Health-engagement control strategies and 2-year changes in older adults' physical health

This study examined the associations between older adults' daily physical symptoms (e.g., chest pain or difficulty breathing) and 2-year changes in chronic health problems (e.g., cardiovascular disease or cancer) and in functional problems (e.g., difficulty dressing or moving around at home). We reasoned that these associations depend on a person's active control processes aimed at counteracting physical health problems (i.e., health-engagement control strategies, or HECS). In particular, we hypothesized that high levels of HECS buffer the adverse effect of daily physical symptoms on increases in chronic and functional health problems. We found that daily physical symptoms were associated with declines in chronic and functional health among older adults who were not engaged in addressing their health problems, but not among their counterparts who reported high levels of HECS. These findings suggest that active control strategies play an important role in the maintenance of older adults' physical health.     

Regret intensity, diurnal cortisol secretion, and physical health in older individuals: evidence for directional effects and protective factors

Two studies were conducted to examine the associations between life regrets and health-relevant variables among older adults. Study 1 explored whether intense experiences of regret would be associated with a health-relevant biological process (i.e., diurnal cortisol secretion) and acute physical problems (N = 183). In Study 2, a group of 103 older adults was followed over a period of 3 months, and changes in cold symptoms and sleep problems were examined. Study 2 incorporated an experimental manipulation, targeted at engaging participants in adaptive social- cognitive processes through writing. The results of Study 1 showed intense life regrets to be associated with a larger volume and a steeper morning rise of cortisol secretion and with higher levels of acute physical symptoms. Study 2 demonstrated that levels of regret intensity generally declined only in the experimental group, whereas certain aspects of regret intensity remained stable in the control group. In addition, the intervention evidenced a beneficial effect on the association between initial regret intensity and increased sleep problems over time.     

Health stresses and depressive symptomatology in the elderly: the importance of health engagement control strategies.

The study presents cross-sectional (N = 127) and longitudinal (n = 111) analyses examining relations between health engagement control strategies (HECSs), depressive symptoms, and health stresses in elderly individuals. HECS was measured as people's behavioral and cognitive investments toward attaining health goals. HECS was related to low levels of depressive symptoms, particularly among people experiencing acute physical symptoms. Moreover, HECS predicted reduction of depressive symptoms over time, and depressive symptomatology predicted negative change in HECS. The findings show that active investments of HECSs significantly moderate the negative affective consequences of health threats. Individuals who are characterized by low levels of HECS and high levels of depressive symptoms may be at increased risk of accelerated decline in their physical and mental health.     

Diurnal cycle of salivary cortisol in older adult men and women with subjective complaints of memory deficits and/or depressive symptoms: relation to cognitive functioning

In populations of young and older adults, it has been shown that individuals may be categorized into one of three diurnal subgroups when salivary cortisol levels are assessed over a 2-day period and compared for their consistency across days: a typical subgroup, a flat subgroup, and an inconsistent subgroup. Interestingly, recent studies have reported that the typical subgroup represents the majority of the young and older adult population, a finding that is difficult to reconcile with previous studies showing increased cortisol levels in older adults with depression or cognitive impairments. In order to assess whether a typical diurnal cortisol profile is representative across different subgroups of older adults, we assessed diurnal cortisol cycle representation in a sample of older adults with subjective complaints of depression and/or memory problems. Furthermore, given the robust relationship between cortisol and cognitive function, the present study examined the association between the three diurnal subgroups and cognitive performance. Forty-two older individuals were recruited on the basis of reporting subjective complaints of either memory problems and/or depressive mood. Participants were asked to sample their saliva over a 2-day period and were then asked to undergo a neuropsychological evaluation that taps into short-term memory, declarative memory and language. The results showed that 69% of the sample presented a Flat cycle of salivary cortisol over a 2-day period while 19% presented an inconsistent pattern and 12% presented a typical pattern. Participants in the flat subgroup were significantly impaired on letter verbal fluency. Furthermore, a relationship was found between diurnal cortisol subgroup representation and subjective complaint profile. These findings show that older adults with complaints of memory problems and/or depressive symptoms do not present the typical profile of the diurnal cortisol cycle, and they provide a preliminary view of how diurnal cortisol profile relates to cognitive function during human aging.     

Depressive symptoms, cortisol, and cognition during human aging: the role of negative aging perceptions

Depressive symptoms and memory impairments are associated with heightened stress hormone levels during aging. A factor that is related to memory deficits during aging is internalized negative aging stereotypes; the idea people have about the process of aging. In this study, we assessed the associations between internalized negative aging stereotypes, depressive symptoms, subjective and objective memory assessments, and cortisol concentration among older adults. Forty older adults aged between 58 and 85 years (18 females and 22 males; mean age?±?SD: 71.25?±?8.80 years) were assessed in this study. Measures of internalized negative aging stereotypes, depressive symptoms, and both subjective and objective memory performance were assessed. Salivary samples were obtained for measurement of cortisol concentration. Stepwise linear regressions were executed in our main analyses. Internalized negative aging stereotypes were associated with increased depressive symptoms and subjective memory complaints. No significant differences were observed for objective memory performance, or cortisol concentration. Internalized negative aging stereotypes are associated with increased depressive symptomatology and subjective complaints of memory; however, they do not predict increased cortisol concentration nor objective memory performance during aging. These results indicate that the mechanism underlying the association between internalized negative aging stereotypes and cognitive impairments may not be related to dysregulations of cortisol secretion among older adults.     

Giving up on unattainable goals: benefits for health?

Three studies examined associations between goal disengagement and goal reengagement tendencies and indicators of physical health (e.g., health problems, cortisol rhythms, sleep efficiency). Based on research showing that goal adjustment tendencies are associated with subjective well-being, the authors predicted that people who are better able to disengage from unattainable goals and reengage with alternative goals also may experience better physical health. Across the three studies, the findings demonstrate that the ability to disengage from unattainable goals is associated with better self-reported health and more normative patterns of diurnal cortisol secretion. Goal reengagement, by contrast, was unrelated to indicators of physical health but buffered some of the adverse effects of difficulty with goal disengagement. The results also indicate that subjective well-being can mediate the associations between goal disengagement tendencies and physical health.     

Depressive affect among health care seekers: how it is related to attachment style, emotional disclosure, and health complaints

The present cross-sectional questionnaire survey investigated depressive affect among persons visiting their general practitioner (GP). It examined the impact of a number of factors likely to be associated with depressive affect, including demographic variables, severity of medical condition, and personal factors such as ease in disclosing personal information, and attachment style. Results showed that among the sample of patients (N = 198) visiting their GP, depressive affect was generally quite high. In particular, those reporting more depressive affect were the elderly, those with more severe health problems, more psychological problems, and a lower level of emotional disclosure frequency. As expected, attachment style was also related to lack of well-being among patients: those with a less avoidant but more anxious attachment style reported higher levels of depressive affect. In total, 38% of the variance of depressive affect was predicted by this model. Security of attachment was also related to reasons why patients consulted their GP, with avoidant attachment related to physical problems and anxious attachment to mental problems. Theoretical relevance of the findings and implications for medical help-seeking are discussed.     

The Content of Behavior Therapy for Depression Demonstrates Few Associations With Treatment Outcome Among Low-Income, Medically Ill Older Adults

We reported previously the results of a randomized controlled trial of a home-based behavioral treatment for dysthymia or minor depression that emphasized problem solving and activity scheduling among low-income, medically ill older adults. This report focuses on the content of treatment sessions as predictors of depressive symptoms, social activity, and physical activity outcomes among 64 participants who completed 2 or more sessions and evaluations at 6 and 12 months after the baseline evaluation. Worksheets from the treatment sessions were coded for focus on 4 types of problems (functional, social, health/physical, emotional); the number of activities planned was counted. More activity scheduling was associated with increased physical activity at the 12-month evaluation relative to baseline. The limited findings suggest either that the study methodology did not reveal extant associations between treatment variables and outcomes or that the session content variables tested in this study are not the active ingredients of treatment.     

Infant Emotion Regulation Strategy Moderates Relations between Self‐Reported Maternal Depressive Symptoms and Infant HPA Activity

Children of mothers with depressive symptoms often have high cortisol levels. Research shows that various child characteristics (e.g., attachment pattern, internalizing behaviours, and temperament) moderate this association. We suggest that these characteristics share common variance with emotion regulation strategy. Therefore, we examine infant emotion regulation strategy as a moderator of the association between maternal depressive symptoms and infant hypothalamic–pituitary–adrenal (HPA) function. We hypothesize that infants who utilize more independent emotion regulation strategies and have mothers who report higher depressive symptoms will exhibit elevated cortisol levels. Participants were 193 mothers and infants (15 months old) recruited from the community. Self‐reported maternal depressive symptoms were assessed. Infant independent regulatory behaviours (withdrawal, wandering away, distraction, scanning, orienting to another object) were coded in the context of a Toy Frustration Task. Infant cortisol was collected via saliva samples at baseline, +20, and +40 minutes. Results indicate that infant emotion regulation strategy moderates the relation between mothers' self‐reported depressive symptoms and infant total cortisol output (AUC_G) and cortisol reactivity (AUC_I). Infants who employed more independent regulatory behaviours and have mothers with higher depressive symptoms experience greater cortisol secretion. We discuss the findings in relation to parent‐infant interactions and the adaptive nature of emotion regulation strategies, as they relate to HPA regulatory capacities. Copyright © 2015 John Wiley & Sons, Ltd.     

The Roles of Social Support and Self-Efficacy in Physical Health’s Impact on Depressive and Anxiety Symptoms in Older Adults

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.     

Coping and physical health during caregiving: the roles of positive and negative affect

The associations among coping, mood, and health variables were examined prospectively over 2 years in 86 HIV positive (HIV+) and 167 HIV negative (HIV-) gay men undergoing the stress of AIDS-related caregiving. Path models suggested that including both positive and negative mood and the men's associated coping strategies increases understanding of why some people suffer adverse health effects during times of stress. Among the HIV- caregivers, higher levels of social coping predicted increases in positive affect, which in turn resulted in lower levels of physical symptoms. In contrast, higher levels of cognitive avoidance predicted increases in negative affect, which in turn resulted in higher levels of physical symptoms. Self-injurious forms of avoidance coping predicted higher levels of physical symptoms independent of mood among the HIV+ caregivers.     

The effects of attention retraining on depressive mood and cortisol responses to depression‐related stimuli1

Although it has been reported that attentional bias at an early stage is found in depression, no study has investigated the effects of modification of attentional bias at an early stage on depressive mood and cortisol response to a stressor. Therefore, this study tested the hypotheses that the modification of attentional bias at an early stage would reduce depressive mood and cortisol response. Fifty‐three participants were allocated alternately either to the training or the control group. They were administered attention retraining for modification of attentional bias or a sham attention task, and then underwent a stress task. With respect to depressive mood response, depressive mood increased in response to a stress task in the control group, while for high‐dysphoric participants in the training group, depressive mood response remained constant. These results indicate that attention retraining is efficacious for reducing depressive mood response. With respect to cortisol response, the percentage change in cortisol is associated with the amount of change in the attentional bias index scores. The results suggest the possibility that attention retraining could reduce cortisol response.     

Cerebrovascular risk factors, activity limitations, and depressed mood in African American older adults

This study investigated the association between cerebrovascular risk factors (CVRFs), physical activity limitations, and depressed mood. The 12-item Short-Form Health Survey (SF-12) was administered to 1,034 urban African American older adults. A chi-square analysis demonstrated that the prevalence of depressed mood among those with high CVRF burden (13.4%) was significantly higher than among those with low vascular burden (7.6%). Physical activity limitations also predicted depressed mood, but this relationship did not mediate the relationship between cerebrovascular burden and depression. These findings highlight the relationships among cerebrovascular burden, physical activity limitations, and depressed mood among African American older adults.     

Is pessimism a risk factor for depressive mood among community-dwelling older adults?

This study examined two senses in which pessimism might be a risk factor for depressive mood among older adults. The first was that a pessimistic explanatory style would predict changes toward depressive mood when combined with stressful life events. The second was that predictive pessimism, or thinking that bad events will happen in the future, would predict changes in depressive symptoms. We found an interaction between explanatory style and life stressors, but it was the optimists who were at higher risk for depressive symptoms after negative life events. We also found support for predictive pessimism, however, as a predictor of depressive symptoms over time.     

Daily Reports of Stress,Mood, and Physical Health in Middle Childhood

Most empirical work examining stress in children focuses on major life events, like divorce of parents, while fewer studies consider the role of daily stressors, or the routine challenges of day-to-day living. Existing work on children’s daily stress is lacking such that it primarily: (1) focuses on children who are ill, disabled, or who face significant environmental risks, (2) relies on retrospective reports, (3) relies on parent or teacher reports of stressors experienced by children, or (4) does not comprehensively examine the role of stress on mood and health. In the current study, we explored daily experiences of stress, mood, and physical health symptoms across five consecutive days in 25 children between 8 and 10 years old. Results showed that children reported a variety of types of stressors, and that more stressors were reported by older children, girls, and on weekdays compared to weekends. Daily reports of stress were linked to same day reports of physical health symptoms but not mood, however the presence of both negative mood and daily stress was associated with even more same day health symptoms. This study extends prior work by examining children’s stress at the daily level as well as relying on children’s self-reports of their stress, mood, and physical health symptoms.     

Do induced moods really influence health perceptions?

OBJECTIVE: To determine whether induced mood alters health reports. DESIGN: Randomized experiments testing a) mood influence on two global self-rated health (SRH) assessments (Study 1; N = 168) and b) testing whether illness relevant thinking moderates the influence of induced negative mood on SRH and physical symptom reports (Study 2; N = 143). MAIN OUTCOME MEASURES: Two global SRH items. Results. Effect sizes for induced mood were near zero across both studies (r's = 0.00-0.07). Aggregate analyses of induced mood studies showed a small adverse effect of induced negative mood on SRH, but these analyses masked roughly equal instances of better SRH among groups with worse mood. CONCLUSION: Published experimental research shows no consistent pattern of poorer SRH following negative mood induction in college-aged samples. Sample size and gender may account for variation in health ratings among induced mood groups.     

Associations Between Financial Strain and the Diurnal Salivary Cortisol Secretion of Long-term Unemployed Individuals

OBJECTIVE: The study investigated the associations between self-rated financial strain and overall diurnal salivary cortisol levels, as well as secretory patterns among long-term unemployed individuals. METHODS: Psychosocial and life-style variables were assessed by means of questionnaires among 85 participants (mean age 42+/-9 years; 56% females). Salivary cortisol was sampled on four occasions during a 24-hour period and data was analysed separately for men and women. RESULTS: Among females, high financial strain was related to higher overall cortisol levels, and to elevated levels in the evening. These associations did not reach significance among men. Multivariate analyses showed that evening levels of cortisol were positively associated with financial strain, but largely unrelated to life-style variables and psychological distress. CONCLUSIONS: The results suggest that high financial strain influences the diurnal cortisol secretion of unemployed individuals in terms of elevated cortisol levels in the evening. The mediating mechanisms are in need of further investigation.     

Longitudinal relationships between depressive symptoms and health in normal older and middle-aged adults

Comorbidity between health and depression is salient in late life, when risk for physical illness rises. Other community studies have not distinguished between the effects of brief and long-standing depressive symptoms on excess morbidity and mortality. S. Cohen and M. S. Rodriguez's (1995) differential hypothesis of pathways between depression and health was used to examine the relationships between health and depression in a prospective probability sample of 1,479 community-resident middle-aged and older adults. Findings suggest that different durations of depressive symptoms have different relationships to health. Health had an impact on short-term increases in depressive symptoms but depressive symptoms had a weaker impact on health. The reciprocal impact was indistinguishable from the health influence on depression. In contrast, longer term depressive symptoms had a clear impact on health. The results imply that physical illness can affect depressive states; depressive traits but not states can affect illness.     

The effects of widowhood on physical and mental health, health behaviors, and health outcomes: The Women's Health Initiative.

This study examined whether widowhood was associated with physical and mental health, health behaviors, and health outcomes using a cross-sectional (N=72,247) and prospective (N=55,724) design in women aged 50-79 years participating in the Women's Health Initiative observational study (85.4% White). At baseline, married women reported better physical and mental health and generally better health behaviors than widowed women. Whereas women who remained married over the 3-year period showed stability in mental health, recent widows experienced marked impairments and longer term widows showed stability or slight improvements. Both groups of widows reported more unintentional weight loss over the 3-year period. Changes in physical health and health behaviors were inconsistent, with generally small effect sizes. Findings underscore the resilience of older women and their capacity to reestablish connections, but point to the need for services that strengthen social support among women who have difficulty during this transition.     

Chronic financial strain, social support, and depressive symptoms among older adults

The purpose of this study is twofold: one, to determine whether chronic financial strain is related to depressive symptoms among a random community sample of older adults, and two, to assess whether social support counterbalances or buffers the deleterious effects of financial strain. The findings suggest that elderly people suffering from financial strain are more likely to be depressed than are older adults with fewer financial problems. In addition, the data support the stress-buffering hypothesis, that is, that older people who have more informational support and who provide support to others, more often report fewer symptoms of depression as a result of financial strain than do elderly respondents who have less informational support and who do not provide support to others. Tangible and emotional support are found to be less effective coping resources when financial strain is present.