep problems. More sleep problems and higher levels of depressive symptoms were also associated with a greater likelihood of being fatigued. CMV antibody titers, but not EBV antibody titers, were associated with higher levels of C-reactive protein (CRP), but CRP was not associated with fatigue. When the cellular immune system is compromised, reactivation of latent herpesviruses may fuel chronic inflammatory responses. Prior work has suggested that fatigue may be related to inflammation and its associated sickness behaviors; accordingly, our findings may be tapping into this same physiological substrate. [Copyright &y& Elsevier]

This study used an attachment theoretical framework to identify factors that contribute to postbreakup emotional adjustment. Individuals who recently experienced a breakup were examined twice over a 1-month period. Greater desire to utilize an ex-partner as an attachment figure predicted less emotional adjustment. Higher levels of attachment anxiety were associated with less emotional adjustment immediately after the breakup. People who reflected more about the breakup exhibited less emotional adjustment immediately after the breakup compared to people who reflected less, and also less emotional adjustment over the ensuing month if they also reported more attachment anxiety. The article highlights the importance of normative attachment processes, in addition to attachment orientations and coping strategies, for understanding postbreakup adjustment. [ABSTRACT FROM AUTHOR]

There are well documented links between close relationships and physical health, such that those who have supportive close relationships have lower rates of morbidity and mortality compared to those who do not. Inflammation is one mechanism that may help to explain this link. Chronically high levels of inflammation predict disease. Across the lifespan, people who have supportive close relationships have lower levels of systemic inflammation compared to people who have cold, unsupportive, and conflict-ridden relationships. Not only are current relationships associated with inflammation, but past relationships are as well. In this article, we will first review the literature linking current close relationships across the lifespan to inflammation. We will then explore recent work showing troubled past relationships also have lasting consequences for people's inflammatory levels. Finally, we will explore developmental pathways that may explain these findings. [ABSTRACT FROM AUTHOR]

Summary: Fatigue is a notable clinical problem in cancer survivors, and understanding its pathophysiology is important. This study evaluated relationships between fatigue and both sympathetic and parasympathetic nervous system activity in breast cancer survivors. Norepinephrine and heart rate variability (HRV) were evaluated at rest, as well as during and after a standardized laboratory speech and mental arithmetic stressor. The participants, 109 women who had completed treatment for stage 0–IIIA breast cancer within the past two years, were at least two months post surgery, radiation or chemotherapy, whichever occurred last. Women who reported more fatigue had significantly higher norepinephrine and lower HRV before and after the stressor than their less fatigued counterparts. Fatigue was not related to treatment or disease variables including treatment type, cancer stage, time since diagnosis, and time since treatment. Importantly, the relationship between HRV and cancer-related fatigue was sizeable. Based on research that has demonstrated characteristic age-related HRV decrements, our findings suggest a 20-year difference between fatigued and non-fatigued cancer survivors, raising the possibility that fatigue may signify accelerated aging. Furthermore, lower HRV and elevated norepinephrine have been associated with a number of adverse health outcomes; accordingly, fatigue may also signal the need for increased vigilance to other health threats. [ABSTRACT FROM AUTHOR]

Over the past decade, psychobiological research on adult attachment has increased dramatically. We review recent findings regarding associations between attachment style and patterns of reactivity in the hypothalamic-pituitary-adrenocortical axis and the autonomic nervous system. The overall pattern of results suggests that both anxiety and avoidance are associated with heightened hypothalamic-pituitary-adrenocortical and autonomic nervous system reactivity to stress, consistent with the notion that attachment insecurity is associated with deficits in emotion regulation. The finding of heightened physiological reactivity among avoidant individuals is particularly notable, given that avoidant individuals typically report dampened levels of subjective distress. Key directions for future study include greater investigation into profiles of physiological functioning across multiple systems and contexts and greater consideration of the relative importance of childhood versus adult patterns of attachment insecurity for adult physiological functioning. [ABSTRACT FROM AUTHOR]

This prospective study ( N = 90) investigated the early formation of romantic relationships within an attachment-theoretical framework. Specifically, it tested whether general attachment to romantic partners was predictive of single individuals' progressing from not dating to dating and from not dating or casual dating to a committed and exclusive relationship when simultaneously considering desire for starting a committed relationship, prior dating involvement, and self-perceived physical attractiveness. Attachment avoidance, but not anxiety, was predictive of not entering into committed dating relationships even with rival predictors included. The transition from not dating to casual or committed dating was mainly predicted by prior dating success with some support for a potential additional role of the desire to form a committed relationship. [ABSTRACT FROM AUTHOR]

During pregnancy, there are significant physiological changes to support a healthy fetus. Parasympathetic activity normatively decreases across pregnancy, and psychological stress can promote even further decreased heart rate variability (HRV). This study evaluated (1) changes in vagally-mediated HRV from pregnancy to postpartum, (2) changes in vagally-mediated HRV from pregnancy to postpartum based on negative partner relationship qualities, and (3) changes in depressive symptoms from pregnancy to postpartum based on negative partner relationship qualities. 78 participants in their 3rd trimester self-reported their relationship quality with their partner at the first visit. Depressive symptoms and vagally-mediated HRV were evaluated at rest at five time points from 3rd trimester to 12 months postpartum. On average, the only significant increase in vagally-mediated HRV occurred between the 3rd trimester and 4–6 weeks postpartum. However, those who reported more negative partner relationship qualities during their 3rd trimester of pregnancy maintained lower vagally-mediated HRV levels across all of the first year postpartum and significantly lower vagally-mediated HRV at both 4 and 8 months postpartum as compared to people who reported fewer negative partner relationship qualities. Across the first year postpartum, people reporting more negative partner relationship qualities experienced more severe depressive symptoms than their counterparts with fewer negative partner relationship qualities; however, there was no difference in the rate of change of depressive symptoms across the first year postpartum based on negative partner relationship qualities. Because lower vagally-mediated HRV is associated with depressive symptoms, future work should explore the temporal relationship between vagally-mediated HRV and depressive symptoms in the postpartum period. • We assessed heart rate variability (HRV) and depressive symptoms from 3rd trimester to 12 months postpartum. • HRV increased between women's 3rd trimester of pregnancy and 4–6 weeks postpartum. • Women in more negative partner relationships during their 3rd trimester of pregnancy had lower postpartum HRV levels. • Women in more negative partner relationships had more severe postpartum depressive symptoms. • No reliable difference in the rate of change of HRV or depressive symptoms based on partner relationship qualities. [ABSTRACT FROM AUTHOR]

Background Affect states are posited to play a pivotal role in addiction-related processes, including tobacco lapse (i.e. smoking during a quit attempt), and distinct affective states (e.g. joy vs. happiness) may differentially influence lapse likelihood. However, few studies have examined the influence of distinct affective states on tobacco lapse. Purpose This study examines the influence of 23 distinct affect states on tobacco lapse among a sample of tobacco users attempting to quit. Methods Participants were 220 adults who identified as African American (50% female, ages 18–74). Ecological momentary assessment was used to assess affect and lapse in real-time. Between and within-person associations testing links between distinct affect states and lapse were examined with multilevel modeling for binary outcomes. Results After adjusting for previous time's lapse and for all other positive or negative affect items, results suggested that at the between-person level, joy was associated with lower odds of lapse, and at the within-person level, attentiveness was associated with lower odds of lapse. Results also suggested that at the between-person level, guilt and nervous were associated with higher odds of lapse, and at the within-person level, shame was associated with higher odds of lapse. Conclusions The present study uses real-time, real-world data to demonstrate the role of distinct positive and negative affects on momentary tobacco lapse. This work helps elucidate specific affective experiences that facilitate or hinder the ability to abstain from tobacco use during a quit attempt. [ABSTRACT FROM AUTHOR]

In the context of bereavement, little is known about the mechanisms that differentiate normative adjustment patterns from those that may indicate potential psychopathology. This study aimed to replicate and extend previous work by (1) characterizing the trajectories of depressive symptoms from 3 to 12 months after the loss of a spouse, (2) examining whether (a) childhood maltreatment and attachment style predicted distinct depression trajectories, and (b) different depression trajectories were associated with the risk of prolonged grief at 12 months post‐loss. Recently bereaved individuals (N = 175) completed self‐report assessments at 3, 4, 6, and 12‐months post‐loss. Trajectories of depressive symptoms were estimated using group‐based trajectory modelling. Four distinct trajectories of depressive symptoms were identified: (1) resilience (minimal/no depression across time points; 45%), (2) moderate depression‐improved (alleviated to 'mild' by 12 months; 31%), (3) severe depression‐improved (alleviated to 'moderate' by 12 months; 15%), and (4) chronic depression ('severe' symptoms across time points; 9%). Higher childhood maltreatment predicted a greater likelihood of belonging to the 'severe depression‐improved' and 'chronic depression' groups than the 'resilient' and 'moderate depression‐improved' groups. Widow(er)s with higher attachment anxiety were more likely to belong to the 'severe depression‐improved' and 'chronic depression' groups than the 'resilient' group. The trajectory groups with persistent levels of depressive symptoms up until 6 months were more likely to exhibit prolonged grief at 12 months post‐loss. Changes from pre‐loss functioning cannot be estimated. Our findings provide insight into the early identification of post‐loss prolonged grief. [ABSTRACT FROM AUTHOR]

According to extensive evidence, we-talk—couples' use of first-person, plural pronouns—predicts better relationship quality and well-being. However, prior work has not distinguished we-talk by its context, which varies widely across studies. Also, little is known about we-talk's consistency over time. To assess the stability and correlates of we-talk in private versus conversational contexts, 43 married couples' language was captured during a marital problem discussion and in each partner's privately recorded thoughts before and after conflict. Participants were asked to describe any current thoughts and feelings in the baseline thought-listing and to focus on their reaction to the conflict itself in the post-conflict sample. Couples repeated this protocol at a second study visit, approximately 1 month later. We-talk in baseline and post-conflict thought-listings was largely uncorrelated with we-talk during conflict discussions, but each form of we-talk was consistent between the two study visits. Their correlates were also distinct: more we-talk during conflict was associated with less hostility during conflict, whereas more baseline we-talk predicted greater closeness in both partners, as well as lower vocally encoded arousal and more positive emotion word use in partners after conflict. These novel data reveal that we-talk can be meaningfully distinguished by its context—whether language is sampled from private thoughts or marital discussions, and whether the study procedure requests relationship talk. Taken together, these variants of we-talk may have unique implications for relationship function and well-being. [ABSTRACT FROM AUTHOR]

Maintaining healthy cognitive functioning and delaying cognitive decline in cognitively intact and cognitively impaired adults are major research initiatives for addressing dementia disease burden. Music interventions are promising, non-pharmaceutical treatment options for preserving cognitive function and psychological health in older adults with varying levels of cognitive function. While passive, music interventions have attracted considerable attention in the abnormal cognitive aging literature, active, music interventions such as music creativity are less well-studied. Among 58 older adults with different levels of cognitive function (cognitively healthy to mild cognitive impairment), we examined the feasibility and acceptability of Project CHROMA, a Stage 1 clinical trial developed to assess the effects of a novel, music creativity curriculum on various health outcomes. Music intervention participation (93%), overall study retention (78%), and intervention satisfaction (100%) rates were comparable to other similarly designed clinical trials. Exploratory analyses using mixed-level modeling tested the efficacy of the intervention on cognitive and psychological outcomes. Compared to those in the control condition, participants in the music condition showed some improvements in cognitive functioning and socioemotional well-being. Findings suggest that a 6-week music creativity clinical trial with several multi-modal health assessments can be feasibly implemented within a sample of varying cognitive ability. [ABSTRACT FROM AUTHOR]

During the early stages of the COVID‐19 pandemic, governments issued public health safety measures (e.g., "stay‐at‐home" ordinances), leaving many people "missing out" on integral social aspects of their own lives. The fear of missing out, popularly shortened as, "FoMO," is a felt sense of unease one experiences when they perceive they may be missing out on rewarding and/or enjoyable experiences. Among 76 participants (ages M = 69.36, SD = 5.34), who were at risk for hospitalization or death if infected with COVID‐19, we found that FoMO was associated with depressive symptoms at Time 1, even when controlling for perceived stress, loneliness, and fear of COVID‐19. However, FoMO did not predict future depressive symptoms, about 1 week later, when controlling for Time 1 depressive symptoms. These findings provide further evidence that FoMO is associated with depressive symptoms in a short period of time even when accounting for other powerful social factors such as loneliness. Future research should explore the potential causal relationships between FoMO and depression, especially those that may establish temporal precedence. [ABSTRACT FROM AUTHOR]

Highlights • Affective disorders impact psychological health and physical health, with increased inflammation a common co-occurring condition. • Treatments for affective disorders are not always effective, as many were developed without reference to neurobiological mechanisms. • Here, we review brain-based measures of emotion regulation strategies and their effects on mental and physical health. • Regions of prefrontal cortex play a key regulatory role in autonomic, endocrine, and attendant immunological processes. • We conclude by proposing a neuro-immuno-affective framework that targets regions of prefrontal cortex with emotion regulation skills training. Abstract In the past century, medical progress has helped increase life expectancy and improve health outcomes more generally. Despite this progress, psychiatric disorders—especially affective disorders including depressive and anxiety disorders—are quite common and have been linked to dysfunction in endocrine and immune systems. In this review, we discuss neurobiological correlates of emotion regulation strategies and their effects on mental and physical health. Some of these correlates, namely sub-regions of prefrontal cortex, also play a key regulatory role in autonomic, endocrine, and immunological processes. Given this functional overlap, we propose a novel neuro-immuno-affective framework that targets improving emotion regulation, in order to: (1) reduce negative affect associated with depressive and/or anxiety disorders; and (2) alter endocrine and immune system functioning (e.g., reduce inflammation)—via changes in activity within (and connectivity between) brain systems that support (successful) emotion regulation. We conclude by arguing that such a framework can be adapted for psychiatric treatment protocols that holistically incorporate neural and immunological biomarkers to promote mental and physical health. [ABSTRACT FROM AUTHOR]

Background: Fatigue is a common symptom in stressed individuals. Bereavement is a major life event that has been associated with impaired mental health. Little research has investigated the prevalence of fatigue and its inflammatory correlates in bereaved individuals.Objectives: To assess fatigue prevalence and its relationship with mental health outcomes and markers of inflammation, as indexed by C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) in bereaved individuals.Methods: Seventy-eight-bereaved adults were examined for fatigue (SF-36 energy/vitality scale), perceived stress (PSS), depression (CES-D), sleep quality (PSQI), pain (SF-36 pain scale), and general health (SF-36 general), and their serum levels of CRP, IL-6 and TNF-α were measured. Group differences between fatigued versus non-fatigued individuals were estimated using analysis of covariance (ANCOVA), with adjustment for body mass index (BMI).Results: Fatigued bereaved individuals (33%; SF-36 energy/vitality score 0-45) had significantly higher CRP levels (p < .05) as compared to non-fatigued bereaved individuals and reported higher levels of pain (p < .001), greater stress (p < .001), depression (p < .001), and sleeping problems (p < .001), as well as poorer social functioning (p < .001) and general health (p < .001) than those in the non-fatigued group. No group differences were found for IL-6 and TNF-α.Conclusions: Fatigued bereaved individuals showed elevated systemic inflammation as measured by CRP in comparison to non-fatigued bereaved individuals. They were also more likely to report mental health problems that co-occur with fatigue in the context of immune activation. Continued research is needed to help clarify the involvement of inflammatory markers in the development of fatigue in a larger sample of bereaved adults. [ABSTRACT FROM AUTHOR]

Abstract: Inhibition is the ability to stop one's self from responding, or paying attention, to tempting/distracting stimuli or thoughts. Those with poor inhibition are at greater risk of depression and a variety of diseases of older adulthood than those with better inhibition. Inflammation may be a mechanism underlying these links. A total of 840 participants from the Midlife in the United States study completed a neuropsychological measure of inhibition, a self‐report measure of depressive symptoms, and a blood draw. Results indicated that poor inhibition was associated with high interleukin‐6 (IL‐6). Inhibition was indirectly associated with metabolic syndrome incidence and depressive symptoms through IL‐6. Findings suggest that IL‐6 may be a mechanism linking inhibition with metabolic syndrome and depression. [ABSTRACT FROM AUTHOR]

Following a stressful life event, there is considerable variation in how individuals respond and adapt. Multiple models of risk and resilience show that adverse childhood experiences may be associated with an individual's response to stress later in life. While there is considerable support that early adversity can sensitize the stress response system and lead to adverse outcomes later in life, there is mounting evidence that in adolescence and young adulthood, certain biological predispositions to stress may be associated with resilience in the context of subsequent stressors. In this study, we evaluated how individual differences in vagally mediated heart rate variability moderated the relationship between childhood maltreatment and grief among a sample of individuals experiencing a stressful life event (i.e., spousal bereavement) over time. Data were collected at approximately 3, 4.5, and 6.5 months after the death of a spouse (n = 130). Heart rate variability moderated the relationship between childhood maltreatment and grief symptoms over time (b = −0.03, p <.001), such that among individuals with more severe experiences of childhood maltreatment, those with higher heart rate variability had a faster recovery from grief than those with low heart rate variability. This research highlights an overall pattern of resilience among older adult's following spousal bereavement, as well as the relationships between childhood maltreatment, heart rate variability, and differential responses to grief following the loss of a spouse. Public Significance Statement: Childhood maltreatment and heart rate variability may be related to differential responses to grief among bereaved spouses over time. Among bereaved spouses with a history of childhood maltreatment, those with higher heart rate variability experienced faster recovery from grief symptoms than bereaved spouses with lower heart rate variability. These findings suggest a pathway to intervention may include increased heart rate variability to mitigate the relationship between adverse childhood experiences and adjustment to stressors later in life, particularly among older adults. [ABSTRACT FROM AUTHOR]

Family members are theorized to influence each other via transactional or systems related processes; however, the literature is limited given its focus on mother–child relationships and the utilization of statistical approaches that do not model interdependence within family members. The current study evaluated associations between self-reported parental affect, parenting behavior, and child depressive symptoms among 103 mother–father–child triads. Children ranged in age from 8 to 12 years. Higher maternal negative affect was associated with greater maternal and paternal harsh/negative parenting behavior. While maternal negative affect was directly associated with child depressive symptoms, paternal negative affect was indirectly associated with child depressive symptoms via paternal harsh/negative behavior. In a separate model, maternal positive affect was indirectly associated with child depressive symptoms via maternal supportive/positive behavior. These results highlight the importance of simultaneously modeling maternal and paternal characteristics as predictors of child depressive symptoms. [ABSTRACT FROM AUTHOR]

The aim of this paper is to develop a further understanding of the relationship between early-life socio-economic status (SES) and adult health disparities. This was accomplished through evaluation of state indicators of positive and negative affect as mechanisms through which early-life SES was associated with susceptibility to a rhinovirus (i.e. the common cold). Analyses were conducted among 286 adults in a viral challenge study in which participants were exposed to a rhinovirus via nasal drops and cold symptoms were evaluated over a period of 5 days. Participant age, body mass index, sex, education, ethnicity, pre-challenge virus-specific antibody titres and subjective adult SES, along with virus type and season of participation, were included as covariates. Early-life SES was associated with cold incidence through state positive affect, but not state negative affect. In addition, contrast analysis indicated that the indirect effect through state positive affect was stronger than the indirect effect through state negative affect. Findings provide further support for early-life SES being an important variable associated with adult health, and that state self-reported positive affect may be an underlying mechanism associated with susceptibility to rhinoviruses. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Sleep problems can boost inflammation and may jeopardize interpersonal functioning, risks that may be magnified in couples. This observational study examined the effects of self-reported recent sleep duration on couples’ inflammation, inflammatory responses to a problem discussion, interpersonal behavior, and use of emotion regulation strategies (emotion expression, cognitive reappraisal) during conflict. People who slept less had higher stimulated interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) production after the marital problem discussion than those who slept more. However, using emotion expression and cognitive reappraisal strategies during conflict protected couples who slept less from inflammatory reactivity. Specifically, people’s short sleep did not relate to inflammatory increases when they expressed their own feelings more or when their partner reappraised or expressed their emotions more. When both partners slept less, couples interacted in a more hostile way than when at least one partner slept more. These data point to the combination of short sleep and marital conflict as a novel path to heightened inflammation, a risk that partners’ emotion regulation strategies may counteract. The study also highlights the role of short sleep in more negative or punishing marital behavior. [ABSTRACT FROM AUTHOR]

Purpose: Debilitating fatigue is a core symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); however, the utility of patient-reported symptom outcome measures of fatigue for ME/CFS patients is problematic due to ceiling effects and issues with reliability and validity. We sought to evaluate the performance of three patient-reported symptom measures in a sample of ME/CFS patients and matched controls.Methods: Two hundred and forty ME/CFS patients and 88 age, sex, race, and zip code matched controls participated in the study. Participants completed the Multidimensional Fatigue Inventory-20, DePaul Symptom Questionnaire, and RAND SF-36.Results: The general and physical fatigue subscales on Multidimensional Fatigue Inventory-20, as well as the role of physical health on the RAND SF-36, demonstrated questionable or unacceptable internal consistency and problematic ceiling effects. The DePaul Symptom Questionnaire demonstrated excellent internal reliability, and less than 5 % of participants were at the ceiling on each subscale. The post-exertional malaise subscale on the DePaul Symptom Questionnaire demonstrated excellent clinical utility as it was able to differentiate between ME/CFS patients and controls (OR 1.23, p < .001) and predicted ceiling effects on other patient-reported outcome subscales. A score of 20 on the post-exertional malaise subscale of the DePaul Symptom Questionnaire optimally differentiated between patients and controls.Conclusions: Significant ceiling effects and concerns with reliability and validity were observed among Multidimensional Fatigue Inventory-20 and RAND SF-36 subscales for ME/CFS patients. The DePaul Symptom Questionnaire addresses a number of concerns typically identified when using patient-reported outcome measures with ME/CFS patients; however, an improved multidimensional patient-reported outcome tool for measuring ME/CFS-related symptoms is warranted. [ABSTRACT FROM AUTHOR]

Hostility and adverse health outcomes are inconsistently associated in the literature. Self-regulation and cortisol secretion may play important roles in differentiating those hostile individuals who are at greater risk of negative health outcomes from those who are not. In the present study, we sought to examine if having high self-regulatory strength, as indexed by high stress-induced high-frequency heart rate variability (HF-HRV), buffered the effects of hostility on cortisol secretion. Participants ( N = 213) completed a self-report measure of hostility and measurement of HF-HRV at rest and during a social stress task. Saliva samples were collected immediately before (one sample), and over a 50 min period after (six samples), the stress task to evaluate cortisol secretion over time. Hostile individuals were less likely to demonstrate cortisol sensitivity (i.e., high change in cortisol over time) when they had high stress-induced HF-HRV. Such findings are important given that cortisol sensitivity increases risk of metabolic and inflammatory disorders via glucocorticoid resistance and inflammation. Therefore, interventions that increase stress-induced HF-HRV may reduce the impact of hostility on health outcomes. [ABSTRACT FROM AUTHOR]

Attachment avoidance and anxiety are associated with negative emotions. However, the mechanisms underlying these associations are not fully understood. We investigated environmental mastery and positive relations with others as two mechanisms behind the attachment–emotion link in a sample of 343 adults. As predicted, attachment avoidance and anxiety were related to greater fear, hostility, envy and depression through lower mastery. Contrary to our hypothesis, positive relations mediated only the attachment–depression link. In addition, by adopting a moderated mediation approach, we were able to show that mastery mattered most for individuals high on avoidance: The indirect effect of avoidance through lack of mastery on fear, hostility and depression (but not on envy) increased with higher avoidance scores. Contrary to our predictions, poor relationships did not matter more as sources of negative emotions as anxiety increased. These findings underscore that the emotional life of avoidantly attached individuals is especially jeopardised by poor mastery. [ABSTRACT FROM AUTHOR]

Depression and inflammation fuel one another. Inflammation plays a key role in depression's pathogenesis for a subset of depressed individuals; depression also primes larger cytokine responses to stressors and pathogens that do not appear to habituate. Accordingly, treatment decisions may be informed by attention to questions of how (pathways) and for whom (predispositions) these links exist, which are the focus of this article. When combined with predisposing factors (moderators such as childhood adversity and obesity), stressors and pathogens can lead to exaggerated or prolonged inflammatory responses. The resulting sickness behaviors (e.g., pain, disturbed sleep), depressive symptoms, and negative health behaviors (e.g., poor diet, a sedentary lifestyle) may act as mediating pathways that lead to further, unrestrained inflammation and depression. Depression, childhood adversity, stressors, and diet can all influence the gut microbiome and promote intestinal permeability, another pathway to enhanced inflammatory responses. Larger, more frequent, or more prolonged inflammatory responses could have negative mental and physical health consequences. In clinical practice, inflammation provides a guide to potential targets for symptom management by signaling responsiveness to certain therapeutic strategies. For example, a theme across research with cytokine antagonists, omega-3 fatty acids, celecoxib, and exercise is that anti-inflammatory interventions have a substantially greater impact on mood in individuals with heightened inflammation. Thus, when inflammation and depression co-occur, treating them in tandem may enhance recovery and reduce the risk of recurrence. The bidirectional links between depression, inflammation, and disease suggest that effective depression treatments could have a far-reaching impact on mood, inflammation, and health. [ABSTRACT FROM AUTHOR]

The death of a spouse is associated with maladaptive immune alterations; grief severity may exacerbate this link. We investigated whether high grief symptoms were associated with an amplified inflammatory response to subsequent stress among 111 recently bereaved older adults. Participants completed a standardized psychological stressor and underwent a blood draw before, 45 min after, and 2 hr after the stressor. Those experiencing high grief symptoms (i.e., scoring > 25 on the Inventory of Complicated Grief) experienced a 45% increase in interleukin-6 (IL-6; a proinflammatory cytokine) per hour, whereas those experiencing low grief symptoms demonstrated a 26% increase. In other words, high grief was related to a 19% increase in IL-6 per hour relative to low grief. The grief levels of recently bereaved people were associated with the rate of change in IL-6 following a subsequent stressor, above and beyond depressive symptoms. This is the first study to demonstrate that high grief symptoms promote inflammation following acute stress. [ABSTRACT FROM AUTHOR]