York Heart Association (NYHA) assessment, 6-minute walk test; diurnal salivary cortisol profiling; and semi-structured interviews.

Results: From a total potential sample of 1400 PAH patients 776 met criteria for inclusion. 54 patients consented to participate in the study and of these, geographical constraints meant that randomisation was restricted to 32 patients. Participants were able to complete questionnaires (full data n= 22) and all attended clinic for physical assessment. Collection of salivary cortisol proved problematic and was largely limited to pre intervention assessment. A steady attrition rate, partly due to ill health, resulted in only 55% completing the programme. Those attending MBSR sessions reported it as useful, interesting and helpful in managing physical symptoms and minimising anxiety associated with their disease. Semi-structured interviews revealed patients were pleasantly surprised by intervention effects and continued to practice many months later. The study was not powered to demonstrate differences between the two arms of the trial.

Conclusions: Employing an in-person group therapeutic approach is difficult in rare diseases such as PAH where participants have significant physical limitations. However, our pragmatic evaluations of effectiveness suggest positive outcomes of MBSR in this population. An on-line intervention, coupled with a trial design that more closely fits the real-world restrictions of this population is recommended.

Funded by NHS National Institute for Health Research (NIHR), Research for Benefit (RfPB) Programme: Project Number PB-PG-0711-25145

## 289) Abstract 1183

# A PILOT RANDOMIZED CONTROLLED TRIAL (RCT) OF MINDFULNESS-BASED STRESS REDUCTION AS AN ADJUNCT INTERVENTION TO CARDIAC REHABILITATION: RATIONALE, STUDY DESIGN AND INITIAL FINDINGS

Susan A. Everson-Rose, PhD, MPH, Prabhjot S. Nijjar, MD, Medicine, John E. Connett, PhD, Roland Z. Brown, BA, Biostatistics, Mary Jo Kreitzer, PhD, RN, Mariann Johnson, BA, Center for Spirituality and Healing, Ruth A. Lindquist, PhD, RN, Nursing, University of Minnesota, Minneapolis, MN, Marsha Burt, MS, RCEP, Aaron Pergolski, MA, RCEP, Cardiac and Pulmonary Rehab Services, Fairview Health Services, Minneapolis, MN

**Background.** Exercise-based outpatient cardiac rehabilitation (CR) is the guideline-recommended standard of care for most patients after a major cardiac event or procedure. CR includes individualized exercise training, education and risk factor control but rarely features evidence-based stress reduction or psychosocial risk management, despite documented psychosocial needs of cardiac patients. CR programs have poor attendance and completion rates, possibly due to patients' unmet psychosocial needs. Mindfulness-Based Stress Reduction (MBSR) is an evidence-based stress management program with promise to enhance CR. MBSR reduces depressive symptoms, anxiety, and stress, and may improve blood pressure, immune function, and heart rate variability (HRV), an indicator of sympatho-vagal balance and flexible emotional regulation typically reduced in cardiac patients. Almost no studies have been reported utilizing MBSR to augment CR. **Methods.** The Mindful Heart Study (ClinicalTrials.gov #NCT02722213) is a pilot RCT of MBSR with patients eligible for exercise-based CR (defined by a qualifying cardiac event or procedure and referral to CR within the past 12 months). Inclusion criteria: no prior MBSR experience, no uncontrolled atrial arrhythmias or paced heart rhythm, age ≥21. Patients were recruited from a university-affiliated hospital system, stratified by current CR enrollment (yes/no), and then randomly allocated to an 8-week MBSR group intervention or usual care control group with a 2:1 (intervention:control) randomization. Assessments include physical function, stress, depression, anxiety, health-related quality of life, health behaviors, lipids, hemoglobin A1c, C-reactive protein, and 24-hour Holter monitoring to assess HRV pre-treatment (baseline), immediately post-treatment (3 months after baseline) and at follow-up 6 months later. **Results.** Recruitment and baseline assessments are

complete and the intervention is ongoing; 47 patients (38.3% female; 78.7% non-Hispanic white; mean age=58.6±10.8 years) enrolled. Findings from the 3-month follow-up (complete in early 2017) will be presented. **Conclusions.** The Mindful Heart Study is examining feasibility of recruitment and retention strategies and safety of an MBSR protocol in CR-eligible patients. Findings will inform a Phase III RCT to evaluate psychosocial and cardiovascular benefits of MBSR for cardiac patients.

## 290) Abstract 1592

# CHRONIC STRESS MODERATES LATE PHASE CORTISOL RECOVERY FROM ACUTE STRESS

Alexander Fiksdal, MA, Psychology, Brandeis University, Waltham, MA, Myriam Thoma, PhD, Psychology, University of Zurich, Zurich, Zurich, Switzerland, Luke Hanlin, MA, Psychology, Brandeis University, Waltham, MA, Danielle Gianferante, PhD, Psychology, T1D Exchange, Boston, MA, Xuejie Chen, MA, Psychology, Brandeis University, Waltham, MA, Nicolas Rohleder, PhD, Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Bavaria, Germany

Background: Chronic stress has been implicated as a contributing factor to dysregulation of hypothalamic pituitary adrenal (HPA) axis responses to stress and a variety of diseases. Although physiological reactivity to stress is often studied in this context, recovery from stress remains less scrutinized. In this study we examined the relationship between chronic stress and cortisol recovery from an acute stressor. Methods: Eighty adults (N=40 female, mean age=37.9 years) completed the Trier Social Stress Test (TSST). Chronic stress was evaluated using the Trier Chronic Stress Inventory (TICS) prior to the TSST. Saliva samples were collected immediately prior and 1, 10, 30, 60, and 120 minutes post TSST. Cortisol concentrations were log transformed to adjust for skewness. Fifty-one (N=19 female, mean age=36.8) participants had baseline to peak increases in log-transformed cortisol concentrations greater than -.32 nmol/l. These individuals were classified as cortisol responders following the baseline-adjusted increase criterion described by Miller et al. (2013) and are the focus of this study. We used linear regression with baseline-to-peak cortisol increases as the dependent variable to analyze reactivity to stress and multilevel modeling incorporating two slope variables to analyze early (peak to 30 minutes post-TSST) and late (30 minutes to 120 minutes post-TSST) phases of recovery. Results: Chronic stress did not predict baseline-to-peak increases in cortisol concentrations (beta= -.12, p=.41). The slope of late recovery was significantly less steep than early recovery [F(1, 91.275) = 52.451, p<.001]. Chronic stress did not moderate early recovery [F(1, 51.524) = 2.57, p=.12], but did moderate late recovery such that individuals with low chronic stress had steeper slopes [beta = .05, F(1, 50.85) = 4.859, p=.031]. This effect remained significant after controlling for age, sex, and baseline-to-peak cortisol increases [F(1, 50.538) = 4.767, p=.034]. Conclusions: Chronic stress was associated with flatter slopes in late, but not early, phase recovery. These results suggest that chronic stress may affect the down-regulation of cortisol secretion following exposure to stress and underscore the importance taking into account nonlinear trajectories of cortisol recovery in analyses.

## 291) Abstract 1387

# HOSTILITY AND CARDIOVASCULAR RESPONSES TO ANGER-PROVOCATION WITH AND WITHOUT SLEEP-RESTRICTION

Brian M. Hughes, PhD, Psychology, National University of Ireland, Galway, Galway, Co Galway, Ireland, Wei Lü, PhD, Psychology, Shaanxi Normal University, Xi'an, Shaanxi Province, China, Siobhán Howard, PhD, Psychology, Mary Immaculate College--University of Limerick, Limerick, Co Limerick, Ireland, Jack E. James, PhD, Psychology, Reykjavík University, Reykjavík, Reykjavík, Iceland
Hostility (Ho) is implicated in several psychosomatic models of cardiovascular disease pathogenesis. Nonetheless, Ho is normally distributed, suggesting that its adaptiveness is subject to Yerkes-Dodson principles: in order to be retained in the gene pool, both low and high extremes for Ho must be maladaptive (on occasion) compared to the mid-range. Sleep restriction is associated with poor cardiovascular health although pathogenic disease mechanisms remain unclear. This study considered how Ho might differently affect SBP stress responses after restricted sleep compared to after normal sleep.

119 female participants were exposed to standardized anger-provocation stress task (in which an ordinary visual tracking task was subverted by randomly disabling the computer mouse) during two laboratory visits, one the morning following normal sleep, the other the morning after sleep-restriction (order was counterbalanced). Beat-to-beat cardiovascular function was recorded during pre-stress, stress, and post-stress phases using a Finometer cardiovascular monitor. Ho scores were derived using the Cook-Medley Hostility Inventory. Profiles of SBP responses were examined within an analysis of covariance model, with Ho scores entered as a covariate and tested as part of a mixed-group (Ho x time) interaction.

Visits following normal sleep represent the control condition. During these visits, Ho was significantly positively associated with SBP during stress and post-stress phases, suggesting that Ho typically inflates SBP during and after anger provocation. Visits following sleep-restriction represent the experimental condition. During these visits, Ho was inversely associated with SBP during stress but positively associated with SBP post-stress ($F(1,116) = 5.638, p = .019$). This profile suggests that low Ho exacerbates stress responding while sleep-restricted, implying that low Ho is maladaptive under certain anger-provocation circumstances.

Findings provide confirmatory evidence that Ho is not unidirectionally maladaptive, helping account for its normal distribution across the population. Also, findings support the view that Ho and sleep-restriction contribute individually and in combination to cardiovascular risk.

## 292) Abstract 1504

# AN EXTENSION ON THE ASSOCIATION BETWEEN CARDIAC AUTONOMIC BALANCE AND DIFFICULTIES IN EMOTION REGULATION: A FOCUS ON GENDER DIFFERENCES

Cameron R. Wiley, B.S., Alexa D. Barton, B.S., DeWayne P. Williams, M.A., Psychology, The Ohio State University, Columbus, Ohio, Julian Koenig, Dr. sc. Hum, Psychology; Child and Adolescent Psychiatry, The Ohio State University; University of Heidelberg, Heidelberg, Baden-Württemberg, Germany, Derek Spangler, Ph.D., Julian F. Thayer, Ph.D., Psychology, The Ohio State University, Columbus, Ohio
Autonomic balance can be described as an internal equilibrium between the body's sympathetic (SNS) and parasympathetic (PNS) nervous system branches of the autonomic nervous system, allowing for the proper regulation of several vital psychophysiological functions. Conversely, autonomic imbalance is characterized by an overactive SNS and an underactive PNS, which can lead to increased susceptibility to cardiovascular disease and general illness. Our recent work showed that better autonomic balance was associated with fewer self-reported everyday difficulties in emotion regulation (ER). Interestingly, research has shown that the relationship between PNS activity and ER difficulties is stronger in women compared to men. Thus, the current study expands on our previously reported relationship between autonomic balance and self-reported difficulties in ER by including a larger sample size and examining the possible differences between men and women. Using an electrocardiogram (ECG), resting-baseline cardiac data (for 5-minutes) was gathered from 84 undergraduate students (57 female, 22 minorities, mean age = 20.05). Participants then completed the Difficulties in Emotion Regulation Scale (DERS). We indexed pre-ejection period (PEP; measure of SNS activation) and high frequency heart rate variability (HF-HRV; measure

of PNS activation) to derive an index of cardiac autonomic balance (CAB), where lower values reflect a shift towards sympathetic dominance (autonomic imbalance). Pearson's r correlation tests showed CAB to be inversely related to overall DERS scores (CAB: $r = -.219, p = .05$), such that lower CAB values were associated with higher DERS scores. When the data was split by gender, results showed a disparity in the relationship between CAB and DERS scores (Female CAB: $r = -.232, p = .041$; Male CAB: $r = -.184, p = .184$). These findings replicate our previous work, suggesting that difficulties in emotional control are not only related to PNS activity, but also autonomic imbalance. These data also suggest that this relationship may differ as a function of gender, such that women showed a stronger and significant relationship compared to the weaker and non-significant correlation observed in men. Implications for health, gender differences, and several facets of ER will be discussed.

## 293) Abstract 1195

# BUCCAL TELOMERE LENGTH AND ITS ASSOCIATIONS WITH CORTISOL, HEART RATE VARIABILITY, AND BLOOD PRESSURE RESPONSES TO AN ACUTE SOCIAL EVALUATIVE STRESSOR

Katrina Hamilton, B.A., Psychology, Ohio University & Heritage College of Osteopathic Medicine, Athens, OH, Alex Woody, M.S., Irina E. Livitz, M.S., Wilson S. Figueroa, M.S., Peggy M. Zoccola, Ph.D., Psychology, Ohio University, Athens, OH

**Background:** Shorter telomeres, a marker of increased cellular aging, have been linked to various chronic conditions and may be affected by stress exposure. Understanding the relationship between stress and telomere length (TL) is of great interest for reducing stress- and age-related disease and death. Physiological reactivity to stressors may underlie the detrimental effects of stress on TL and ultimately health. Thus, the current study tested the relationship between buccal TL and physiological reactivity (salivary cortisol, heart rate variability, and blood pressure) to an acute social evaluative stressor.

**Methods:** A sample of 77 healthy young adults (53% male; $M_{age} = 19.82 \pm 2.01$) provided buccal samples before undergoing a modified Trier Social Stress Test (TSST). Salivary cortisol was collected +40 and +65 minutes post-stressor onset. Systolic and diastolic blood pressures (BP) were recorded at baseline and twice during the modified TSST. Heart rate was recorded continuously throughout the session, and root mean square of successive deviations (RMSSD) was selected as a time-domain measure of heart rate variability (HRV). Relative TL was determined using cycle threshold (Ct) values from qPCR assay. Ct values were then used to compute telomere to single copy gene ratios for each participant. Peak reactivity in each outcome were determined by subtracting baseline values from the peak value.

**Results:** TL was negatively associated with total cortisol exposure (AUCg), $\beta = -.26, p = .040$, but not cortisol reactivity, $p_{S} > .14$. In addition, TL remained a significant negative predictor of cortisol exposure in the presence of BMI and sex, $\beta_{s} = -.25, p_{S} < .042$. TL was associated with RMSSD reactivity, with greater reductions in HRV related to shorter TL, $\beta = .43, p = .015$. TL was not associated with BP reactivity $p_{S} > .05$.

**Conclusion:** Overall, these findings indicate there are mixed associations between stress reactivity and telomere length across physiological systems. Future research should consider multiple stress-responsive systems to fully understand what forms of stress reactivity are related to TL, and ultimately increased risk for cellular aging and disease. Further, telomerase, an enzyme that may respond more rapidly than TL, should be included to better understand responses to stress reactivity and how that may impact cellular aging.

## 294) Abstract 1439

# LOWER HIGH-FREQUENCY HEART RATE VARIABILITY IS ASSOCIATED WITH GREATER NEGATIVE SPOUSAL INTERACTIONS IN DAILY LIFE AMONG WOMEN.
Jean-Philippe Gouin, PhD, Erin Barker, PhD, Warren Caldwell, M.Sc.,
Sasha MacNeil, B.A., Chelsea da Estrela, M.A., Psychology, Concordia
University, Montreal, Quebec, Canada

Porges' Polyvagal Theory proposes that high-frequency heart rate variability (HRV) indexes a neurophysiological system supporting social engagement behaviors. Empirical research also shows that individual differences in HRV are associated with self-regulation processes that are important to manage social relationship conflict. Accordingly, the goal of this study was to evaluate whether HRV would predict negative spousal interactions in daily life. Eighty-two heterosexual couples first completed the Couple Satisfaction Index to assess overall marital satisfaction. Then, the couples underwent a heart rate variability assessment during a structured marital problem-solving task. Subsequently, each member of the couple completed 6 days of daily dairy assessing negative spousal interactions, i.e., perception of the partner ignoring them, rejecting them, or being selfish. Actor-Partner Interdependence modeling evaluated whether the participant's own HRV and their partner's HRV during the marital interaction task in laboratory predicted their own daily negative spousal interactions during the following week. The moderating effect of marital satisfaction at baseline was also evaluated. Results indicated that among women lower HRV was associated with greater daily negative spousal interactions. Furthermore, among women reporting low levels of marital satisfaction both their own and their partner's HRV moderated the impact of marital satisfaction on daily negative spousal interactions. In contrast, among men neither their own nor their partner's HRV were associated with daily negative spousal interactions. In conclusion, HRV is associated with daily negative spousal interactions among women, suggesting a potential mechanism through which HRV influences aspect of social relationships quality that influence mental health.

## 295) Abstract 1355

### SOMATIC DECISION MAKING: MAKING SENSE OF SIGNALS FROM THE BODY

Nadia Zacharioudakis, Ma, Psychology and Educational Sciences, KU Leuven, Leuven, Leuven, Belgium, Sibylle Petersen, PhD, Faculté des Lettres, des Sciences Humaines, des Arts et des Sciences de l'Éducation, Université du Luxembourg, Esch-sur-Alzette, Esch-sur-Alzette, Luxembourg, Omer Van den Bergh, PhD, Psychology and Educational Sciences, KU Leuven, Leuven, Leuven, Belgium

**Objective:** Somatic decision making determines whether individuals perceive bodily sensations as benign or as a sign of disease. In this decision process, different strategies are possible. A "wait and see"-strategy puts a stronger emphasis on avoiding wrongly classifying a sensation as a symptom, whereas a "better safe than sorry"-strategy is more tolerant for false alarms in order to avoid missing symptoms. Little is known on the relation between somatic decision making and individual differences, as well as changes in decision strategies with repeated exposure to bodily sensations. We examined intensity-based somatic decision making over time in healthy persons differing on habitual symptom reporting.

**Methods:** In two studies, healthy female participants were selected on habitual symptom reporting in daily life, creating groups of high and low symptom reporters (Study 1 N=50; Study 2 N=60). Eight inspiratory resistances (loads; POWERbreathe, International Ltd., Southampton, UK) differing in intensity with a constant factor (0.3) were administered. In Phase 1, all loads were presented in a (pseudo)random order while a label was given on a screen and participants were asked to memorize the labels of the loads (A1, A2, A3 and A4, forming a category of low resistances; B1, B2, B3 and B4 forming a category of high resistances). During Phase 2, participants were asked to identify the stimuli by assigning the correct label. Participants of Study 2 were invited to a subsequent experimental session 7-10 days later, in which they were again asked to correctly identify stimuli with their category label.

**Results:** Somatic decision making became more liberal towards the category border in all participants. For high habitual symptom reporters, however, the change towards a "better safe than sorry"-strategy was specific for the ambiguous low-intensity stimuli and stronger than in the low habitual symptom reporters. These effects increased over time with repeated exposure.

**Discussion:** Our results show that individuals high in habitual symptom report exhibit a more liberal somatic decision strategy and that this tendency increases with repeated exposure. This suggests that in the long term, a shift in category border may ensue, resulting in over-inclusive high-intensity sensation categories (such as symptoms).

## 296) Abstract 1279

### C-REACTIVE PROTEIN AND HEART RATE VARIABILITY WITH RESPECT TO DEPRESSIVE SYMPTOMS AND ADVERSE CARDIAC EVENTS IN PATIENTS WITH NON-OBSTRUCTIVE CORONARY ARTERY DISEASE

Paula M.C. Mommersteeg, PhD, Romy Beckers, MSc, Medical and clinical psychology, Tilburg University, Tilburg, NoordBrabant, Netherlands, Jos W. Widdershoven, MD PhD, Wilbert Aarnoudse, MD PhD, Cardiology, Elisabeth-Tweesteden Hospital, Tilburg, NoordBrabant, Netherlands, Johan Denollet, PhD, Medical and clinical psychology, Tilburg University, Tilburg, NoordBrabant, Netherlands, Yori Gidron, PhD, Pharmacology and Pharmacokinetics, Free University of Brussels, Brussels, Brussels, Belgium

**Background:** Patients with non-obstructive coronary artery disease (NOCAD) may be at risk for repeated health care utilization. High sensitive C-reactive protein (CRP) and heart rate variability (HRV) have been associated with depressive symptoms and adverse outcomes in patients with obstructive CAD. We examined whether decreased HRV and elevated CRP, and the HRV/CRP ratio (reflecting neuro-immunomodulation- NIM) are associated with depressive symptoms and with incidence of emergency department (ED) visits in patients with NOCAD.

**Methods:** Patients with NOCAD (<60% stenosis, N=547, mean age 61.4±9.4 years, 52% women) in the TweeSteden Mild Stenosis (TWIST) observational cohort study, were followed since 2009. Blood samples were analyzed for CRP, with elevated CRP >3mg/ml. Interbeat intervals were assessed from 10 sec electrocardiograms for HRV measurements, and coded into SDNN (standard deviation of normal to normal beat intervals). A decreased SDNN was coded ≤30 msec. The ratio of continuous SDNN/CRP was calculated to reflect NIM. Depressive symptoms were measured with the Hospital Anxiety and Depression Scale (cutoff ≥ 8). ED visits and dates were extracted from Medical Records. Logistic regression analysis was used for depression and Cox proportional hazard models were used to predict ED, considering time since diagnosis.

**Results:** In total, 15% (80/547) of the patients with NOCAD had an ED on average 3.5±1.4 years after diagnosis. Elevated levels of CRP were associated with more depressive symptoms (OR= 2.02, 95%CI 1.27-3.21), but not with ED (HR= 1.28, 95%CI 0.77-2.15). No significant associations were found between SDNN and depressive symptoms (OR= 0.97, 95%CI 0.66-1.47) or with ED visits (HR= 0.82, 95%CI 0.53-1.28). An increased SDNN/CRP-ratio was associated with less depressive symptoms (OR= 0.74, 95%CI 0.62-0.90), but not with ED visits (HR= 0.97, 95%CI 0.77-1.20). Adjustment for covariates (age, sex, and lifestyle factors), or using continuous scores for CRP and SDNN did not alter the findings.

**Conclusion:** Among patients with NOCAD, 15% returned to the ED, but this was not predicted by elevated CRP or SDNN at baseline or by the SDNN/CRP ratio. Elevated CRP and a decreased SDNN/CRP ratio were associated with depressive symptoms. Patients with NOCAD are not event free, and identifying other prognostic factors in patients with NOCAD is warranted.
LOW FREQUENCY HEART RATE VARIABILITY DUE TO SLOW YOGA BREATHING IS VAGALLY MEDIATED

Richard D. Lane, M.D., Ph.D., Psychiatry, University of Arizona, Tucson, AZ, Bryan Kromenacker, B.S.N., Psychology, Anna Sanova, B.S., Psychiatry, John J. Allen, PhD, Psychology, University of Arizona, Tucson, Arizona

**Background:** Breathing interventions aim to reduce stress and induce a state of calm, an effect that may be vagally-mediated. However, the best index of cardiac vagal control is high frequency (HF) heart rate variability (HRV), which captures variance in the inter-beat interval series greater than 0.12 Hz (or sometimes 0.15 Hz) corresponding to breathing rates higher than 7.2 (or 9) breaths per minute (bmp). Since breathing interventions typically involve slower breathing rates closer to 6 bpm, and since low frequency HRV (below 0.12 or 0.15 Hz) can reflect sympathetic contributions that are not seen in HF-HRV, we sought to clarify the autonomic mechanisms of HRV change with slow breathing.

**Method:** Six healthy subjects (2 females, mean age= 22 years) received a continuous intravenous infusion of an anticholinergic agent (glycopyrrolate), a beta blocker (esmolol) or saline for one hour on three separate occasions within a 1-week period in a single blind protocol. In each session there were 11 5-minute trials (order counterbalanced) during which subjects engaged in paced yoga breathing at each of 11 different rates (from 4.0 to 9.0 breaths per minute in 0.5 bpm increments) in a 4-4-6-2 cadence of inspiration, pause, expiration, pause for the first minute, followed by 4 minutes of rest. Heart rate, HRV (power at breathing frequency), and respiratory rate (peak frequency during each trial) were assessed during the first minute of each trial.

**Results:** HRV spectral power was maximal at the frequency corresponding to the paced respiratory rate. Figure 1 demonstrates the significant effect of the drug (Wilks' $\lambda$= .181, approximate F(2,4) = 9.03, p<.05) such that HRV at each breathing rate was virtually absent during glycopyrrolate (p=.016 vs saline) whereas esmolol had a minimal effect on HRV compared to saline (p=.671 vs saline), except at the slowest breathing rates where HRV showed a slight decline with esmolol relative to saline (at 4.0 bpm, p<.005) and a slight elevation during glycopyrrolate. Adherence to the paced breathing protocol was confirmed, with peak respiratory frequency during each trial correlating 0.94 (p<.01) with the paced frequency.

**Discussion:** These results demonstrate that changes in HRV due to slow yoga breathing are vagally mediated, with only minimal effect of sympathetic influences below 6 bpm.

<figure><img src="image_36.png" /></figure>

HRV spectral power at the breathing frequency as a function of paced frequency and drug condition.

THE ASSOCIATION BETWEEN WORK-LIFE BALANCE, INFLAMMATORY MARKERS AND DEPRESSIVE SYMPTOMS IN THE WHITEHALL II STUDY

Tahera Razavi, PhD Epidemiology and Pub, Epidemiology and Public Health, University College London, London, England, United Kingdom, Meena Kumari, PhD, Institute for Social and Economic Research, University of Essex, Colchester, Essex, United Kingdom, Yvonne Kelly, PhD, Jessica Abell, PhD, Epidemiology and Public Health, University College London, London, England, United Kingdom Work and family are two fundamental aspects of adult life and the conflict between them is considered a source of stress. Work-family conflict (WFC) has been found to be negatively associated with a number of health conditions including depression. Depression has been associated with inflammatory markers. Studies have identified an association between WFC and depression. However, these studies have not examined both work to family interference (WFI) and family to work interference (FWI) in the same population. Furthermore, the association between inflammatory markers and WFC has not been examined.

Data from the Whitehall II study of British civil servants were used to explore the associations between WFC, inflammatory biomarkers (CRP and IL-6) and depressive symptoms (GHQ-30). WFC is assessed using a series of 8 questions, 4 measure WFI and 4 measure FWI. Data was collected at phase 3 of the Whitehall II study (1991-1994).

Regression analysis identified that both WFI and FWI were significantly associated with higher GHQ scores (n=6466), the association persisted upon adjustment for health behaviours (WFI: $\beta$ coefficient=0.778, standard error (S.E): 0.0383, $p<0.001$; FWI: $\beta$=0.851, S.E 0.0386, $p<0.001$). Both WFI and FWI were associated with higher CRP levels (WFI: $\beta$=0.0347, S.E: 0.00891, $p<0.001$; FWI: $\beta$=0.0212, S.E: 0.00907, $p<0.05$). However, the association was not robust to adjustment for health behaviours (alcohol dependence, cigarette smoking, BMI and moderate exercise). There was no association between either WFI or FWI and IL-6 (n=5911).

In conclusion, findings suggest that experiencing WFC is associated with psychological distress. However, the association between WFC and inflammatory markers is inconsistent. Further research is necessary to determine the temporal associations. These findings could encourage employers to implement work-place policies which minimise conflict between family life, in order to reduce adverse mental health related outcomes.

ASSOCIATIONS OF HEART RATE VARIABILITY AND SALIVARY ALPHA AMYLASE UNDER ACUTE PSYCHOSOCIAL STRESS

Ursula Schade, Lecturer, Department of Psychology, University of Erlangen, Erlangen, Bayern, Germany, Myriam V. Thoma, PhD, Department of Psychology, University of Zürich, Zürich, Kanton Zürich, Switzerland, Luke Hanlin, PhD Candidate, Danielle Gianferante, PhD, Xuejie Chen, PhD Candidate, Department of Psychology, Brandeis University, Waltham, MA, Nicolas Rohleder, PhD, Department of Psychology, University of Erlangen, Erlangen, Bayern, Germany

**Rationale:** Acute social stress evokes physiological reactions by the hypothalamus pituitary adrenal (HPA) axis and also by the autonomic nervous system (ANS). These reactions are thought to be adaptive when coping with a specific acute threat, but maladaptive when experiencing frequent stressful situations. Assessing ANS activity by by plasma catecholamines limits its use to context in which blood samples can be taken easily, stimulating a search for easier, non-invasive measures. Heart Rate Variability (HRV) as well as salivary alpha-Amylase (sAA) have received attention, but few studies have tested whether HRV and sAA measures of ANS responses to acute stress converge.
LOW SUBJECTIVE SOCIAL STATUS IN THE POLICE IS LINKED TO HEALTH-RELEVANT CHANGES IN DIURNAL SALIVARY ALPHA-AMYLASE ACTIVITY IN SWISS POLICE OFFICERS: A MULTILEVEL REGRESSION ANALYSIS STUDY

Stephanie Habersaat, PhD, Sébastien Urben, PhD, Psychiatry, University Hospital of Lausanne, Lausanne, Vaud, Switzerland, Sid Abdellaoui, PhD, Psychology, University of Lorraine, Nancy, Lorraine, France, Jutta M. Wolf, PhD, Psychology, Brandeis University, Waltham, MA

Background: Police work often includes exposure to high levels of occupational stress and an increased physical and mental health risk. Subjective social status (SSS) is a well-established health predictor and we recently identified subjective social status as a particularly powerful predictor of stress-related health outcomes in police officers. The current study aimed at elucidating underlying stress-related mechanisms, particularly the role of sympathetic nervous system dysfunctions assessed by diurnal salivary alpha-amylase (sAA) activity patterns.

Method: Fifty-six police officers self-reported their subjective social status and their health status (depression, posttraumatic stress, and physical symptoms) and collected a total of 12 saliva samples over two days for sAA assessment.

Results: Multilevel regression analyses revealed that subjective social status in the police (β08 = -7.89; p = .044, d = .28, CI: 14.15-1.63) and physical symptoms (β05 = 2.26; p = .021, d = .31, CI: 0.66-3.83) explained a significant part of the variance in diurnal sAA activity patterns (all other: p > .05). However, diurnal sAA activity did not mediate the relationship between subjective social status in the police and physical symptoms.

Discussion: The current findings support the idea that more narrowly defined subjective social status may be more closely linked to biological stress mechanisms than subjective social status related to a larger group (i.e., the country, the community, and among friends). Specifically, police officers with lower subjective social status showed higher sAA activity over the day compared to police officers with a higher subjective social status. Importantly, this same pattern was then linked to police officers reporting more physical symptoms. Together, these results suggest that perceiving one's status among co-workers to be lower is linked to health-relevant changes in sympathetic nervous system activity.
Adversity: From Community to Genes

Saturday, March 18 from 2:15 - 3:15 pm

Abstract 1186

PERCEIVED NEIGHBORHOOD DISADVANTAGE IS
ASSOCIATED WITH POORER OBJECTIVELY MEASURED
SLEEP EFFICIENCY IN A PROBABILITY SAMPLE OF
AFRICAN AMERICAN ADULTS

Wendy M. Troxel, PhD, Behavioral and Policy Sciences, RAND Corporation, Pittsburgh, PA, Matthew P. Buman, PhD, Exercise Science and Health Promotion, Arizona State University, Phoenix, AZ, Robin Beckman, MS, Bonnie Ghosh-Dastidar, PhD, Amy DeSantis, PhD, Behavioral and Policy Sciences, RAND Corporation, Santa Monica, CA, Daniel J. Buysse, MD, Psychiatry, University of Pittsburgh, Pittsburgh, PA, Lauren Hale, PhD, Preventive Medicine, Stony Brook University, Stony Brook, NY, Tamara Dubowitz, PhD, Behavioral and Policy Sciences, RAND Corporation, Pittsburgh, PA

African Americans (AA) and individuals living in disadvantaged neighborhoods have disproportionately high rates of chronic health conditions, yet the mechanisms underlying these links are poorly understood. Sleep is a critical health behavior that may contribute to these health disparities. However, existing research on neighborhood disadvantage and sleep has primarily utilized self-reports of sleep and neighborhood characteristics, and few studies have focused on high-risk populations, including AAs. The current study examines the association between objective and subjective neighborhood characteristics and actigraphy-measured sleep duration and efficiency in a randomly recruited sample of households from two urban neighborhoods [N=825; 77% female; 95% AA; mean (SD) age =55.4 (16.3) years]. Perceived neighborhood characteristics included neighborhood safety, social cohesion, satisfaction, and infrastructure (e.g., presence of sidewalks, street lighting). Objective neighborhood characteristics were assessed by environmental audits of randomly selected street segments and crime data. Average sleep duration and efficiency (SE) were measured via actigraphy over 7 days. Bivariate and adjusted linear regression models examined the association between neighborhood characteristics and sleep. There were no significant associations between perceived or objective neighborhood characteristics and sleep duration. Bivariate analyses revealed significant associations between greater perceived neighborhood safety, social cohesion, satisfaction, and infrastructure, as well as objective measures of land use (e.g., public spaces, services, retail stores) and higher SE. Higher levels of violent crime were associated with lower SE. After adjusting for covariates (e.g., age, sex, education, body mass index), significant associations persisted between subjective neighborhood infrastructure and safety and sleep efficiency (β= .08, p=.03 and β=.09, p=.02, respectively). These findings are among the first to evaluate the association between objective and subjective measures of neighborhood characteristics and objectively measured sleep, in a high-risk sample of African Americans. Consistent with prior studies focused on subjective sleep, perceived neighborhood safety and infrastructure were the most robust correlates of objectively-measured sleep efficiency.

Abstract 1540

RETROSPECTIVE RECALL OF CHILDHOOD ABUSE AND
MIDLIFE SUBCLINICAL CARDIOVASCULAR DISEASE:
CROSS-SECTIONAL AND LONGITUDINAL ASSOCIATIONS

Thomas E. Kraynak, BA, Anna L. Marsland, PhD, Peter J. Gianaros, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA

Childhood abuse confers risk for poor physical health in adulthood; however, it is still unclear whether childhood abuse relates to the

progression of subclinical cardiovascular disease (CVD) in midlife or whether such a relationship is moderated by age. Among otherwise healthy adults, we thus tested for cross-sectional, longitudinal, and age-moderated associations of retrospective reports of childhood abuse with carotid artery intima-media thickness (cIMT), a marker of subclinical CVD.

Participants were 316 un-medicated, community volunteers free of clinical CVD and other chronic illnesses (age 30-51 yrs, M = 40.2 yrs, 51% male; 70% Caucasian). A subsample (N = 215) were assessed again (M follow-up = 2.9, SD=0.6 yrs). Childhood abuse was assessed by the Childhood Trauma Questionnaire. Individuals who exceeded established reporting thresholds for the emotional, physical, or sexual abuse subscales were coded as experiencing childhood abuse. cIMT was assessed by B-mode ultrasonography.

Approximately 31% of participants reported emotional, physical, or sexual abuse in childhood. A linear regression analysis of cross-sectional data showed that experiencing childhood abuse related to increased cIMT, after controlling for age, sex, race, cardio-metabolic risk factors (waist circumference, blood pressure, fasting glucose and lipids), childhood socioeconomic status (highest parental education), and recent negative life events (β = 0.106 p = 0.027).

In longitudinal analyses that adjusted for initial cIMT, abuse did not relate to follow-up cIMT (β = 0.010, p > 0.8). However, age significantly interacted with abuse to predict follow-up cIMT (β = 0.087, p = 0.039). Here, older adults (over the age of 41) who reported abuse exhibited a faster progression of cIMT than younger adults.

These results extend cross-sectional evidence on childhood abuse and midlife CVD risk, and they provide provisional evidence that childhood abuse may relate to premature cardiovascular aging.

Supported by R01HL089850-08 and 5T32HL007560-33.

Abstract 1254

MULTIMODAL ASSOCIATIONS OF CHILDHOOD
MALTREATMENT WITH THE STRIA TERMINALIS AND ITS
BED NUCLEUS

Layla Banihashemi, PhD, Psychiatry, University of Pittsburgh, Pittsburgh, PA, Christine Peng, B.A., Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, Timothy Verstynen, PhD, Psychology, Carnegie Mellon University, Pittsburgh, PA, Howard Aizenstein, MD, PhD, Anne Germain, PhD, Psychiatry, University of Pittsburgh, Pittsburgh, PA

The bed nucleus of the stria terminalis (BNST) is a central visceral hub, integral to a network of stress-control regions including the paraventricular nucleus of the hypothalamus (i.e., the apex of the HPA axis) and the amygdala, which are all connected by the white matter of the stria terminalis (ST). Childhood maltreatment is known to dysregulate later stress reactivity, yet how it alters the neural correlates of stress responses is virtually unknown. Here, our goal was to examine childhood maltreatment-related differences in ST structural integrity and BNST stress reactivity in a mixed adult sample. We hypothesized that higher maltreatment would correspond to both greater ST structural integrity and BNST stress reactivity. Participants had a range of depression and anxiety symptoms and a history of moderate to severe childhood abuse on average. Preliminary analyses were performed on data from 50 participants (27 females, 1 transgender M to F, mean age = 27). The Childhood Trauma Questionnaire (CTQ) provided an assessment of childhood maltreatment (i.e., emotional and physical abuse (EA, PA) and neglect (EN, PN), and sexual abuse (SA)). Participants underwent a 271-direction diffusion spectrum imaging sequence and performed a mild cognitive stress task (i.e., the multisource interference task) in the MRI scanner. Structural integrity (i.e., normalized quantitative anisotropy, QA) measures were extracted from a ST tract of interest defined by tractography using Human Connectome Project data. Parameter estimates from the contrast between task control and stress conditions were extracted from a hand-drawn BNST region of interest. CTQ total (cumulative maltreatment), EN and PA were correlated with left ST QA (CTQ total: .236, p = .050,
EN: r = .312, p = .014, PA: r = .256, p = .036). EN was also significantly correlated with right ST QA (EN: r = .280, p = .024). CTQ total, EA, PA and SA significantly correlated with left BNST stress reactivity (CTQ total: r = .262, p = .033, EA: r = .242, p = .045; PA: r = .304, p = .016; SA: r = .267, p = .031). Thus, adults with higher levels of childhood maltreatment displayed greater ST structural integrity (suggesting overuse) and greater BNST stress reactivity, indicating that a "structure-function" relationship may exist within BNST-related circuits that could contribute to higher physiological stress reactivity.

## Abstract 1112

### TRAUMA-ASSOCIATED MECP2 GENE METHYLATION IN REFUGEES: IMPLICATION FOR HPA-AXIS REGULATION

Bengt B. Arnetz, MD, PhD, MPH, MScEpi, Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, Jolin B. Yamin, B.S. in Psychology, Psychology, Wayne State University, Detroit, MI, Hikmet J. Jamil, MD, PhD, Family Medicine, Michigan State University, West Bloomfield, MI, Judith Arnetz, PhD, MPH, PT, Family Medicine, Michigan State University, East Lansing, MI, Susan J. Land, PhD, OB/GYN, Katherine Gurdziel, PhD, Institute of Environmental Health, Wayne State University, Detroit, MI, Abir Dhalimi, PhD, Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, Douglas Ruden, PhD, OB/GYN, Wayne State University, Detroit, MI

Trauma-related disorders are associated with dysregulation of the HPA axis with long-term consequences for the person's ability to combat stress. Prior work also suggests that individuals suffering from PTSD exhibit changes in blood levels of glycerophospholipids, indicating increased break-down of cellular membranes in the central nervous system. In the current study, we determined whether there were trauma-related changes in the methylation of the MECP2 gene, which regulates production of MECP2 protein and related epigenetic marks. The MECP2 protein regulates stress-dependent epigenetic programming of genes (CRH, AVP and POMC) controlling HPA axis activity.

Within one month of arrival in the U.S., 66 male and female refugees from Syria were interviewed by an Arab-speaking research assistant using a validated structured Arab-language survey. The survey included questions on socioeconomic, trauma and stressor exposures, resilience, and PTSD symptoms. Refugees with PTSD Checklist-Civilian (PCL-C) scores above 30 were classified as PTSD and were compared to those with lower scores.

Results show that refugees with PTSD symptoms have decreased methylation of MECP2 (11 probes with an average decrease of 6.1% [4.3% to 9.0%]; p-values < 0.001). They also had a significant increase in methylation of a number of probes that assess methylation of genes related to the regulation of the aminophospholipid transporters ATP9B, ATP9A, ATP10A, ATP11B, ATP10D, ATP11C, ATP8B4, and ATP8A1. There was also increased methylation in a probe for the CRP gene, but no significant differences in probes related to AVP and POMC.

These results suggest dysregulation in molecular pathways regulating the expression of MECP2 with downstream consequences for an individual's ability to cope with stressor exposures.

Acknowledgement: Supported by R01MH085793 from NIMH/NIH and NIEHS/NIH CURES grant P30ES020957.

### Cohorts of Cardiovascular Disease

Thursday, March 16 from 3:30 - 4:30 pm

## Abstract 1508

### OCCUPATIONAL STATUS MODERATES THE ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS AND PREDICTED 10-

### YEAR RISK OF CORONARY HEART DISEASE IN PARTICIPANTS OF THE FRENCH CONSTANCES COHORT

Emmanuel Wiernik, PhD, Psychiatry and Neurosciences Center, INSERM UMR 894, Paris Descartes University, Paris, 75014, France, Hermann Nabi, PhD, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, 94807, France, Jean-Philippe Empana, MD, PhD, Inserm U970, Paris Cardiovascular Research Centre, Paris Descartes University, Paris, 75015, France, Sébastien Czernichow, MD, PhD, Nutrition, Paris Descartes University, AP-HP, European Hospital Georges Pompidou, Paris, 75015, France, Marie Zins, MD, PhD, Inserm UMS 011 Population-based Epidemiological Cohorts, Versailles Saint-Quentin University, Villejuif, 94807, France, Cédric Lemogne, MD, PhD, Psychiatry, Paris Descartes University, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, 75015, France

**Background:** A growing body of evidence suggests that the association of psychological variables with cardiometabolic risk might depend upon socioeconomic status. Here, we examined the moderating effect of occupational status (OS) on the association between depressive symptoms and predicted 10-year risk of coronary heart disease (CHD) in working participants from the population-based CONSTANCES cohort.

**Methods:** A total of 34,059 participants (15,736 men, mean age: 44.0 ± 10.4 years) without a history of cardiovascular disease completed the Center of Epidemiologic Studies Depression scale (CES-D). The presence of depressive symptoms was defined as a CES-D score ≥ 19. The 10-year French CHD risk equation model included age, gender, age x gender interaction, current smoking status, diabetes status, systolic blood pressure, total and HDL cholesterol (Empana JP et al. Predicting CHD risk in France: a pooled analysis of the D.E.S.I.R., Three City, PRIME, and SU.VI.MAX studies. Eur J Cardiovasc Prev Rehabil. 2011;18:175-85). OS was categorized in 3 classes: (1) high (e.g., managers); (2) medium (e.g., clerks or first-line supervisors); (3) low (e.g., blue collar workers). Associations between depressive symptoms and CHD risk were estimated with coefficients (b) and 95% confidence intervals (CI) computed in linear regressions.

**Results:** Overall, the predicted 10-year risk of coronary heart disease was 17.1% in men and 1.8% in women. In men, there was an interaction between depressive symptoms and OS (p=0.048). Significant associations with depressive symptoms were found among participants of medium OS [b (95% CI): 1.45 (0.33;2.57)] and low OS [b (95% CI): 3.05 (1.15;4.95)] but not in participants of high OS [b (95% CI): 0.33 (-0.09;1.61)]. In women, the interaction between depressive symptoms and OS was not significant (p=0.091). Sensitivity analyses using the CESD-D score as a continuous variable yielded similar results.

**Conclusions:** The association between depressive symptoms and predicted 10-year risk of CHD could depend upon OS among men. A lower risk of CHD in women at this mean age could explain the lack of such a moderating effect. This study suggests that OS should be considered when evaluating the risk of CHD in depressed individuals, at least in men.

## Abstract 1199

### THE HOSTILE, THE TENSE AND THE DISTRESSED - DETERMINANTS OF MULTIDIMENSIONAL PSYCHOSOCIAL RISK PROFILES IN PATIENTS WITH CORONARY HEART DISEASE - THORESCI STUDY

Eveline van Montfort, MSc, Johan Denollet, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, the Netherlands, Jos Widdershoven, MD PhD, Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Noord-Brabant, the Netherlands, Nina Kupper, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, the Netherlands

**Background:** Single psychosocial factors have been associated with cardiovascular outcomes, but these factors often co-occur, e.g. depression, anxiety, negative affectivity (NA). However, it is still unclear how other psychosocial factors cluster, and whether the
prognostic effects of clustered factors differ from the effects of single factors. Therefore, we examined whether latent multidimensional psychosocial risk profiles could be identified and whether these profiles were associated with specific determinants. Method: 681 percutaneous coronary intervention patients (65y±10.6;80% men) completed the European Society of Cardiology psychosocial screening interview, comprising 15 items with 7 predefined components: low socioeconomic status, work-family stress, social isolation, depression, anxiety, hostility, Type D personality. Multiple self-report questionnaires were administered (depression: PHQ-9, anxiety: GAD-7, negative affectivity and social inhibition: DS14, coping: CISS, optimism: LOT-R, resilience: DRS-15, early adverse life-events and psychiatric history: LES). Clinical information was extracted from patients' medical records. Results: Latent class analysis identified 4 psychological clusters (Figure 1): 1. Low psychological distress (n=424), 2. High hostility (n=128), 3. High tension (n=77), 4. High psychological distress (n=51) and 2 social clusters: Low (n=554) and High (n=127) work stress. Wald statistics showed that characteristics increasing the odds to be in the "High hostility" cluster, were male sex, NA, and psychiatric history. "High tension" membership was associated with female sex, being single, a sedentary lifestyle, seeking social support, NA, early adverse life-events, depression and anxiety and psychiatric history. "High distress" characteristics were younger age, smoking, sedentary lifestyle, NA, depression and anxiety, early adverse life-events and psychiatric history. Being single, concomitant cardiac diseases, hypercholesterolemia, alcohol use, and seeking social support and avoidance-oriented coping increased the odds to be in the "High work stress" cluster.

Conclusion: This study revealed 4 psychological and 2 social latent risk profiles, all associated with specific determinants. This indicates the importance of a multidimensional psychosocial screening instrument, covering multiple cognitive-emotional and chronic stress factors.

<figure><img src="image_37.png" /></figure>

Note: NA= negative affectivity; SI = Social inhibition

## Abstract 1206

# PREVALENCE AND RISK MARKERS OF EARLY PSYCHOLOGICAL DISTRESS AFTER ICD IMPLANTATION IN THE EUROPEAN REMOTE-CIED STUDY COHORT.

Ivy Timmermans, MSc, Henneke Versteeg, PhD, Mathias Meine, PhD, Cardiology, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands, Edgar Zitron, PhD, Cardiology, Medical University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany, Philippe Mabo, PhD, Cardiology, Centre Hospitalier Universitaire de Rennes, Rennes, Brittany, France, Johan Denollet, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands

**Background:** Evidence on psychological distress in patients living with an implantable cardioverter defibrillator (ICD) is inconclusive. The current study is the first to examine the prevalence and risk

markers of anxiety and/or depression in a large international cohort of European ICD patients.

**Method:** Heart failure patients (N=595) from France, Germany, Spain, Switzerland and the Netherlands participating in the REMOTE-CIED study completed a set of questionnaires 1-2 weeks post ICD-implantation, including the 7-item Generalized Anxiety Disorder scale and the 9-item Patient Health Questionnaire to assess anxiety and depressive symptoms, respectively. Patients' clinical data were obtained from medical records.

**Results:** The prevalence of anxiety was 19% and that of depression 22%, with 29% of patients reporting one or both types of distress. Multivariable logistic regression analysis showed that younger age (odds ratio (OR)=2.2 [95% confidence interval =1.1-4.4]), having a threatening view of heart failure (OR=4.0 [2.3-6.8]), a high level of ICD-related concerns (OR=2.9 [1.7-4.9]), Type D personality (OR=2.5 [1.4-4.4]), poor patient-reported health status (OR=2.2 [1.3-3.8]) and receiving psychological treatment (OR=3.5 [1.2-10.4]) or medication (OR=2.7 [1.4-5.1]) were positively associated with distress, while attending cardiac rehabilitation (OR=0.3 [0.2-0.7]) was negatively associated with distress.

**Conclusion:** A significant subset of European ICD patients reports anxiety and/or depression in the first weeks post ICD-implantation. Patients' psychological characteristics, especially negative perceptions about their illness and treatment, were the strongest associates of distress. Timely identification of these patients is essential as they may benefit from psychological interventions and cardiac rehabilitation in terms of improved quality of life and prognosis.

## Abstract 1397

# ALEXITHYMIA WAS NOT ASSOCIATED WITH THE RISK OF INCIDENT CARDIOVASCULAR DISEASES IN THE SUPPLEMENTATION EN VITAMINES ET MINERAUX ANTIOXYDANTS (SU.VI.MAX) COHORT

Emmanuel Wiernik, PhD, Psychiatry and Neurosciences Center, INSERM UMR 894, Paris Descartes University, Paris, 75014, France, Cédric Lemogne, MD, PhD, Psychiatry, Paris Descartes University, AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, 75015, France, Léopold Fezeu, MD, PhD, Nathalie Arnault, MSc, Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Bobigny, 93017, France, Serge Hercberg, MD, PhD, Public Health, Avicenne Hospital (AP-HP), Bobigny, 93017, France, Emmanuelle Kesse-Guyot, PhD, Pilar Galan, MD, PhD, Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University, Bobigny, 93017, France

**Background:** Alexithymia is a personality construct defined by difficulties in identifying and labelling one's own emotional state. Although it has been suggested to be associated with cardiovascular diseases and mortality, studies are scarce and a causal relationship is questionable. For instance, no study examined the association of alexithymia with the incidence of cardiovascular diseases among a nonclinical population. The aim of this study was to explore this prospective association in participants without cardiovascular history at baseline.

**Methods:** The 26-item Toronto Alexithymia Scale (TAS-26) was completed by 5,586 participants of the French Supplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) cohort (41.4 % of men, mean age ± SD: 52.2 ± 6.3 years). All participants were free from cardiovascular history at baseline. Covariates measured at baseline were age, occupational status, depressive symptoms, smoking status, body mass index, hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia. The cardiovascular events were recorded using self-reported information or clinical visits, and were validated by an independent expert committee. Associations between alexithymia as well as covariates at baseline and cardiovascular events at follow-up
were estimated with hazard ratios (HR) and 95% confidence intervals (CI) computed in Cox regressions.

**Results:** A total of 173 first cardiovascular events were recorded and validated during an average of 11.4 years of followup. After an initial adjustment for age and occupational status, the association between baseline alexithymia and cardiovascular events at follow-up was not significant among men (HR [95% CI] 1.00 [0.99-1.02]) or among women (HR [95% CI] 1.00 [0.97-1.03]). Similar results were found after further adjustment for all covariates. Likewise, exploratory analyses based on TAS-26 subscores showed no association.

**Conclusion:** In this large prospective study, alexithymia and incident cardiovascular events were not associated among a nonclinical population. Greater CV mortality previously associated with alexithymia might result from poorer outcome in individuals with CV diseases rather than from increased incidence. The association between alexithymia and CV diseases in cross-sectional studies might result from the psychological impact of CV diseases.

## Conflict, Support and Optimism

Thursday, March 16 from 3:30 - 4:30 pm

### Abstract 1425

### NOREPINEPHRINE REACTIVITY TO MARITAL SUPPORT: AGE MAKES A DIFFERENCE FOR SYMPATHETIC RESPONSES

Stephanie J. Wilson, PhD, Institute of Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, Brittney E. Bailey, MS, Biostatistics, The Ohio State University, Columbus, OH, William B. Malarkey, MD, Internal Medicine, The Ohio State College of Medicine, Columbus, OH, Janice K. Kiecolt-Glaser, PhD, Institute of Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH

Autonomic responses to stressors become dysregulated with age. However, emotion theories of aging suggest that older adults maintain well-being by proactively avoiding stressors and positively reframing challenges. Studies of couples' age-graded autonomic responses have focused almost exclusively on marital conflict, with mixed results. The present study examines age differences in couples' sympathetic and mood reactivity to a novel interaction, support. A sample of 42 married couples ages 22–77 engaged in separate discussions regarding 1) an issue that required support from the partner, and 2) the partner's issue that required their support. Spouses reported the quality of the interaction; affect ratings and plasma norepinephrine samples were obtained before and after each interaction. Accounting for baseline norepinephrine, older partners had higher norepinephrine than their younger counterparts after receiving poor-quality support (p = .04). Older adults also exhibited a stronger sympathetic response than younger adults to giving high-quality support (p = .04). However, older adults' post-support positive affect did not depend on support quality. Research has shown that marital support becomes increasingly important in older age as social networks shrink and chronic health problems emerge. Consistent with theory, our older adults' positive mood did not vary with support quality. In contrast, their physiological responses diverged from their mood ratings. These results point to discrepancies between affect and physiology that clearly merit exploration, to inform theories of aging and better understand support's health implications. In particular, older couples who receive low-quality support or give high-quality support may face heightened health risks. Indeed, norepinephrine responsiveness has downstream consequences for proinflammatory signaling through NF-κB activation, and thus foreshadows older adults' increased vulnerability to inflammation-based “diseases of aging” and functional decline.

### Abstract 1275

### PARTNER CONFLICT AND SATISFACTION ARE ASSOCIATED WITH HIGH STABLE CARDIO-METABOLIC RISK AT 6 AND 12 MONTHS POSTPARTUM

Kharah M. Ross, PhD, Christine Dunkel Schetter, PhD, Christine Guardino, PhD, Psychology, University of California, Los Angeles, Los Angeles, CA, Calvin J. Hobel, MD, Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA

Partner relationships characterized as relatively low in both positive and negative qualities (i.e., support and conflict) have been associated with greater inflammatory markers toward the end of pregnancy, in a manner consistent with preterm birth risk. This work suggests that partner relationships low in positive and negative features may adversely affect a woman's physiology during pregnancy, and it is likely that effects extend to physiological profiles after birth. The purpose of this study was to assess whether commonly studied positive (satisfaction) and negative (conflict) relationship features, and their interaction, predict cardio-metabolic risk 12 mo after birth. **Methods.** Women were recruited in 5 US communities by the NIH Community Child Health Network following a birth. Analyses focused on 778 women who were in an intimate relationship and had not had a pregnancy metabolic disorder. Partner conflict and satisfaction were assessed by the Dyadic Adjustment Scale (Spanier 1976) at 6 mo postpartum. A cardio-metabolic risk index was calculated using biomarkers collected at 6 and 12 mo postpartum: Mean arterial pressure, waist-hip ratio, glycosylated hemoglobin and total cholesterol:HDL ratio. Linear regression models were used to predict 12 mo postpartum cardio-metabolic risk controlling for 6 mo values. Covariates were weeks between assessments, age, poverty status, pre-pregnancy BMI, parity, alcohol health behaviors, breastfeeding and employment status. **Results.** Higher partner satisfaction predicted lower 12 mo postpartum cardio-metabolic risk. Partner conflict was not independently associated with 12 mo postpartum cardio-metabolic risk. These results were qualified by a significant conflict x satisfaction interaction. Simple slope analyses revealed that when partner satisfaction was low, lower partner conflict was significantly associated with higher 12 mo postpartum cardio-metabolic risk, controlling for 6 mo values and covariates (Fig 1). **In sum,** partner relationships relatively low in both conflict and satisfaction 6 mo after birth were associated with higher cardio-metabolic risk 1-year after birth. These findings extend past work linking a similar partner relationship pattern with greater inflammation during pregnancy and may have implications for future cardiovascular health in mothers. Future research is required to understand mechanisms.

<figure><img src="image_38.png" /><figcaption>**Figure 1.** The interaction between partner conflict and partner satisfaction predicting cardio-metabolic risk at 12 mo postpartum, independent of 6 mo postpartum values, weeks between assessments, age, race/ethnicity, poverty status, parity, and pre-pregnancy BMI.</figcaption></figure>
## POSITIVE AND NEGATIVE FEATURES OF SOCIAL RELATIONSHIPS IN MOTHERS RELATED TO TELOMERE LENGTH 3 YEARS LATER

Jonah E. Price, BA, Psychology, University of California Los Angeles, Los Angeles, CA, Christine Dunkel Schetter, PhD, Christine Guardino, PhD, Psychology, University of California Los Angeles, Los Angeles, California, Madeleine Shalowitz, MD, MBA, Pediatrics, North Shore University Health System, Evanston, Illinois, Sharon L. Ramey, PhD, Psychology and Psychiatry, Virginia Tech Carilion Research Institute, Roanoke, Virginia, Judith Carroll, PhD, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California

**Background:** Positive social relationships are beneficial for health, with more social support predicting reduced disease. Shorter telomere length (TL), which indicates cellular aging, is a valuable biomarker of aging and health risk. Limited research has examined the role of social relationships in cellular aging, though some evidence suggests that more social support is associated with longer telomeres in older adults. Less clear is whether social support may be related to cellular aging in diverse samples. We sought to examine frequency and quality of support from two sources, perceived available support, and negative couple interactions as they relate to buccal cell TL in a multi-ethnic sample of mothers of young children.

**Methods:** Women were recruited following the birth of a child in 5 sites across the U.S. by the Community Child Health Network (CCHN). Analyses were conducted on a majority non-white subsample of 45 mothers (67% Non-White). Interviews during the year after the birth included multi-item scales of frequency and quality of support from the baby's father and from family/friends, negative interactions, and perceived available support, categorized as high or low. Mother's buccal cell TL (bTL) was determined using standard qPCR techniques. bTL values were categorized as short (bottom quartile) and longer (top three quartiles) telomere length.

**Results:** Age-adjusted logistic regression analyses found that mothers with low perceived available support were more likely to have shorter bTL, OR [95%]=8.85[1.2,65.1], p=.03. Father support, whether measured as frequency or satisfaction, was unrelated to mother's bTL. Further analyses suggested that low available support and high negative interactions with the baby's father interacted to predict an increased likelihood of mother's having short bTL (B(SE)=-1.45, p=.05).

**Conclusion:** In this sample of mothers, low perceived available support was related to an increased likelihood of greater cellular aging, as indicated by short TL. These findings suggest that social support during child-rearing years may be protective against cellular aging, while conflictual relationships with the baby's father may be detrimental particularly among women with limited support. The findings highlight the importance of looking at multiple sources of support and both positive and negative social interactions in cellular aging.

## DISPOSITIONAL OPTIMISM PREDICTS INFLAMMATION IN CROSS-SECTIONAL AND LONGITUDINAL ANALYSES

Jos A. Bosch, PhD, Psychology, University of Amsterdam, Amsterdam, NH, The Netherlands, Raphael M. Herr, PhD, MIPH, University of Heidelberg Medical School, Mannheim, BW, Germany, Burkhard Schmidt, PhD, Organisational Psychology, College of International Management Heidelberg, Heidelberg, BW, Germany, Adrian Loerbroks, PhD, Institute of Occupational and Social Medicine, University of Dusseldorf, Dusseldorf, NW, Germany, Nina Schmidt, PhD, Winfried Maerz, PhD, Synlab Academy, Synlab Academy, Mannheim, BW, Germany, Huib van Dis, MSc, Psychology, University of Amsterdam, Amsterdam, NH, The Netherlands, Hans U. Wittchen, PhD, Psychology, Technische Universität Dresden, Dresden, S, Germany

Optimism is associated with better health, and inflammatory activity has been proposed as a potential biological pathway. However, the

evidence implicating inflammation has been adduced largely by cross-sectional studies, and the directionality of the optimism-inflammation relationship has remained unclear. The present analyses therefore tested if optimism predicts inflammatory activity or whether inflammation predicts optimism.

Participants (N=6.890; 59% Female; Mean age 57 years; Range 18-90) were recruited among unselected patients attending GP practices throughout Germany, as part of a larger nation-wide study on cardiovascular risk factors in primary care (DETECT study). Data were collected in 2003, 2004, and 2007. Health and life style data were provided by clinical examination and patient self-reports. Self-report questionnaires were used to assess dispositional optimism (LOT-R) and depression (DSQ). Plasma C-Reactive Protein (CRP) was used as a marker of inflammation.

Cross-sectional analyses replicated prior reports of an inverse relation between optimism and inflammation (Beta >0.057; p<.001), adjusting for age, gender, SES, life style (smoking, alcohol, BMI), and depression. Longitudinal analyses showed that optimism also predicted lower inflammation at one year (applying the same adjustments, as well as inflammation at baseline; p<.01). Optimism still predicted inflammation 4 years later, adjusting for age, gender, SES, and depression (p<.05). Further adjustment for life-style, in particular smoking, rendered this association non-significant. Conversely, inflammation at baseline did not predict optimism measured 1 or 4 years later (p>.40).

The present analyses showed stable longitudinal associations between optimism and inflammation. The results suggested that optimism is a determinant of inflammation, but analyses provided no support for a reverse association.

## Daytime Field Research

Thursday, March 16 from 5:00 - 6:00 pm

## IS FATIGUE AT WORK DUE TO RESOURCE DEPLETION OR REDUCED MOTIVATION? A REAL-TIME INTENSIVE EMA STUDY OF WORKING NURSES.

Derek W. Johnston, PhD, Psychology, Julia Allan, PhD, Cheryl Bell, MSc, Health Psychology, University of Aberdeen, Aberdeen, Aberdeenshire, UK, Barbara Farquharson, PhD, Nursing, Edinburgh Napier University, Edinburgh, Midlothian, UK, Martyn C. Jones, PhD, Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK, Marie Johnston, PhD, Health Psychology, University of Aberdeen, Aberdeen, Aberdeenshire, UK

Background. One of the striking regularities of human behaviour is that a prolonged period of demanding physical, cognitive or emotional activity leads to feelings of fatigue. There are essentially two long standing types of explanation for such fatigue. One emphasises the depletion of a finite resource of physical and psychological energy needed to maintain performance (e.g., Baumeister's ego depletion theory) while the other focuses on motivation and emotion, goal setting and effort (e.g., Hockey's motivational control theory). There are few modern studies of fatigue with frequent comprehensive real time measurement. We examined whether fatigue increased in most people over a prolonged work period and tested predictions from the contrasting theories in a study of subjective fatigue in nurses over two 12 hour shifts.

Method. Using electronic diaries, 100 ward nurses rated fatigue, stress, demand, control and reward every 90 minutes during two work shifts using a mixture of analogue and binary scales. Energy expenditure was measured objectively using the well validated Actiheart system. The determinants of fatigue were tested by predicting fatigue from a) the accumulated values of energy expended, demand, stress, control and reward over the shift and b) from distributed lag models of the same variables at Lag1 (90 minutes prior to the fatigue rating being
predicted).

Results. Virtually all participants showed an increase in fatigue over the work period. Fatigue was typically stable for the first 4 hours at work then increased steadily for the remainder of the shift. Fatigue was not dependent on the energy expended nor the work demands experienced by the nurses. However it was related to the stress experienced earlier in the shift, the control the nurses had over their work and the degree to which the found their work rewarding. Conclusion. This real-time study using valid and intensive measurement offers little support for the resource depletion model of fatigue as neither directly measured energy expenditure nor perceived demands of the work predicted fatigue in nurses over the course of a 12 hour shift. In contrast, the finding that perceived stress, perceived control and perceived reward all predicted fatigue over time, supports a motivational account of fatigue.

## Abstract 1566

# THE RELATIONSHIP BETWEEN WORK SOCIAL SUPPORT AND AMBULATORY BLOOD PRESSURE

Lori Wadsworth, PhD, Romney Institute of Public Management, Wendy C. Birmingham, PhD, Erin Kaseda, N/A, Tyson Wade, N/A, Psychology, Brigham Young University, Provo, Utah

**Background:** Individual social support in the work place is the perception of support and aid that can come from supervisors and coworkers. Organizational social support is the employees' perceptions that they are valued by the organization. Research has demonstrated that such work social support and assistance can aid in reducing stress, and increasing work-related communication and productivity. However, less is known about the specific health benefits of such support, specifically as it relates to cardiovascular-risk-reducing indicators such as ambulatory blood pressure. The current study is an examination of the relationship of these three sources of work social support on ambulatory blood pressure (ABP), which is directly related to cardiovascular health. ABP offers a large number of readings across the day, chronicling daily fluctuations, providing a more complete picture of cardiovascular (CV) functioning.

**Methods:** 92 participants completed work social support questionnaires and wore ambulatory blood pressure monitors for 24 hours. ABP was assessed randomly twice an hour during wake hours and once an hour during sleep. Participants completed diary readings measuring posture, activity level, temperature, location and other factors that impact ABP via Survey Monkey after each ABP reading during the wake hours. These factors were included in our analysis as control variables.

**Results:** Analysis found greater perceived social support received from coworkers was significantly associated with both decreased systolic blood pressure (p = .0008) and diastolic blood pressure (p = .07). In addition, greater perceptions of supervisor social support were significantly associated with decreased systolic blood pressure (p = .02); no significant relationship with diastolic blood pressure was found. Additionally, no significant relationship was found for either systolic or diastolic blood pressure and organizational social support.

**Conclusions:** Participants demonstrated physical benefits in terms of ABP from both coworker and supervisor social support; we did not find similar associations for organizational social support. Supportive relationship with coworkers and supervisor rather than a perception of the organizations' concern for their well-being may be an important factor associated with reduced cardiovascular risk.

## Abstract 1171

# THE IMPACT OF HOSTILITY REDUCTION TREATMENT ON AFFECTIVE RESPONSES TO STRESSORS THROUGHOUT THE DAY

Lisa E. Nilsson, Medical Student, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden, Kathleen M. McIntyre, LMSW, Psychiatry, Columbia University Medical Center, New York City, NY, Peter A. Shapiro, MD, Ethan Gorenstein, PhD, Psychiatry, Columbia University Medical Center, NYC, NY, Jacqueline Mogle, PhD, College of Nursing, Penn State University, University Park, PA, David Almeida, PhD, Center for Healthy Aging, Penn State University, University Park, PA, Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, NYC, NY

**Objective:** Daily stressors are known to be adversely associated with short-term physiological changes that might be related to disease. Affective reactivity has been identified as a possible mechanism by which daily stressors influence health outcomes. We test the hypothesis that there is a direct relationship between negative affect and stressors on a momentary basis and that this relationship can be altered by exposure to a CBT-based hostility reduction program.

**Method:** 158 healthy adults, aged 20-45 and high in hostility were randomized into two groups; one enrolling a 12 week CBT-treatment program, the other assigned a waitlist control condition. Prior to randomization, subjects completed a burst of ecological momentary assessments (EMA) approximately every 20 minutes for 24 hours. At each EMA participants reported on exposure to stressors and current negative affect. After the CBT program an identical burst of 24-hour EMAs took place. Multilevel models (assessments nested in persons) were used to examine whether stressor exposure and affective reactions to momentary stressors changed from pre- to post-treatment in the CBT group. All models controlled for demographic characteristics and trait hostility.

**Results:** Initial t-tests confirmed randomization. The treatment and control groups did not differ on age, gender, ethnicity, or trait hostility (all p's>.49). Participants completed a total of 7,186 surveys across the two EMA bursts. Stressor exposure did not differ across the two conditions (OR=.836; 95% CI: .546-1.280) but was significantly lower at the second burst of EMA assessments (OR=.593; 95% CI: .455-.774). This trend did not differ across treatment groups (p=.743). Exposure to a current stressor was associated with higher negative affect (b=3.609, SE=.224, p<.01) across groups and bursts of EMA. The treatment group demonstrated significantly smaller changes in negative affect in response to stressors at the second burst of EMA compared with the first (p=.026) while this was not true for the control group (p=.606).

**Conclusion:** Negative affect was higher during exposure to stressors than at other times. A CBT-based hostility reduction program reduced this negative affect reactivity, suggesting that this intervention may reduce the risk associated with elevated affective responses to stressors experienced throughout the day.

## Abstract 1530

# INDIVIDUAL DIFFERENCES IN DAILY STRESS PROCESSES AND COGNITIVE HEALTH IN OLD AGE: A MEASUREMENT BURST APPROACH

Robert S. Stawski, PhD, School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, OR, 97330, Stuart W. MacDonald, PhD, Psychology, University of Victoria, Victoria, BC, Canada

Daily stress has been identified as an important modifiable risk factor for health, and more recently cognitive health, in later life. Previous research shows that daily stress predicts poorer performance across multiple cognitive domains including working memory, attention, and episodic memory. However, comparatively little research has considered daily stress effects on response time inconsistency (RTI), trial-to-trial fluctuations in response time latencies. RTI is suggested to be a behavioral indicator of central nervous system (CNS) integrity and
a potentially early marker of normal and pathological cognitive aging. Although RTI may be modulated by both durable (e.g., CNS) and labile (e.g., stress) processes, it is unclear whether both exposure and reactivity to daily stressors are associated with RTI in old age. Using data from a measurement burst design, 111 older adults ($M_{age}=80$ years, Range=66-95) completed a processing speed task on 6 occasions over a 14-day period, repeating this protocol every 6 months for 2.5 years. Participants also completed measures of daily stressful experiences, positive and negative affect, and pain at each assessment occasion. Adjusting for average levels of daily affect (negative and positive) and pain, results indicated that: 1.) individual differences in daily stressor exposure were negatively associated with RTI ($p<.001$), such more frequent stressor occurrence was associate with lower RTI; 2.) individual differences in affective reactivity to daily stressors, both larger stressor-related increases in negative affect and decreases in positive affect, were associated with increased RTI ($ps<.001$); and 3.) individual differences in stressor-related increases in pain were associated with decreased RTI ($p=.02$). These findings suggests that emotional reactivity to daily stressors is an important risk factor for compromised cognitive health among older adults, and may be a candidate target for intervention and prevention efforts. Discussion will focus on the importance of different dimensions of daily stress processes for understanding cognitive health during old age, and the utility of measurement burst designs for examining stress-RTI links.

## Depression and the Heart

Saturday, March 18 from 3:30 - 4:30 pm

### Abstract 1477

THE ASSOCIATION BETWEEN VISUAL, HEARING AND DUAL SENSORY IMPAIRMENT WITH DEPRESSION AND ANXIETY OVER SIX YEARS : FINDINGS FROM THE TROMSO STUDY

Suzanne Cosh, PhD, Lifelong exposures and healthy aging team, University of Bordeaux, Bordeaux, Aquataine, France, Therese von Hanno, PhD, Department of Opthamology, UiT the Artic University of Norway, Tromso, Nordland, Norway, Catherine Helmer, PhD, Lifelong exposures, health and aging team, University of Bordeaux, Bordeaux, Aquataine, France

background: Due to a narrow focus on depression, anxiety has been largely overlooked in the sensory impairment literature. Few studies have examined multiple and single impairments concurrently and there remains an ongoing need to better differentiate the relative impact of single and dual impairments in relation to mental health, especially longitudinally.

Aim: To examine anxiety and depressive symptoms over six years in those with visual, hearing or dual impairments.

Method: A subsample of 2890 adults aged 60 or above from the Tromso study (surveys 5 and 6), a population-based study in northern Norway. Depression and anxiety symptoms were assessed via the HSCL 10 at baseline and six year follow up. Linear mixed models examined the impact of baseline presenting-correction visual impairment, self-reported hearing impairment or dual sensory impairment on anxiety and depression symptoms at baseline and six year follow up.

Results: After adjustment for socio-demographic and physical health covariates, vision impairment was associated with an increase in depression symptoms after six years (b - 0.0218, SE - 0.01, p - .034). Hearing impairment showed cross-sectional associations with both depression (b - 0.1813, SE - 0.07, p - .015) and anxiety (b - 0.1816, SE - 0.08, p - .022), although these were not significant at six years. Dual impairment did not pose an additive risk beyond single impairments.

Conclusion: Older adults with vision and hearing impairments have different mental health profiles and thus varying treatment and intervention needs.

### Abstract 1178

ANXIETY AND DEPRESSIVE SYMPTOMS PROFILES ASSOCIATED WITH SUBCLINICAL ATEROSCLEROSIS AMONG HISPANICS: RESULTS FROM THE PREVENCION STUDY

Diana A. Chirinos, Ph.D., Luz M. Garcini, Ph.D., M.Ph., Christopher A. Fagundes, Ph.D., Psychology, Rice University, Houston, TX, Julio A. Chirinos, M.D., Ph.D., Medicine, University of Pennsylvania, Philadelphia, PA, Josefina Medina-Lezama, M.D., Research Institute, Santa Maria Catholic University, Arequipa, Arequipa, Peru

Depression and anxiety are both important predictors of atherosclerosis and overall cardiovascular risk. The presentation of symptoms, however, can be highly heterogeneous and few studies have examined the impact of comorbid anxiety and depressive symptoms on atherosclerosis. In this study, we used latent class analysis (LCA) to provide (1) a comprehensive characterization of anxiety and depressive symptom profiles in a community-based sample of South-American Hispanic adults, and (2) examine their association with subclinical atherosclerosis, measured by carotid intima-media thickness (IMT). Participants included 445 adults (58.20% female) enrolled in the population-based PREVENCION study. We used LCA to derive symptom profiles using individual items of the Hospital Anxiety and Depression Scale (HADS). Four anxiety and depressive symptom profiles were identified. The "No symptoms" subgroup (43.60% of the sample) was comprised of individuals who did not endorse symptoms of anxiety or depression. The "Anhedonia" subgroup (23.15%) included individuals who endorse primarily symptoms of anhedonia, such as lack of enjoyment in activities or hobbies, inability to laugh and see the funny side of things as well as lack of interest in appearance. The "Primary Anxiety" subgroup (22.02%) included individuals endorsing primarily anxiety symptoms such as restlessness, worry as well as feeling frightened and tense. Finally, the "Anxious Depression" subgroup (11.24%) included individuals endorsing comorbid anxiety and depressive symptoms. Both the "Anhedonia" ($\beta=0.176, p=0.001$) and the "Anxious Depression" ($\beta=0.162, p=0.002$) subgroups were significantly associated with increased carotid IMT. After controlling demographic characteristics, as well as cardiovascular risk factors including smoking, waist circumference, blood pressure, lipids and fasting glucose levels, the association between the "Anhedonia" subgroup and carotid IMT was attenuated, while the association for the "Anxious Depression" subgroup ($\beta=0.076, p=0.040$) remained significant. This is the first study to empirically derive anxiety and depressive symptom profiles in a community-based sample of Hispanics and link them to subclinical atherosclerosis. Future work should examine potential pathways to increased cardiovascular risk, and the impact of tailored interventions on atherosclerosis.

<figure><img src="image_39.png" /><figcaption>Figure 1. Conditional probabilities of endorsement of anxiety and depressive symptoms across subgroups.</figcaption></figure>
Abstract 1124

DEPRESSIVE SYMPTOMS IN PATIENTS WITH AN
IMPLANTABLE CARDIOVERTER DEFIBRILLATOR: IS IT
ALL ABOUT TREATMENT EXPECTATIONS?

Susanne Pedersen, PhD, Psychology, University of Southern Denmark & Odense University Hospital, Odense, Southern Denmark, Denmark, Johan Denollet, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands, Barbara van Veen, MSc, Psychology, University of Southern Denmark, Odense, Southern Denmark, Denmark, Mirela Habibovic, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands

Depressive symptoms are prevalent in 20-25% of patients with an
implantable cardioverter defibrillator (ICD). ICD Patients with
depression have a higher risk for impaired quality of life and premature
death, despite state-of-the art treatment. Little is known about the
influence of patients' treatment expectations on depression. Hence, we
examined whether treatment expectations is as important a correlate as
known correlates of depression in this population (i.e., gender,
personality, heart failure, and ICD shock) at 12 months follow-up. A
subset of first-time implant patients from the WEBCARE study
(n=177; 83.1% men: mean age = 59±10) completed the 10-item
EXPECTations towards ICD therapy (EXPECT-ICD) questionnaire,
the Patient Health Questionnaire (PHQ-9) and the Type D Scale at
baseline and the PHQ-9 at 12 months follow-up. The EXPECT-ICD
questionnaire taps into both negative (e.g. "the device will make me feel
more anxious") and positive treatment expectations (e.g. "the device
will make me feel more confident"). Using hierarchical linear
regression analysis entering the variables of interest in three blocks: (1)
baseline depression, negative and positive treatment expectations, (2)
Type D personality, and (3) gender, heart failure, shocks at 12 months
follow-up, the models accounted for the following variance (adjusted
R-squared) in depressive symptoms: Model 1 = 22.2%; Model 2 =
24.1%; and Model 3 = 23.3%, with a statistically significant change
(p=.042) between models 1 and 2 but not between models 2 and 3
(p=.652) in terms of explained variance. Table 1 displays the
unstandardized and standardized beta coefficients and significance
level for each of the models and its correlates. These results show that
patients' expectations towards ICD treatment is an important correlate
of depression, even when adjusting for baseline depressive symptoms
and other factors known to influence depression outcomes in ICD
patients. These results suggest that it is important to assess patients'
treatment expectations at the time of implant with a view to a dialogue
between patients and health care professionals if these expectations are
generally negative in order to prevent depression.

<table><caption>**Table 1.** Treatment expectations as correlate of depressive symptoms at 12 months post implant</caption><thead><tr><th rowspan="2">Model</th><th colspan="2">Unstandardized Coefficients</th><th>Standardized Coefficients</th><th rowspan="2">t</th><th rowspan="2">p</th></tr><tr><th>B</th><th>Std. Error</th><th>Beta</th></tr></thead><tbody><tr><td>1 (Constant)</td><td>.934</td><td>.913</td><td></td><td>1.023</td><td>.308</td></tr><tr><td>Negative expectations</td><td>.188</td><td>.079</td><td>.202</td><td>2.365</td><td>.020</td></tr><tr><td>Positive expectations</td><td>.020</td><td>.088</td><td>.018</td><td>.222</td><td>.824</td></tr><tr><td>Baseline depression</td><td>.345</td><td>.076</td><td>.376</td><td>4.526</td><td>.000</td></tr><tr><td>2 (Constant)</td><td>.872</td><td>.903</td><td></td><td>.966</td><td>.336</td></tr><tr><td>Negative expectations</td><td>.157</td><td>.080</td><td>.169</td><td>1.967</td><td>.051</td></tr><tr><td>Positive expectations</td><td>.029</td><td>.087</td><td>.027</td><td>.336</td><td>.737</td></tr><tr><td>Baseline depression</td><td>.322</td><td>.076</td><td>.350</td><td>4.228</td><td>.000</td></tr><tr><td>Type D personality</td><td>1.802</td><td>.879</td><td>.162</td><td>2.050</td><td>.042</td></tr><tr><td>3 (Constant)</td><td>.112</td><td>1.301</td><td></td><td>0.86</td><td>.932</td></tr><tr><td>Negative expectations</td><td>.167</td><td>.081</td><td>.180</td><td>2.048</td><td>.043</td></tr><tr><td>Positive expectations</td><td>.025</td><td>.088</td><td>.023</td><td>.283</td><td>.778</td></tr><tr><td>Baseline depression</td><td>.325</td><td>.077</td><td>.353</td><td>4.207</td><td>.000</td></tr><tr><td>Baseline depression</td><td>1.670</td><td>.904</td><td>.150</td><td>1.847</td><td>.067</td></tr><tr><td>Type D personality</td><td>.062</td><td>.635</td><td>.008</td><td>.098</td><td>.922</td></tr><tr><td>Heart failure</td><td>.524</td><td>.843</td><td>.049</td><td>.622</td><td>.535</td></tr><tr><td>Gender</td><td>1.459</td><td>1.254</td><td>.090</td><td>1.163</td><td>.247</td></tr><tr><td>Shocks during 12 months FU</td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

Abstract 1556

ASSOCIATION OF DEPRESSIVE SYMPTOMS WITH HEART RATE VARIABILITY DENSITY IN VETERAN TWINS

Amit J. Shah, MD, MSCR, Epidemiology, Emory University, Atlanta, GA, Rachel Lampert, MD, Internal Medicine, Cardiology, Yale University, New Haven, CT, Jack Goldberg, PhD, Epidemiology, University of Washington, Seattle, WA, J. Douglas Bremner, MD, Psychiatry, Viola Vaccarino, MD, PhD, Epidemiology, Emory University, Atlanta, GA

Introduction: Depression is a known predictor of adverse CVD events, and one proposed mechanism is autonomic dysfunction. Heart Rate Variability Density (Dyx) is a new prognostic biomarker based on multipole/density analysis of the Poincaré plot. Recent studies have shown superior prognostic value compared with traditional time and spectral series metrics for arrhythmia and death. We hypothesized that depressive symptoms are independently associated with reduced Dyx. Methods: The sample included 443 male veteran twins from the Emory Twins studies, recruited from the Vietnam Era Twin Registry. Depressive symptoms were measured with the Beck Depression Inventory-2 (BDI-2), and primarily examined as a continuous exposure. Twins underwent 24-hours of ambulatory ECG monitoring and a Dyx value was calculated for each hour, and the mean value was evaluated as the primary outcome. Multivariate analyses were used to adjust for potential traditional CVD risk factors and generalized estimating equations evaluated familial/genetic confounding and derived within-pair effects.

Results: The mean (SD) age was 56 (3) years, and 14% of the twins had a BDI-2 score of 14 or higher, indicating at least mildly elevated depressive symptoms. The BDI score was inversely associated with the mean Dyx score in a dose-response relationship (see figure, p for trend <0.0001). Each 10-point increase in BDI-2 associated with a 0.18 unit decreased Dyx (p<0.0001). This effect size was reduced to 0.13 when adjusting for traditional CVD risk factors, but still statistically significant (p<0.0001). Further adjustment for familial factors by analyzing depression-discordant twin pairs further reduced the effect size to 0.12 units Dyx per 10-point increase in BDI-2, but it was still significant in adjusted models (p<0.0001). No interaction with zygosity was noted, denoting no genetic confounding.
Conclusion: In veteran twins, we found a highly significant, dose-response association between depressive symptoms and Dyx. This supports an autonomic mechanism by which depression may increase risk of death and arrhythmia.

<figure><img src="image_40.png" /><figcaption>Figure - Association of Depressive Symptoms with Dyx in Male Veteran Twins. Trend p <0.0001</figcaption></figure>

## Drugs and Placebos

Saturday, March 18 from 3:30 - 4:15 pm

### Abstract 1245

### DO ANTIDEPRESSANT SMOKING CESSATION TREATMENTS PRODUCE THE BEST OUTCOME FOR DEPRESSED SMOKERS?

George D. Papandonatos, PhD, Biostatistics, Brown University School of Public Health, Providence, RI, Allison J. Carroll, MS, Amanda R. Mathew, PhD, Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, Ray Niaura, PhD, Health, Behavior, & Society, Johns Hopkins, Bloomberg School of Public Health, Baltimore, Maryland, Robert A. Schnoll, Ph.D., Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, Brian Hitsman, PhD, Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois

**Background:** In a prior systematic review and meta-analysis (Hitsman et al. 2013 Addiction), past major depression (MD) was associated with 17% and 19% lower odds, respectively, of short- and long-term abstinence. Using the same database, this study examined whether antidepressant smoking cessation treatments produce the best outcome for past MD smokers. **Methods:** For each study in our 2013 meta-analysis (N=42), we coded the highest-level experimental arm and the lowest-level placebo/alternative control arm for psychological and pharmacological components. Four factors were coded: 1) standard behavioral treatment (none, self-help, face-to-face); 2) cognitive behavioral mood management (CBMM; none, self-help, face-to-face); 3) standard cessation pharmacotherapy (none, placebo, nicotine replacement therapy [NRT], other); 4) and antidepressant cessation pharmacotherapy (none, placebo, varenicline, serotonergic, catecholaminergic). We used Generalized Estimating Equations, with study ID as the cluster identifier, to predict short- (≤3 months) and long-term abstinence≥6 (months) using the coded treatment components. For the analysis of long-term abstinence, we included separate terms to distinguish standard (<12 weeks) vs. extended ≥12 weeks) treatment length. Analyses controlled for type of MD assessment. **Results:** Short-term abstinence (N=30, n=2,604) was significantly increased by CBMM face-to-face (6 arms; odds ratio [OR]=2.04), NRT (21 arms; OR=2.86), catecholaminergic medication (11 arms; OR=1.36), and varenicline (2 arms, OR=2.92). For long-term outcomes (N=35, n=2,836), only catecholaminergic medication (14

arms; OR=1.49) and varenicline (2 arms, each 12-week duration; OR=2.49) improved abstinence. Neither CBMM (6 arms) nor NRT (22 arms) had an effect on long-term abstinence. **Conclusion:** Varenicline was shown to provide the greatest long-term benefit for smokers with past MD, more than doubling long-term abstinence rates. However, a novel, targeted behavioral treatment model may be needed to produce sustained smoking cessation among these high-risk smokers.

### Abstract 1502

### GENETICS, SHARED, OR NON-SHARED ENVIRONMENT? AN EXPERIMENTAL TWIN STUDY ON PLACEBO ANALGESIA

Katja Weimer, PhD, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, BW, Germany, Nils J. Mönnikes, -, Andreas Stengel, MD, Medical Department, Division of Psychosomatic Medicine, Charité - Universitätsmedizin, Berlin, Berlin, Germany, Paul Enck, PhD, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, BW, Germany
The prediction of patients who could be "placebo responders" is crucial to minimize placebo effects in clinical trials and to maximize them in treatments. Recent studies show that individual experiences, social observational learning as well as genetics influence placebo effects. To investigate the effects of genetics, social as well as individual learning, an experimental pilot study with mono- and dizygotic twins was performed for the first time.

This study employed 48 healthy participants comprising 16 monozygotic (MZ) and 8 dizygotic (DZ) twin pairs (29 ± 8 years; MZ: 12 female, 4 male pairs; DZ: 4 female, 2 male, 2 mixed pairs). To induce an individual learning experience, participants were conditioned on the efficacy of an inert ointment by manipulation of heat pain temperatures on the non-dominant forearm, but were told that it is a potent treatment. After a short period, the conditioned analgesic placebo effect was tested on the dominant forearm, and compared to a control ointment. Pain ratings and expectations about the efficacy of the ointments were rated on a visual analog scale, and psychological questionnaires were assessed.

MZ as well as DZ twins reported significant placebo analgesia through lower pain ratings when the "potent" compared to the control ointment was applied on the dominant forearm (MZ: p=.003; DZ: p=.021). Pain ratings during conditioning and placebo test were significantly related in MZ twins (r=.556, p=.001), but not in DZ twins (p>.05). However, the extent of placebo analgesia was neither significantly related within MZ nor within DZ twin pairs. Assessed expectations and psychological variables partially influenced pain ratings, but not placebo analgesia. Due to the missing relationship in placebo analgesia between MZ and DZ twins, neither genetics nor shared environmental influences seem to affect placebo responses. The partial relations found between conditioning and placebo response as well as between psychological variables and pain ratings point to an impact of individual learning experiences.

This study was supported by a grant of the German Research Foundation (DFG; WE5658/2-1).

### Abstract 1503

### SOCIAL LEARNING OF PLACEBO EFFECTS THROUGH OBSERVATION IN CHILDREN: UNFAMILIAR MODELS ARE MORE EFFECTIVE THAN THE MOTHER

Katja Weimer, PhD, Nazar Mazurak, MD, Christina Wolf, -, Rebekka Meyer, -, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, BW, Germany, Marco D. Gulewitsch, PhD, Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, BW, Germany, Paul Enck, PhD, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, BW, Germany

Studies showed that placebo effects can be elicited through live observation as well as through video-based observation of an effective
treatment in adults. This social learning effect could be important in children as they have fewer own experiences in medical settings. Furthermore, video-based learning would be a practical and efficient application to enhance placebo effects and treatments.

We employed 88 children (11.5 ± 2.6 years, 42% girls) and their mothers (44.3 ± 5.7 years) who were randomized to four interventional and one control group. In a 2x2 study design, children observed a manipulated, effective intervention to reduce heat pain in their mother or an unfamiliar woman (a trained model), either live or in a video. Afterwards, this intervention was conducted with the child: the same inert ointment was applied to two areas on the forearm, and the information was given that one is a control ointment and the other is a pain killer. On both areas, similar heat pain stimuli were applied and rated on a visual analog scale by the child. Placebo analgesia was investigated as the difference in pain ratings between those two areas. Furthermore, heart rate variability (HRV), expectations and psychological questionnaires were assessed.

A 2x2x2 ANOVA (area x model x observation mode) revealed a significant placebo analgesia effect when an unfamiliar model was observed compared to the own mother (F=6.194, p=.015), independently of the mode of observation (F=0.026, p>.05). The control group, which was only told that the ointment is effective, reported a significant placebo analgesia, too (t=2.902, p=.012). First analyses of HRV revealed that in children in the mother-live condition (worst placebo analgesia), parasympathetic parameters (e.g. the high frequency power) were significantly positive correlated with pain ratings, whereas there were no such correlations in children in the unfamiliar-live condition (best placebo analgesia).

Our results show that placebo effects can be induced in children and adolescents through social observational learning as well as verbal suggestions only, whereas observation of unfamiliar persons could be more effective. Relationships between HRV, social aspects of learning and pain ratings will be further explored and presented.

This study was supported by a grant of the German Research Foundation (DFG; WE5658/2-1).

## From Rumination to PTSD

Saturday, March 18 from 2:15 - 3:15 pm

### Abstract 1450

#### RESTING HEART RATE VARIABILITY AND ITS RELATION TO MALADAPTIVE AND ADAPTIVE FACETS OF RUMINATION AND TRAIT ANXIETY

Nicole Feeling, M.A., DeWayne P. Williams, M.A., Psychology, The Ohio State University, Columbus, OH, LaBarron K. Hill, Ph.D., Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, Derek P. Spangler, Ph.D., Psychology, The Ohio State University, Columbus, OH, Julian Koenig, Dr. sc. hum., Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Heidelberg, Germany, Julian F. Thayer, Ph.D., Psychology, The Ohio State University, Columbus, OH

The current study explores the relationships between resting vagally mediated heart rate variability (vmHRV), rumination, and trait anxiety. Perseverative cognition – defined as the repetitive or sustained activation of cognitive representation of a stressor – is a primary mechanism linking psychological vulnerability with poor health and disease. This is outlined in the perseverative cognition hypothesis (PCH). Resting vmHRV is an important indicator of self-regulatory abilities, stress vulnerability, and overall health. Individuals with lower resting vmHRV are more vulnerable to stress, and thus more likely to engage in perseverative cognition. These individuals also experience subsequent negative mental health outcomes such as anxiety. Recent research suggests that rumination – a core mechanism underlying

perseverative cognition – contains (at least) two maladaptive (depressive and brooding) and one adaptive (reflective) facets. However, to date, research has not examined how the association between resting vmHRV may differ between these three facets of rumination, in addition to the role of these facets in linking lower resting vmHRV with greater trait anxiety. These relationships were explored in the current study in a sample of 203 subjects (112 females, mean age = 19.43). Resting vmHRV was assessed via electrocardiogram during a 5-minute-resting period. Self-report scales of trait rumination and anxiety were collected. Significant negative associations were found between resting vmHRV and maladaptive, but not adaptive, forms of perseverative cognition (depressive: r = -.273, *p* < .001; brooding: r = -.175, *p* < .05). Similarly, mediation analyses showed a significant indirect relationship between resting vmHRV and anxiety through maladaptive, but not adaptive, facets of rumination (depressive: B = -3.70 (1.09), [-6.09, -1.80], *p* < .05; brooding: B = -1.01 (0.49), [-2.29, -0.25], *p* < .05). Our findings support the PCH such that those with stress vulnerability, as indexed by lower resting vmHRV, are more likely to engage in maladaptive perseverative cognition and thus experience negative outcomes such as anxiety. Our data also lend a novel outlook on the PCH in that resting vmHRV is not related to reflective rumination and thus, not all forms of perseverative cognition play a role in the link between stress vulnerability and psychological well being.

### Abstract 1292

#### CHALLENGE AND THREAT IMAGERY MANIPULATES HEART RATE AND ANXIETY RESPONSES TO STRESS

Sarah E. Williams, PhD, Jet Veldhuijzen van Zanten, PhD, Gavin P. Trotman, MRes, Mary L. Quinton, BSc, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK, Annie T. Ginty, PhD, Psychology and Neuroscience, Baylor University, Waco, Texas

**Background:** Mental imagery is often used to reduce responses experienced from psychological stress such as elevations in anxiety and heart rate. However, recent research suggests that instead of lowering these stress responses, it may be more beneficial to help individuals view the symptoms as facilitative or helpful. Previous research demonstrates that imagery encompassing responses to stress alongside feeling confident and in control leads to a challenge state and the imagined stress responses are perceived to be facilitative. In contrast, imaging the same stress responses without feeling confident and in control evokes a threat appraisal and debilitative evaluation of these responses. However, research has yet to examine the effects of challenge and threat evoking imagery on the subsequent stress response. **Aim:** Investigate the influence of three types of imagery (i.e., challenge, threat, and neutral) on anxiety and heart rate responses to a speech preparation task. **Methods:** Using a within-subject design, twenty-five females (M age = 23.24; SD = 4.19) imaged three scripts (challenge, threat, and neutral) to manipulate appraisal of a speech preparation task. Following each script, participants completed a speech preparation task. Cognitive and somatic anxiety and self-confidence were assessed prior to the imagery and again prior to each speech preparation trial (immediately following imagery). Heart rate was recorded continuously during resting baseline and speech preparation for each condition. **Results:** Each speech preparation task induced an increase in heart rate and anxiety. Following threat imagery, the speech preparation task was reported as significantly more stressful and threatening than the challenge and neutral conditions (*p*'s < .01). Participants experienced lower levels of confidence (*p* < .001), more negative interpretations of cognitive and somatic anxiety symptoms (*p*'s < .01), and a greater increase in heart rate (*p* < .05) following threat imagery compared with challenge and neutral imagery. **Conclusions:** Findings demonstrate that imagery can alter stress appraisal and the accompanying cardiovascular and psychological responses to standardized stress tasks. Imagery
interventions, acknowledging the stressful nature of events, but
emphasising feelings of confidence and control (i.e., challenge
imagery) may lead to more adaptive coping.

**Abstract 1586**

POST-TRAUMATIC STRESS DISORDER IN PRIMARY CARE

Raz Gross, MD, MPH, Psychiatry, Sheba Medical Center, Tel
Hashomer, Ramat Gan, Israel, Talya Greene, PhD, Department of
Community Mental Health, Faculty of Social Welfare and Health
Sciences, Haifa University, Haifa, Haifa, Israel, Yuval Neria, PhD,
Psychiatry, Columbia University, New York, NY

Post-traumatic stress disorder (PTSD) is associated with comorbid
health conditions, poor functioning, and increased health care
utilization. This presentation combines results from two studies: A
review of the empirical literature on PTSD in primary care settings; and
a systematic review of the utility of case-finding instruments for PTSD
among primary care and high risk populations.

We obtained relevant studies by means of: 1. Electronic search using MEDLINE and PsycINFO (1980--December 2014) databases, and a secondary search through the bibliographies and citations of the studies returned from the electronic search. 2. Electronic search using MEDLINE and the National Center for PTSD's Published International Literature on Traumatic Stress (PILOTS) databases. Study quality was rated using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria.

Current PTSD prevalence in primary care patients ranged widely
between 2% to 39%, with significant heterogeneity in estimates
explained by samples with different levels of trauma exposure. Six
studies found detection of PTSD by primary care physicians ranged
from 0% to 52%. High comorbidity was reported between PTSD and
other psychiatric disorders and with functional impairment or
disability.

Two screens, the PC-PTSD and the PTSD Checklist (PCL) were the best performing instruments. The 4-item PC-PTSD has a positive likelihood ratio of 7.1 (95% CI=5.5-9.2) and a negative likelihood ratio of 0.28 (95% CI= 0.21-0.37) using the same score indicating a positive screen as used by the Department of Veterans Affairs in all of its primary care clinics. The 17-item PCL has a positive likelihood ratio of 9.0 (95% CI=6.2-13) and a negative likelihood ratio of 0.38 (95% CI=0.30-0.38) using scores of around 40 as indicating a positive screen. Clinical implications: Primary care clinics are important locations for detection of PTSD. The finding that PCPs were not successful at detecting PTSD suggests that there should be a more active and consistent screening process in primary care. Administering brief and sensitive screening tools, such as the PC-PTSD or the PCL to trauma-exposed patients, is likely to identify individuals with undiagnosed PTSD. Raising PCPs' awareness of common correlates of PTSD, such as comorbid mental health problems, somatic complaints and functional impairment, may also improve detection.

**Abstract 1599**

ECOLOGICAL MOMENTARY ASSESSMENT OF DAILY
VARIATION IN POSTTRAUMATIC STRESS SYMPTOMS

Quinn M. Biggs, Ph.D., M.P.H., Carol S. Fullerton, Ph.D., Jing Wang, Ph.D., Psychiatry, David Krantz, Ph.D., Medical & Clinical Psychology, Gary Wynn, M.D., Deborah Probe, M.A., Nicole Dacuyan, B.S., Franz Mackenzie, B.S., Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, Russell B. Carr, M.D., Behavioral Health, Walter Reed National Military Medical Center, Bethesda, MD, Robert J. Ursano, M.D., Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD

Assessments of post traumatic stress symptoms (PTSS) and associated
disorders (e.g., PTSD) have traditionally been done retrospectively with
paper and pencil assessments. Retrospective assessment methods are
susceptible to biases in memory, errors in reporting, and do not account

for daily symptom changes. Ecological momentary assessment (EMA)
methods involve repeated sampling of current symptoms and
experiences while respondents are engaged in their normal daily
routines. EMA methods are adaptable to smart technology devices and
may provide the most detailed, reliable, and up-to-date assessments.
This study used EMA methods to assess PTSS and examined the daily
variation in PTSS in individuals with and without PTSD. Forty current
or former U.S. military service members completed PTSS assessments
four times daily for 15 consecutive days. PTSS were measured with
eighteen items from the PCL-5. Daily variation in PTSS was examined
using linear mixed models with daily assessments (level-1) nested
within subjects (level-2). Day of week, PTSD group, and the day of
week x PTSD group interaction term were included in the model.
Analyses tested how PTSS varied across seven days and by weekday
versus weekend within each PTSD group. PTSS varied across the seven
days among participants with PTSD (p < .001), but not among those
without PTSD (p = .354). In pairwise comparisons adjusted for
multiple comparisons, PTSS was lower on Saturday than Monday
through Thursday among participants with PTSD. There was no
significant pairwise comparisons among participants without PTSD.
Similarly, when comparing weekdays and weekends, PTSS were lower
on weekends than weekdays among participants with PTSD (p < .001),
but not among those without PTSD (p = .085). EMA of PTSS was well
tolerated and many participants reported personal benefits from
repeated assessment. Understanding the daily variation of PTSS will
help us better assess and treat individuals with PTSD. Interventions
may be targeted to days/times when symptoms are most critical. These
findings suggest that changes in PTSS are related to daily activities.
Further study using EMA methods to examine the temporal
relationship between daily activities and changes in PTSS is indicated.

Health Behaviors

Saturday, March 18 from 4:45 - 5:30 pm

**Abstract 1396**

PERSEVERATIVE COGNITION AND HEALTH BEHAVIORS:
A SYSTEMATIC REVIEW AND META-ANALYSIS

Daryl B. O'Connor, PhD, Clancy Faye, MSc, Andrew Prestwich, PhD, Psychology, Lizzie Caperon, MSc, Health Sciences, University of Leeds, Leeds, West Yorkshire, UK

Recent developments in stress theory have emphasized the significance of perseverative cognition (worry and rumination) in furthering our understanding of stress-disease relationships. Substantial evidence has shown that perseverative cognition (PC) is associated with somatic outcomes and numerous physiological concomitants have been identified (i.e., cardiovascular, autonomic and endocrine nervous system activity parameters). However, there has been no synthesis of the evidence regarding the association between PC and health behaviors. This is important given such behaviors may also directly and/or indirectly influence health and disease outcomes (triggered by PC). Therefore, the aim of the current review was to synthesise available studies that have explored the relationship between worry and rumination and health behaviors (health risk: behaviors which, if performed, would be detrimental to health; health promoting: behaviors which, if performed, would be beneficial for health). A systematic review and meta-analyses of the literature were conducted. Studies were included in the review if they reported the association between PC and health behavior. Studies identified in MEDLINE or PsycINFO (k = 7504) were screened, of which19 studies met the eligibility criteria. Random-effects meta-analyses suggested increased PC was generally associated with increased health risk behaviors but not health promoting behaviors. Further analyses indicated that increases in rumination, (r = .122), but not reflection (r = -.080, or worry, r = .048) were associated with health risk behaviors. In conclusion, these results
showed that increases in PC are associated with increases in health risk behaviors (substance use, alcohol consumption, unhealthy eating and smoking) that are driven primarily through rumination. These findings provide partial support for our hypothesis that in Brosschot and colleagues (2006) original perseverative cognition hypothesis, there may be scope for additional routes to pathogenic disease via poorer health behaviors.

## Abstract 1338

### APPEARANCE CONCERNS BUT NOT HEALTH PROMOTION MOTIVATES FITBIT-ASSESSED PHYSICAL ACTIVITY BEHAVIOR IN MIDDLE-AGED AND OLDER WOMEN.

William K. Goodman, M.A., Ashley M. Geiger, M.A., Claire Elling, M.A., Reena Corvil, B.A. in progress, Eliana Bernstein, B.A. in progress, Jutta M. Wolf, Ph.D., Psychology, Brandeis University, Waltham, MA

In western culture, emphasis is placed on a woman's appearance. Pursuing these societal ideals, women often exercise for physical attractiveness benefits. However, while primarily studied in younger women, little is known about exercise motivations in older females, nor how those motivations translate into physical activity (PA). Similarly, recent findings emphasize the mental health benefits of exercise behaviors, but little is known whether actual and/or self-reported PA is linked to depressive symptoms in middle and particularly older age.
80 women (59.16 +/-6.54 years) were assessed for PA motivations (physical appearance, weight management, health pressures, positive health / ill-health avoidance), depressive symptoms (CESD-R), physical activity (1 week Fitbit measurements), and self reported activity levels.

Cluster/correlation analysis identified physical appearance, weight management and health pressures as motivators to PA across all ages. Regressions (controlled for age) revealed appearance concerns motivated actual PA (B=134.38, p=.034), while self-reported PA was higher in those reporting more health pressures (B=-125.68, p=.042). Interestingly, at no age were health promotion and ill-health avoidance linked with Fitbit-measured or self-reported PA(p's>.57). Lastly, neither actual (p=.52) nor self-reported PA (p=.73) predicted depressive symptom severity in middle or older age women. Instead, more weight management concerns was significantly linked with higher depressive symptoms independent of physical activity (B=-0.74, p=.04).

Extending findings in younger adults, we observed that appearance, weight management and health pressures are important PA motivators in older female adults as well. However, only physical appearance predicted actual PA behaviors consistently across ages, while pro-health motivations were not significantly linked with actual PA at any age. These findings emphasize the dichotomy between health-related and appearance-related motivations for PA prevalent in western cultures, and negate the popular idea that appearance becomes less health relevant in older age. Interestingly, neither self-reported nor Fitbit-assessed PA were linked to depressive symptom severity. Instead, weight concern-related exercise motivation was linked with depressive symptoms, thus presenting a second age-independent health risk factor for women.

## Abstract 1490

### WHICH EXERCISE OR BEHAVIORAL INTERVENTIONS ARE MOST EFFECTIVE FOR TREATING FATIGUE IN PEOPLE WITH MULTIPLE SCLEROSIS (MS)? A DETAILED SYSTEMATIC REVIEW WITH NETWORK META-ANALYSIS

Rona Moss-Morris, PhD, Health Psychology, King's College London, London, Greater London, United Kingdom, Anthony M. Harrison, PhD, Psychology, KCL, London, London, UK, Reza M. Safari, PhD, 2Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland, Scotland, Tom Mercer, PhD, School of Health Sciences, Queen Margaret University, Edinburgh, Scotland, UK, Sam Norton, PhD, Health Psychology,

Claire White, PhD, Health and Social Care Research Division, King's College London, London, London, UK, Marietta van de Linden, PhD, Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland, UK, Sarah Thomas, PhD, Clinical Research Unit, Bournemouth University, Bournemouth, Dorset, UK

Background: Fatigue is one of the most common and disabling symptoms of Multiple Sclerosis (MS). There are no recognised biomedical treatments for MS fatigue. Most patients' fatigue remains untreated. The aim of this study was to determine the most promising exercise and behavioral treatments for MS fatigue using a network meta-analysis of all relevant trials conducted to date.

Methods: All randomised and quasi-randomised controlled trials of exercise and behavioral interventions for MS with self-reported fatigue as outcomes were included. 17 databases were searched, papers hand-searched, and relevant authors contacted. Studies were screened and assessed for eligibility by two independent reviewers. Information was extracted according to Cochrane and TIDieR guidance and statistical data were double extracted. Effect sizes were expressed as standardised mean differences (SMD) between groups at the post-intervention assessment calculated as hedge's g. Statistical heterogeneity between study effect sizes was quantified using the I2 statistic and funnel plots with Eggers test. The network meta-analysis was estimated using restricted maximum likelihood by the mvmeta command and network packages.

Results: 1880 abstracts and 227 full text articles were screened. 82 studies with a total of 179 treatment arms were included in the meta-analysis. Categories of similar interventions were created and compared (5 exercise, 6 behavioral, and 2 combined). SMD ranged from -0.07 (-0.33, 0.47) for resistive exercise to -0.61 (-0.85,-0.37) for exercise with more than one overload component and -.91 (-1.37, -0.45) for balance exercise. Cognitive behavioural therapy (CBT) was the most effective behavioral treatment (SMD=-.61; 0.85, -0.37) with CBT for fatigue having higher estimates SMD=-.77 (-1.21, -.33) than CBT for distress SMD=-.56 (-.88, -.23). Combining behavioural and exercise programs showed no added benefits SMD=-.38 (-0.63,-0.13). Energy conservation studies had the highest level of evidence but SMD was small .26 (-0.54,0.02).

Discussion: Balance and exercise programmes with more than one overload/progression component and CBT for fatigue are the most promising interventions for MS fatigue. There was substantial heterogeneity within most groupings. Large clinical and cost effectiveness trials of these interventions are needed. (PROSPERO 2016:CRD42016036671).

## Irritable Bowel Syndrome and the Brain

Saturday, March 18 from 4:45 - 5:30 pm

## Abstract 1498

### RESTING STATE FUNCTIONAL CONNECTIVITY IN IRRITABLE BOWEL SYNDROME

Michiko Kano, MD, PhD, Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan, Patrick Dupont, PhD, Laboratory for Cognitive Neurology, University of Leuven, Leuven, Flemish Brabant, Belgium, Joe Morishita, MD, PhD, Tomohiko Muratsubaki, PhD, Behavioral Medicine, Tohoku University, Sendai, Miyagi, Japan, Lukas Van Oudenhove, MD, PhD, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Flemish Brabant, Belgium, Shin Fukudo, MD, PhD, Behavioral Medicine, Tohoku University, Sendai, Miyagi, Japan

**Introduction:** Resting-state functional magnetic imaging (rs-fMRI) investigates synchronous activations between regions of the brain that are spatially distinct and may provide the functional architecture in
health and diseases. The aim of the study was to characterize the resting-state functional connectivity in irritable bowel syndrome (IBS) using graph theoretical analysis.

**Methods:** The study included sex and age matched 35 IBS patients and 35 controls. The rs-fMRI data was pre-processed using SPM8. Forty five ROIs were defined based on the brain matrix and default mode network previously demonstrated. The time series of each ROI was extracted and partial correlations between the ROIs were calculated. Using graph analysis based on the Fisher r-to-z transformed partial correlations with a weighted network, the following network measures were computed: (1) node strength, which is number of the connections the node has. (2) the clustering coefficient, which is related to the connectedness of neighbouring nodes, (3) the average path length; a measure of global connectedness, which is the average length of the shortest connection between all pairs of nodes, (4) global efficiency, which is the inverse of the average shortest path, (5) between centrality, which is the fraction of shortest paths within the graph that pass through a node.

**Results:** There was a significant difference in IBS and controls in the partial correlation coefficient between right amygdala and left precuneus (p<0.047, FDR corrected). The averaged node strength, normalized clustering coefficient, normalized path length, normalized global efficiency, and normalized between centrality were 8.985, 1.148, 0.778, 0.959, 1.03 for controls, and 8.89, 1.17, 0.567, 0.963, 1.002 for IBS group. Permutation test did not show significant difference between controls and IBS in any of the graph measures.

**Conclusion:** The global network measures by graph analysis were very similar between IBS and controls. However, local connectivity is significantly different between IBS group and controls. Studies indicate that the people with stress-related disorders (anxiety disorders and/or depression) show strong rsfMRI connectivity between amygdala and precuneus. Comorbidity of tendency of stress-related anxiety trait and depression may contribute to the stronger rsfMRI partial connection in IBS group.

**Abstract 1500**
IMPAIRED TOP-DOWN REGULATION TO HYPOTHALAMIC-PITUITARY-ADRENAL AXIS FROM THE PREGENUAL ANTERIOR CINGULATE CORTEX IN PATIENTS WITH IRRITABLE BOWEL SYNDROME

Michiko Kano, MD, PhD, Frontier Research Institute for Interdisciplinary Sciences, Tomohiko Muratsubaki, PhD, Mao Yagihashi, MA, Joe Morishita, MD, PhD, Motoyori Kanazawa, MD, PhD, Behavioral Medicine, Tohoku University, Sendai, Miyagi, Japan, Patrick Dupont, PhD, Laboratory for Cognitive Neurology, Lukas Van Oudenhove, MD, PhD, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Flemish Brabant, Belgium, Shin Fukudo, MD, PhD, Behavioral Medicine, Tohoku University, Sendai, Miyagi, Japan

**Introduction:** Stress is a known trigger of irritable bowel syndrome (IBS) and hyper-responsiveness of the Hypothalamus-pituitary-adrenal (HPA) axis has been reported in IBS patients. The aim of this study is to investigate the brain function associated with HPA axis responsiveness between controls and patients with IBS.

**Methods:** This study included age and sex matched 29 healthy controls and 26 IBS patients of non-constipated subtype. In the first experiment, corticotropin-releasing hormone (CRH) 2µg/Kg was administrated intravenously during rectal barostat measuring gut motility. Plasma adrenocorticotropic hormone (ACTH) and cortisol were examined from blood samples just before (0) and 15, 30, 60, and 120 min after CRH administration. In the second experiment, the blood oxygen level dependent (BOLD) signal response to mechanical rectal distension was measured among the same subjects by functional magnetic resonance imaging (fMRI). A whole-brain voxel-based analysis was conducted at a voxel-level threshold of p (FWE-corrected) < 0.05, which was adopted for the between-group regression analysis with individual area under the curve of ACTH response (ACTH-AUC).

**Results:** The increase in ACTH relative to pre-infusion time point was significantly higher in IBS patients compared to healthy controls subjects at 30 min after infusion (p=0.04). In cortisol response to CRH, a significant difference between groups in male subjects and male IBS patients had lower basal cortisol levels (p=0.012). In the brain fMRI study, a significantly greater negative association between ACTH-AUC value and BOLD response during rectal distention was observed in the bilateral pregenual anterior cingulate cortex (pACC) and right superior frontal gyrus in the control group versus the IBS group (p<0.05, FEW-corrected).

**Conclusion:** Greater ACTH reactivity in IBS patients than in controls is consistent with previous reports. The hyper-reactivity may be related to upregulation of CRH receptor 1 in the anterior pituitary of IBS patients. Human neuroimaging studies and animal studies demonstrated that the medial prefrontal cortex (mPFC) and adjacent pACC regulate the function of the HPA axis in a top-down fashion. Our results suggest that mPFC/pACC top-down inhibitory regulation of the HPA axis is impaired in IBS.

**Abstract 1337**
ALEXITHYMIC FAMILIES? HIGHER LEVELS OF ALEXITHYMIA IN ADOLESCENTS WITH INFLAMMATORY BOWEL DISEASE VS ADOLESCENTS WITH CYSTIC FIBROSIS

Sergio Oteri, PhD Clin. Psychologist, Experimental and Clinical Medicine Department - University of Messina, Giuseppe Magazzù, MD, Pediatrics Department, University of Messina, Messina, Sicily, Italy, Salvatore Pellegrino, MD, Stefano Costa, MD, Pediatrics, Policlinico "G. Martino", Messina, Sicily, Italy

**Introduction:** Several psychosomatic hypotheses have contributed on considering the Inflammatory Bowel Disease as psychosomatic diseases in which specific patterns of personality (alexithymia, symbolic poorness, negative affectivity, social inhibition, tendency to perfectionism), specific defense mechanisms and coping strategies (aimed at the removal and avoidance of emotional experience) (McCombie A.M., 2013). Some trigger events, associated with certain personality characteristics, could cause a difficulty of symbolic processing and the activation of neurophysiological circuits of the intestinal inflammation (Wood et al, 1987 and 1989).

**Aim:** The finality of the study is to compare the levels of alexithymia in adolescent patients (14-18 years), diagnosed with IBD (Inflammatory Bowel Disease), both Crohn's disease and Ulcerative Colitis, and their parents vs a control group of adolescent patients with cystic fibrosis (CF), matched for age and gender.

**Material and methods:** We used medical chart to collect meaningful clinical data of the patients such as CCDAI (Crohn's Disease Activity Index) PUCAI (Pediatric Ulcerative Colitis Activity Index), ongoing therapy, complications, comorbidities, etc. Furthermore we used BFQ-1 (Big Five questionarie-1), CISS (Coping Inventory for stressfull Situations), PSI (Parenting Stress Index) and TSIA (Toronto Structured Interview for Alexithymia). We enrolled a total of 232 subjects so divided: for the sample group, 41 patients with IBD diagnosis and 78 parents, and 39 patients with CF and 74 parents.

**Results:** We have found significant differences between the two group. Patients with IBD and their parents have higher levels of alexithymia than patients with CF and their parents. In the scores of the BFQ-1 we have found higher levels in the scale of *Scrupulousness* in the patients with IBD and higher levels of *Impulse Control* in the IBD's parents in comparison with CF' parents. Furthermore the levels of parent's stress are higher in IBD's parents. In the two groups there are not significant differences in the use of coping strategies.

**Conclusion:** The results show a strict link between alexithymia of IBD adolescents and their parents and specific psychological characteristics that could contribute to figure out the etiopathology of IBD.
## References:

1. E.M. Lennon, N. Maharshak, H. Elloumi, L. Borst, S.E. Plevy, A.J. Moeser, *Early Life Stress Triggers Persistent Colonic Barrier Dysfunction and Exacerbates Colitis in Adult IL-10-/-Mice*, Inflamm Bowel Disease, 2013.

2. Gray W. N., Graef D. M., Schuman S. S., Janicke D. M., and Hommel K., *Parenting stress in pediatric IBD: Relations with child psychopathology, family functioning, and disease severity*, Journal Dev Behaviour Pediatrics, 2013.

3. McCombie A. M., R. T. Mulder, R. B. Gearry, *How IBD patients cope with IBD: A systematic review*, Journal of Crohn's and Colitis N.7, 2013.

4. Wood, B., Watkins, J. B., Boyle, J. T., Nogueira, J., Zimand, E., & Carroll, L., *Psychological functioning in children with Crohn's disease and ulcerative colitis: Implications for models of psychobiological interaction*. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 1987.

# Let's Be Positive

Thursday, March 16 from 5:00 - 6:00 pm

## Abstract 1323

# THE INTERACTION BETWEEN STRESS AND POSITIVE AFFECT IN PREDICTING MORTALITY

Judith A. Okely, MSc, Psychology, University of Edinburgh, Edinburgh, Scotland, UK, Catharine Gale, PhD, Medicine, University of Southampton, Southampton, England, UK

Objective: There are two mechanisms by which positive affect might influence mortality risk. Positive affect could impact directly on physiological and behavioural processes associated with good health; additionally, positive affect could protect against the health harming effects of psychological stress. If this second mechanism plays a role, then the association between high positive affect and longevity should be most apparent among individuals also reporting higher levels of stress. Here, we test this stress-buffering hypothesis.

Methods: The sample consisted of 8,542 participants aged 32-86 from the National Health and Nutrition Examination Survey Epidemiological Follow-up Study (NHEFS). We used Cox proportional hazards regression to test for an interaction between positive affect and stress in predicting mortality risk over a 10 year follow up period.

Results: the interaction between positive affect and stress was significant (p <0.001), we found a stronger association between positive affect and mortality risk in people reporting higher levels of subjective stress. This interaction remained significant following adjustment for demographic variables, health behaviours and depressive symptoms. In the fully adjusted model, a standard deviation increase in positive affect score was associated with a 16% (HR = 0.84; 95% CI = 0.75, 0.95) reduction in mortality risk among participants that reported high levels of stress. The association between positive affect and mortality risk was not significant among participants that reported low levels of stress (HR = 0.98; 95% CI = 0.89, 1.08).

Conclusion: Our results support the stress-buffering model of the association between positive affect and health. Positive affect may have the greatest impact on health among individuals that experience higher levels of stress.

## Abstract 1102

# POSITIVE EMOTION VARIABILITY IS ASSOCIATED WITH CIRCULATING INFLAMMATORY MARKERS

Dusti R. Jones, MS, Biobehavioral Health, Pennsylvania State University, State College, PA, Joshua M. Smyth, PhD, Biobehavioral

Health/ School of Medicine, Pennsylvania State University, State College, Pennsylvania, Martin J. Sliwinski, P, Human Development and Family Studies, Christopher G. Engeland, PhD, Biobehavioral Health, College of Nursing, Nancy L. Sin, PhD, Center for Healthy Aging/ Biobehavioral Health, Pennsylvania State University, STATE COLLEGE, PA, Richard B. Lipton, MD, Psychiatry and Behavioral Sciences/ Neurology / Epidemiology and Population Health, Mindy J. Katz, MPH, Neurology, Albert Einstein College of Medicine, Bronx, NY, Dave Almeida, PhD, Human Development and Family Studies/ Center for Healthy Aging, Pennsylvania State University, STATE COLLEGE, PA, Jennifer E. Graham-Engeland, PhD, Biobehavioral Health/ Center for Healthy Aging, Pennsylvania State University, University Park, PA

Emotional variability (EV; the extent to which individuals vary in emotional states over time) is associated with health-related indicators (e.g., global subjective health, diurnal cortisol, heart rate variability). EV has broadly been related to worse health indicators, with some indications that associations are stronger for men, older individuals, and positive emotion variability (PEV). Moreover, previous research has suggested a curvilinear relationship between EV and health, with both very high and very low EV relating to worse health indicators. In a diverse sample of participants (N=251; aged 25-65; 65% female; 62% Black; 25% Hispanic), we examined if PEV and negative emotion variability (NEV) exhibited linear or curvilinear associations with circulating inflammatory markers (IL-1β, IL-6, TNF-α, IFN-γ, and CRP), and if age or gender moderated these associations. Emotional states were assessed using ecological momentary assessments (EMA) five times per day for two weeks, with a blood draw at the end of the EMA burst to assess inflammatory markers. Person average standard deviations of emotional states assessed in the second week of EMA were used to index EV. As emotion assessments proximal in time to the blood draw appear more robustly associated with inflammatory biomarkers, only week two emotion data was utilized. Marital status, income, ethnicity, BMI, and grand-mean centered emotion were covariates. There were no significant linear or curvilinear associations between NEV and biomarkers (p's>.16). PEV exhibited curvilinear (but no linear) associations with TNF-α and IFN-γ (p's<.05), such that those with lower PEV and higher PEV exhibited higher TNF-α and IFN-γ. Gender did not moderate NEV or PEV relationships. Age, however, interacted with linear PEV; for older adults, greater PEV was more robustly associated with greater IL-1β, IL-6, and TNF-α (p's<.05), and marginally greater IFN-γ and CRP (p's<.09). These data are the first to our knowledge to suggest that PEV is associated with inflammation, and are consistent with emerging evidence that PEV, but not NEV, may be associated with indicators of poor health. These associations may be stronger for older participants. Because inflammation can contribute to and exacerbate chronic illnesses, future research should examine if PEV causally relates to inflammation and health outcomes.

## Abstract 1618

# DISPOSITIONAL OPTIMISM AND DEPRESSIVE SYMPTOMS SHOW INDEPENDENT AND INTERACTIVE ASSOCIATIONS WITH INFLAMMATION

Jos A. Bosch, PhD, Psychology, University of Amsterdam, Amsterdam, NH, The Netherlands, Raphael M. Herr, PhD, MIPH, University of Heidelberg Medical School, Mannheim, BW, Germany, Adrian Loerbroks, PhD, Institute of Occupational and Social Medicine, University of Dusseldorf, Dusseldorf, NW, Germany, Burkhard Schmidt, PhD, Organisational Psychology, College of International Management Heidelberg, Heidelberg, BW, Germany, Huib van Dis, MSc, Psychology, University of Amsterdam, Amsterdam, NH, The Netherlands, Nina Schmidt, PhD, Winfried Maerz, PhD, Synlab Academy, Synlab Academy, Mannheim, BW, Germany, Hans U. Wittchen, PhD, Psychology, Technische Universität Dresden, Dresden, S, Germany
Although low optimism is a diagnostic feature of depression, theory and clinical observation emphasize important distinctions. If indeed partly separable, this may imply that depression and low optimism could independently impact biology. A further implication is the possibility of interactive effects, e.g., whereby the biological impact of depression could be modified by optimism. To address these questions, the present study aimed to determine the independent and interactive effects of depressive symptoms and optimism on inflammation.

Analyses drew on a cross-sectional sample of 6,980 unselected primary care patients (41% male; mean age 57 years; range 18-90) attending GP practices throughout Germany (the DETECT-study). Health and life style data were collected through clinical examination and patient self-report. Dispositional optimism (LOT-R) and depression (DSQ) were also assessed. Plasma C-Reactive Protein (CRP) was used as a marker of inflammation. Regression models were adjusted for age, sex, SES, life style (alcohol, smoking, BMI), and physical health.

Depression and optimism showed the expected moderate association (B=-0.39, p<.001). Also in line with prior research, depression and optimism were each associated with inflammation, whereby patients in the highest depression or optimism quartile had, respectively, 23% higher or 18% lower CRP levels (as compared to the lowest quartile; p<.001). Although mutual adjustment attenuated these associations, each parameter remained significantly (p<.005) associated with inflammation: when added together the variance explained (delta-R2) was approximately 50% higher than the delta-R2 for each parameter separately. Subsequently adding the interaction term to the model, which already included both main effects, contributed an equal amount of delta-R² (p<.001) as the main-effects, i.e., cumulatively doubling the variance explained by depression and optimism.

In summary, higher depression and lower optimism independently accounted for individual differences in inflammation. Moreover, to our knowledge the present study is the first to demonstrate an additional interactive effect, whereby hopeful future expectations moderated inflammation among individuals with elevated depressive symptoms.

## Abstract 1327

# POTENTIAL MECHANISMS LINKING POSITIVE EMOTIONS AND HEALTH: IS PSYCHOLOGICAL WELL-BEING RELATED TO THE ADOPTION OF A HEALTHIER LIFESTYLE OVER TIME?

Claudia Trudel-Fitzgerald, Ph.D., Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, Julia K. Boehm, Ph.D., Department of Psychology, Chapman University, Orange, California, Shelley S. Tworoger, Ph.D., Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, Laura D. Kubzansky, Ph.D., MPH, Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

**Methods:** Women from the Nurses' Health Study cohort who were free of chronic conditions at the time they reported levels of well-being were included in the analytic samples. Well-being was assessed in 1992 (happiness N=38,054, mean age 56.7 years) and in 2004 (optimism N=34,700, mean age 68.4 years). Health-related behaviors (i.e., exercise, body mass index, diet, alcohol consumption, smoking) were self-reported in 1992, and every 4 years until the last assessment available (2010). A composite measure of lifestyle was derived from these 5 health-related behaviors; the endorsement of recommended levels for ≥4 out of 5 healthy behaviors was categorized as a healthy lifestyle. Logistic regressions estimated the odds ratio (OR) and their 95% confidence intervals (CI) of reporting a healthy lifestyle at the end of follow-up. Models were adjusted for potential confounders (i.e., demographics, recent physical exam, anxiety and depression symptoms). Secondary analyses were stratified by baseline level of lifestyle (healthy vs. unhealthy).

**Results:** Compared to women with low levels of happiness, those with moderate and high levels had a 12% and 33% greater likelihood,

respectively, of reporting a healthy lifestyle 18 years later (OR=1.12, 95% CI=1.04-1.20 and OR=1.33, 95% CI=1.25-1.41). Similarly, women with moderate and high (vs. low) levels of optimism were 19% and 38% more likely, respectively, to report a healthy lifestyle 6 years later (OR=1.19, 95% CI=1.13-1.26 and OR=1.38, 95% CI=1.31-1.45). No interaction between baseline lifestyle and psychological well-being was evident ($p_{interaction} > .05$), suggesting that the relationship of happiness and optimism with future lifestyle was similar regardless of women's baseline set of health behaviors. Associations remained significant, although somewhat attenuated, after controlling for anxiety and depression symptoms in the models.

**Conclusions:** In midlife women, both happiness and optimism were related to a greater likelihood of having a healthy lifestyle 6 to 18 years later, independent of levels of psychological distress and other potential confounders. Future clinical studies should investigate whether enhancing psychological well-being may truly lead to healthier lifestyles, in order to contribute to strategies aimed at preventing the development of cardiometabolic or other chronic diseases.

# Metabolic Syndrome, Diabetes and Mental Health

Friday, March 17 from 2:45 - 3:45 pm

## Abstract 1166

# SOCIOECONOMIC STATUS AND PREVALENCE OF METABOLIC SYNDROME AND RISK FACTORS: THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL)

Tasneem Khambaty, PhD, Neil Schneiderman, PhD, Maria M. Llabre, PhD, Ashley E. Moncrief, PhD, Psychology, University of Miami, Miami, FL, Martha Daviglus, MD, PhD, Preventive Medicine, University of Illinois, Chicago, IL, Gregory A. Talavera, MD, MPH, Health Promotion and Behavioral Science, San Diego State University, San Diego, CA, Carmen R. Isasi, MD, PhD, Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, Linda C. Gallo, PhD, Psychology, San Diego State University, San Diego, CA, Samantha A. Reina, MS, Psychology, Tali Elfassy, MSPH, Epidemiology, Denise Vidot, PhD, Psychology, University of Miami, Miami, FL, Gerardo Heiss, MD, PhD, Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Little is known about factors that contribute to Hispanics/Latinos having a disproportionately higher risk of the metabolic syndrome (MetSyn) than other race/ethnicity groups. Given that socioeconomic status (SES) has been inversely linked to MetSyn in other groups, we examined the association of SES with MetSyn and its components among Hispanic/Latino individuals of diverse backgrounds living in the US.

Participants were 14,029 individuals, comprising a community based cross-sectional probability sample derived from four U.S field centers [mean age: 41 years, 51% female]. SES proxy variables, income (income brackets), education (years of school completed), and employment status (full-time employed versus unemployed) were examined as individual independent variables, and as indicators of a latent variable. MetSyn was defined using 2009 harmonized guidelines. MetSyn components, waist circumference (cm), triglycerides (mg/dL), HDL-cholesterol (md/dL), systolic and diastolic blood pressure (mmHg), and fasting plasma glucose (mg/dL) were also examined individually as continuous dependent variables.

Multivariate regression analyses (adjusted for age, sex, field center, Hispanic/Latino background, nativity/length of residence in the U.S, and health insurance) revealed that higher income (OR = 0.96, 95% CI = 0.93-0.98, *p* < .001), higher education (OR = 0.97, 95% CI = 0.96-0.98, *p* < .001), and full-time employment versus unemployment (OR = 0.76, 95% CI = 0.67-0.85, *p* < .001) were associated with decreased odds of having MetSyn, as was SES when examined as a latent variable
(OR = 0.91, 95% CI = 0.85-0.96, p < .001). SES proxy and latent variables were associated in the expected directions with all MetSyn components (ps < .007) except diastolic blood pressure. The association of income with MetSyn was found for women but not men (p = .002), and those with but not without current health insurance (p = .003), while the association of education with MetSyn was also found among women but not men (p = .009).

Overall, higher SES is associated with a 4-24% decreased odds of having MetSyn among Hispanics/Latinos, with effect modification by sex and by health insurance status. Public health research and policy should increase focus on relationships among SES, women's health, health insurance, and improved diabetes prevention and cardiometabolic health.

## Abstract 1092

### ETHNICITY AND EXCESS MORTALITY IN SEVERE ILLNESS: A COHORT STUDY

Jayati Das-Munshi, PhD MSc MRCPsych MBBS BS, Health Services & Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, London, UK, Chin-Kuo Chang, PhD, Psychological medicine, KCL, London, London, UK, Rina Dutta, PhD, Psychological medicine, Craig Morgan, PhD, Health Services & Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, London, United Kingdom, James Nazroo, PhD, Centre on Dynamics of Ethnicity, University of Manchester, Manchester, Manchester, United Kingdom, Robert Stewart, PhD, Psychological medicine, Martin Prince, MD, Health Services & Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, London, United Kingdom

**Background:** Excess mortality in severe mental illnesses [SMI] (schizophrenia-spectrum and bipolar disorders) is well described however little is known about this inequality in ethnic minorities.

**Objective:** To establish cause-specific mortality in an ethnically diverse cohort of individuals with SMI.

**Methods:** We identified a cohort of 25871 individuals with a valid SMI diagnosis (1st January 2007 to 31 December 2014), using a case-registry from a secondary mental healthcare provider covering 1.36 million people in the UK. All-cause and cause-specific mortality by ethnicity, standardised by age and gender to the population of England & Wales in 2012, was determined. Risk factors for mortality in SMI were assessed using regression methods.

**Findings:** There were 1,767 deaths within the cohort (14.6%). Compared to the general population, age and gender-standardised mortality ratios [SMRs] in the SMI population were high; Suicide: (SMR 7.65, 95% confidence interval [CI]:6.43-9.04), non-suicide unnatural-cause mortality: (SMR 4.01, 95%CI: 3.34-4.78), respiratory disease: (SMR: 3.38, 95%CI:3.04-3.74), cardiovascular disease: (SMR 2.65, 95%CI:2.45-2.86), neoplasms: (SMR 1.45, 95%CI:1.32-1.60). SMRs were broadly similar by ethnicity, although a lower SMI for neoplasm-mortality in the South Asian SMI group (SMR 0.49, 95%CI:0.21-0.96) was evident.

Within the SMI cohort, Hazard Ratios for all-cause mortality were lower in most ethnic minority groups relative to the White British group; (taking the White British group with SMI as reference) adjusted Hazard Ratios (HRs) for mortality were: 0.67(95% CI 0.56, 0.81) (Black Caribbean); 0.43(95% CI: 0.30, 0.64)(Black African); 0.73(95% CI 0.51, 1.04) South Asian and 0.88(95% CI 0.62, 1.25)Irish (p<0.001) at 7 years+ follow up. There were similar trends by ethnicity for natural-cause and unnatural-cause mortality and associations persisted despite taking into account the possibility that ethnic minorities were more likely to migrate out of the cohort.

**Interpretation:** Relative to the general population, people with SMI experience excess mortality, irrespective of ethnicity. Within a cohort of people with severe mental illness, some ethnic minorities experienced reduced mortality compared to the reference White British

population. This may be due to socio-environmental factors which require further exploration.

## Abstract 1030

### SPECIFIC SYMPTOMS OF DEPRESSION AND INCIDENT TYPE 2 DIABETES: RESULTS FROM THE EMOTIONAL WELL-BEING, METABOLIC FACTORS, AND HEALTH STATUS STUDY

Sonya S. Deschênes, Ph.D., Rachel J. Burns, Ph.D., Norbert Schmitz, Ph.D., Psychiatry, McGill University, Montreal, Quebec, Canada

Though depression is a well-established risk factor for type 2 diabetes (T2D), depression is a multifaceted construct and there is substantial heterogeneity in the reported strengths of association between depression and incident T2D. Examining individual depressive symptoms has recently been suggested as a way to better understand depression heterogeneity and health outcomes. For instance, individual depressive symptoms differ in their associations with functional impairment and inflammatory biomarkers. The goal of the present study was to explore the independent associations between specific depressive symptoms and the risk of incident T2D. This study was a secondary data analysis of the Emotional Well-Being, Metabolic Factors and Health Status Study and included 2521 adults aged 40-69 years without diabetes at baseline. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and data on metabolic risk factors (hypertension, impaired glycaemic control, low high-density lipoprotein cholesterol, elevated triglycerides, and central obesity) were collected. Participants were queried about diagnosed T2D by telephone interview approximately 4.6 years after baseline. Analyses adjusted for age, sex, education, and marital status. A series of logistic regression analyses were first conducted to examine associations between each PHQ-9 item (range=0-3) and incident T2D in separate models, followed by analyses that additionally adjusted for the sum of the remaining PHQ-9 items. A final set of analyses additionally adjusted for metabolic factors. Results showed that although most symptoms were associated with incident T2D, the only association that remained after adjusting for overlap with other depressive symptoms was fatigue ("feeling tired or having little energy") (OR=1.50, 95% CI=1.17-1.92). This association also remained after additionally adjusting for metabolic risk factors (OR=1.34, CI=1.03-1.76). These results suggest that, although depression syndrome is a risk factor for T2D, fatigue seems to independently contribute most to this association. This effect does not seem to be solely due to metabolic risk factors. A better understanding of which symptoms contribute most to the depression-diabetes association can help identify who is at greatest risk and highlight which symptoms should be primary targets of preventive interventions.

## Abstract 1237

### TYPE 2 DIABETES MELLITUS IN SEVERE MENTAL ILLNESS; INEQUALITIES BY ETHNICITY AND AGE. CROSS-SECTIONAL ANALYSIS OF 588,408 RECORDS FROM THE UK

Jayati Das-Munshi, PhD MSc MRCPsych, Health Services Research & Health of Populations, Michael E. Dewey, PhD, HSPR, KCL, London, London, UK

**Aims:** The prevalence of type 2 diabetes mellitus (T2DM) is elevated in severe mental illness (SMI) however the nature of this association by ethnicity is less clear. The aim of this study is to investigate whether the association of SMI with T2DM varies by ethnicity and age.

**Methods:** Cross-sectional analysis of data from an ethnically diverse sample of 588408 individuals aged 18+years, registered to 98% of general practices (primary care) in London, United Kingdom. Outcome was prevalent T2DM.

**Results:** Relative to people without SMI, relative risk (RR) of T2DM in people with SMI was greatest in the youngest age groups. In the White British group this was RR: 9.99 (95% CI: 5.34, 18.69) at 18-34 years, 2.89 (95% CI: 2.43, 3.45) at 35-54 years and 1.16 (95% CI: 1.04,
1.30) at 55+ years, with similar trends across all ethnic minority groups. Additional adjustment for antipsychotic prescriptions only marginally attenuated associations. Assessment of estimated prevalence of T2DM in SMI by ethnicity (absolute measures of effect) indicated that the association between SMI and T2DM was more marked in ethnic minorities

**Conclusions:** Relative risk of T2DM is elevated in younger populations. Most associations persisted despite adjustment for antipsychotic prescriptions. Ethnic minorities had a higher prevalence of T2DM in the presence of SMI. Future research and policy, particularly with respect to screening and clinical care for T2DM in SMI populations, should take these findings into account.

## NeuroImmunology

Saturday, March 18 from 3:30 - 4:15 pm

### Abstract 1235

#### ELEVATED THREAT-SENSITIVITY AND REDUCED REWARD-SENSITIVITY ASSOCIATED WITH INCREASED PERIPHERAL INFLAMMATION AMONG YOUNG ADULTS

Iris Ka-Yi Chat, MA, Psychology, Northwestern University, Evanston, IL, Meanne Chan, PhD, Psychology, University of Toronto, Toronto, ON, Canada, Meghan Vinograd, MA, Michelle Craske, PhD, Madeline Roth, BA, Psychology, University of California, Los Angeles, Los Angeles, CA, Gregory E. Miller, PhD, Richard Zinbarg, PhD, Psychology, Robin Nusslock, PhD, Department of Psychology, Northwestern University, Evanston, Illinois

**Objectives:** Elevated threat-sensitivity (i.e., neuroticism) and dampened reward sensitivity have both been linked with elevated inflammation – a known risk factor for mental and physical and health related problems. Research has yet to examine the nature of the relationship between threat and reward sensitivity in predicting inflammation. Drawing on existing research, the present study predicted that individuals with elevated threat sensitivity and attenuated reward sensitivity would be most likely to display elevated inflammation.

**Method:** One hundred and fifty-two participants aged 18 to 19 (female = 92) were drawn from an ongoing study of the relationship between threat- and reward-sensitivity and mental and physical health. Recruitment strategies were designed to maximize variance in both threat and reward sensitivity. Threat-sensitivity was assessed using the Eysenck Personality Questionnaire Neuroticism subscale, and reward sensitivity by the Behavioral Activation System (BAS) Total scale. To measure circulating inflammatory proteins, aspirated serum from an antecubital venipuncture was assayed in duplicate with MSD Meso Scale Discovery Human ProInflammatory 7-Plex Base Kits, and an inflammation composite score was computed from levels of IL-6, IL-8, IL-10, and TNFa. Age, gender, and ethnicity were included as covariates.

**Results:** In line with prediction, there was a significant interaction between self-reported threat- and reward-sensitivity in predicting inflammation (b = -1.27, t = -1.95, p < .05), such that individuals with elevated neuroticism and reduced reward sensitivity displayed the highest levels of inflammation as indexed by a composite score.

**Conclusions:** The present study is the first to examine the relationship between threat- and reward-sensitivity in modulating peripheral inflammation. Results show that individuals with both elevated threat-sensitivity and reduced reward sensitivity display the greatest levels of peripheral inflammation. These results are in line with the recently developed Neuroimmune Network (NIN) model which proposes that elevated threat-sensitivity and attenuated reward-sensitivity facilitate self-medicating behaviors typically associated with elevated inflammation. Specific patterns across different domains of reward seeking patterns as well as changes in neuroticism over time will be discussed.

### Abstract 1374

#### EXPOSURE TO AN INFLAMMATORY CHALLENGE ENHANCES NEURAL SENSITIVITY TO NEGATIVE AND POSITIVE SOCIAL FEEDBACK

Keely A. Muscatell, PhD, Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, Mona Moieni, C.Phil, Psychology, UCLA, Los Angeles, CA, Tristen K. Inagaki, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA, Janine M. Dutcher, PhD, Psychology, Carnegie Mellon University, Pittsburgh, PA, Ivana Jevtic, MS, Psychology, Elizabeth C. Breen, PhD, Psychiatry & Biobehavioral Sciences, Michael R. Irwin, MD, Psychiatry & Biobehavioral Sciences; Psychology, Naomi I. Eisenberger, PhD, Psychology, UCLA, Los Angeles, CA

Inflammation, part of the body's innate immune response, can lead to "sickness behaviors," as well as alterations in social and affective experiences. Elevated levels of pro-inflammatory cytokines have been associated with increased neural sensitivity to social rejection and social threat, but also decreased neural sensitivity to rewards. However, recent evidence suggests that inflammation may actually enhance sensitivity to certain social rewards, such as those that signal support and care. Despite a growing interest in how inflammation influences neural reactivity to positive and negative social experiences, no known studies have investigated these processes in the same participants, using a similar task. To examine this issue, 107 participants were randomly assigned to receive either placebo or low-dose endotoxin, which safely triggers an inflammatory response. When levels of pro-inflammatory cytokines were at their peak, participants were scanned using fMRI while they received positive, negative, and neutral feedback from an "evaluator" (actually a confederate) about how they came across in an audio-recorded interview. In response to negative feedback (vs. neutral), participants in the endotoxin condition showed heightened neural activity in a number of threat-related neural regions (i.e., bilateral amygdala, dorsal anterior cingu- late cortex) and a key mentalizing-related region (i.e., dorsomedial PFC), compared to placebo participants. Interestingly, when receiving positive feedback (vs. neutral), endotoxin (vs. placebo) led to greater neural activity in the ventral striatum and ventromedial PFC, regions often implicated in processing reward, as well as greater activity in dorsomedial PFC. Together, these results reveal that individuals exposed to an inflam- matory challenge are more "neurally sensitive" to both negative and positive social feedback, suggesting that inflammation may lead to a greater vigilance for both social threats and social rewards.

### Abstract 1521

#### PRO- AND ANTI-INFLAMMATORY CHALLENGES DIFFERENTIALLY MODULATE AMYGDALA EMOTIONAL REACTIVITY AND PREDICT DEVELOPMENT/AMELIORATION OF DEPRESSIVE SYMPTOMS

Neil A. Harrison, MBBS PhD, Ella Cooper, MSc, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK, Jerry Tibble, MD, Hepatology, Brighton & Sussex University Hospital, Brighton, East Sussex, UK, Valerie Voon, MD PhD, Psychiatry, Cambridge University, Cambridge, Cambridgeshire, UK, Hugo D. Critchley, MBBChir DPhil, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK

**Background:** Inflammation is increasingly implicated in the aetiology of major depressive disorder (MDD). One in three patients receiving cytokine (Interferon-α: IFN-α) based therapies for hepatitis-C develop depression. Conversely, cytokine blockade (with anti-TNF therapies) shows efficacy in MDD. Heightened amygdala reactivity to negatively valenced emotions is a hallmark of MDD. However, whether pro-(IFN-α) and anti-inflammatory (anti-TNF) therapies predispose/ameliorate depressive symptoms through opposing actions on amygdala emotional-reactivity is currently unclear.

**Methods:** Utilising a prospective study design, we recruited 32 patients initiating IFN-α based therapy of Hepatitis-C and 32 patients initiating
anti-TNF therapies for inflammatory arthritis. All patients completed an emotional face-processing task during fMRI and blood sampling before and after initiating therapy (4 hours after their first IFN or 48 hours after first anti-TNF injection). All were then followed up with psychiatric assessments for 3-months of treatment.

**Results:** IFN-α significantly increased depression symptoms (HAMD) from 4 to 12 weeks (p<0.001) but not 4-hours after first dose (p>0.1). Conversely, anti-TNF was associated with a significant reduction in depressive symptoms (p<0.002) by 12 weeks of treatment. As anticipated, emotional face stimuli robustly activated the ventral visual stream, including bilateral fusiform face areas and amygdala regions of interest (ROI). Neither IFN-α not anti-TNF had a significant effect on the visual processing pathway. However both significantly modulated amygdala reactivity with IFN-α selectively enhancing right amygdala responses to sad (compared to neutral) face stimuli (ROI FWE p=0.037) and anti-TNF conversely reducing right amygdala reactivity (ROI FWE p=0.05). Furthermore, acute changes in right amygdala reactivity to IFN-α additionally predicted increases in HAMD depressive symptoms at 4 weeks (p=0.038).

**Conclusions:** IFN-α and anti-TNF rapidly reorient amygdala reactivity to emotionally valenced information, an action that predicts the subsequent development of depressive symptoms following IFN-α. Together, these data identify a common brain-based mechanism through which peripheral inflammation and anti-inflammatory predispose to or ameliorate depressive symptoms.

## Neuroscience

Saturday, March 18 from 4:45 - 5:30 pm

### Abstract 1525

#### CROSS-SECTIONAL AND LONGITUDINAL ASSOCIATIONS BETWEEN BLOOD PRESSURE AND HIPPOCAMPAL VOLUME.

Annie T. Ginty, PhD, Psychology and Neuroscience, Baylor University, Waco, Texas, Peter J. Gianaros, PhD, Matthew Muldoon, MD, MPH, Psychology, Howard Aizenstein, MD, PhD, J. Richard Jennings, PhD, Psychiatry, University of Pittsburgh, Pittsburgh, PA

**Background:** Both hypertension and hippocampal atrophy have been associated with cognitive deterioration and the development of Alzheimer's disease. However, the association between hypertension and hippocampal atrophy is complex. Some studies have found hypertension, or high blood pressure (BP), to associate with reduced hippocampal volume, while others have found no relationship. Longitudinal research suggests hypertension itself is a risk factor for hippocampal atrophy, yet there is little direct evidence that changes in BP over time predict changes in hippocampal volume. **Aim:** Test whether increased BP relates to reduced hippocampal volume both cross-sectionally and longitudinally. **Methods:** Participants were midlife adults meeting the criterion of untreated pre-hypertension (N = 154, mean age = 49 years, 45% male). At enrollment and 2 years later (time 1, time 2), participants, had resting, seated systolic (SBP) and diastolic (DBP) BP measured (4 readings over 2 days and the average derived) and underwent a structural magnetic resonance imaging scan. Grey matter volumes were processed and calculated using semi-automated methods (Wu et al., 2006). Cross-sectional analyses tested whether mean SBP and/or DBP over 2 days related to hippocampal volume. Analyses controlled for age, gender, income, body mass index, and whole brain volume at the given time. Longitudinal analyses examined if the change in SBP and/or DBP over the 2-year period predicted hippocampal volume at time 2 and controlled for the same covariates with the addition of hippocampal volume at time 1. **Results:** There were no associations cross-sectionally between SBP or DBP and hippocampal volume at either time 1 or time 2. However, the change in SBP between time 1 and time 2 was significantly related to hippocampal volume at time 2 (standardized β = -.082, *p* = .030), as were DBP changes, (standardized β = -.155, *p* = .048). Specifically, an

elevation in BP over a 2-year period was associated with a greater decrease in hippocampal volume over the same time. **Conclusions:** While previous research has focused on whether or not a participant has a diagnosis of hypertension, this work suggests the actual magnitude of BP change may be related to hippocampal atrophy. Future research should examine the functional consequences of these BP-brain tissue associations on cognitive and other age related outcomes.

### Abstract 1546

#### EMOTIONAL PROCESSING IN SUPPORTIVE MARRIAGES: INCREASED AMYGDALA ACTIVATION IN AN FMRI INVESTIGATION

Erin Kaseda, N/A, Neuroscience, Wendy C. Birmingham, PhD, Christopher B. Kirwan, PhD, Spencer J. Nielson, BS, Psychology, Malia Anderson, PhD, Neuroscience, Zachary Blackhurst, BS, Sean Aaron, BS, Scott R. Braithwaite, PhD, Psychology, Brigham Young University, Provo, UT

**Background:** Marital relationships are not always specifically positive or negative but may contain both high levels of positivity and high levels of negativity (ambivalent). Such relationships may not have the same positive influence on health as those which are high in positivity and low in negativity (supportive). Vagal pathways which dampen the fight/flight response of the limbic system may react differentially in supportive and ambivalent relationships. The current study examined the impact of perceived supportiveness or ambivalence in marital quality on the responsiveness of the neural pathways of the limbic system.

**Method:** 22 married participants aged 22-39 (M=28; N=10 female, 12 male) completed surveys and participated in a video-recorded discussion conflict task with their spouse. Within 48 hours, structural and functional MRI images were obtained as each participant watched a rotating video of the discussion task (30 seconds) spliced with neutral stimuli (30 seconds). Functional data was analyzed for amygdala and hippocampus activation. Exclusionary criteria included health factors that may have altered neural activation patterns.

**Results:** Participants were mostly educated, middle-income, and white (82%). Defining the amygdala as our ROI, we quantified activation and dichotomized individuals into supportive and ambivalent groups based on self-reported responses. We found a significant difference in functional activation (p=0.01) in the right amygdala while viewing the conflict task in individuals with supportive relationship quality versus those with ambivalent relationship quality, such that amygdala activation during the conflict task was higher for those reporting supportive relationship quality. Right hemisphere amygdala activation is associated with control over emotion.

**Conclusions:** Previous studies have implicated increased amygdala activation in the emotional processing of complex stimuli, and that emotional conflict leads to amygdala activation. Our finding of reduced amygdala activation in individuals who perceive their spouse as ambivalent could indicate attenuation to spousal conflict and decreased emotional conflict resolution which could impact marital processes such as intimacy and disclosure. This decreased activation may have long term health consequences from emotional numbing, including an increased risk for depression and anxiety.
<figure><img src="image_41.png" /><figcaption>Table 1. Age at peak volume and cortical surface area for each model in the unweighted and weighted data, and the difference in peak age between the two models.</figcaption></figure>

<table><thead><tr><th></th><th>Age at peak<br>(Unweighted)</th><th>Age at peak<br>(Weighted)</th><th>Difference in age at<br>peak (unweighted -<br>weighted)</th></tr></thead><tbody><tr><td colspan="4"><strong>Total Cortical Surface Area Measures</strong></td></tr><tr><td>Total Surface Area</td><td>11.0</td><td>9.7</td><td>1.3</td></tr><tr><td>Total Surface Area (L)</td><td>11.0</td><td>9.7</td><td>1.3</td></tr><tr><td>Total Surface Area (R)</td><td>11.0</td><td>9.7</td><td>1.3</td></tr><tr><td colspan="4"><strong>Cortical Surface Area Measures by Lobe</strong></td></tr><tr><td>Occipital Lobe (L)</td><td>12.9</td><td>9.0</td><td>3.9</td></tr><tr><td>Occipital Lobe (R)</td><td>12.3</td><td>8.8</td><td>3.5</td></tr><tr><td>Parietal Lobe (L)</td><td>9.8</td><td>8.6</td><td>1.2</td></tr><tr><td>Parietal Lobe (R)</td><td>9.7</td><td>8.6</td><td>1.1</td></tr><tr><td>Temporal Lobe (L)</td><td>12.2</td><td>10.2</td><td>2.1</td></tr><tr><td>Temporal Lobe (R)</td><td>12.6</td><td>10.7</td><td>1.9</td></tr><tr><td>Frontal Lobe (L)</td><td>12.5</td><td>10.8</td><td>1.7</td></tr><tr><td>Frontal Lobe (R)</td><td>12.5</td><td>11.0</td><td>1.5</td></tr><tr><td colspan="4"><strong>Total Cortical Volume Measures</strong></td></tr><tr><td>Total Cortical Volume</td><td>6.8</td><td>6.8</td><td>0</td></tr><tr><td>Total Cortical Volume (L)</td><td>6.8</td><td>6.8</td><td>0</td></tr><tr><td>Total Cortical Volume (R)</td><td>6.9</td><td>6.8</td><td>0.1</td></tr></tbody></table>

(L) – Left hemisphere

(R) – Right hemisphere

<figure><img src="image_42.png" /><figcaption>Figure 1. Predicted values for cortical surface area in unweighted (blue) and weighted (red) models.</figcaption></figure>

## Abstract 1404

### THE REPRESENTATIVE DEVELOPING BRAIN: DOES SAMPLING STRATEGY MATTER FOR NEUROSCIENCE AND WHAT ARE THE IMPLICATIONS FOR STUDIES INTEGRATING THE SOCIAL AND BIOLOGICAL?

Kaja Z. LeWinn, Sc.D., Psychiatry, University of California, San Francisco, California, Margaret A. Sheridan, PhD, Clinical Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Katherine M. Keyes, Ph.D., Ava Hamilton, BS, Epidemiology, Columbia University, New York, NY, Kate McLaughlin, Ph.D., Psychology, University of Washington, Seattle, WA

Introduction: Most neuroimaging studies rely on small, non-representative samples. Samples that do not represent a target population (e.g., sampling undergraduates when the target population is healthy adults) can introduce bias and limit generalizability of findings. We examine whether sample composition influences how brain structure varies with age. Methods: Structural MRI data from a large sample of typically developing children aged 3-18 (N=1,208) were analyzed to generate cortical area and thickness measures for the frontal, parietal, occipital, and temporal lobes, as well as for total cortical thickness, area, and volume. To approximate associations of age with brain structure in a representative sample, we applied an epidemiologic method called raking to weight the sample according to the distributions of socioeconomic status (SES), race, and sex in the U.S. Census. We compared associations between age and brain structure in this weighted sample to those in the unweighted original sample, adjusting for sex, race, SES, and scanner type. The modeling strategy applied to both samples was identical and used AIC to determine whether a linear, quadratic, or cubic term for age provided the best fit. We graphed predicted values for each final model and calculated age at peak area where applicable. Results: The unweighted sample had higher SES than the U.S. population. Compared to unweighted models, we observed pronounced differences in the relationship between age and cortical surface area indicating a more complex functional form (cubic versus quadratic- Figure 1) and an earlier age at peak area (0-3.9 years) in weighted models (Table 1). The largest differences were observed for the occipital and temporal lobes. Notably, weighted models more closely reflected broad understanding of brain development progression, which generally follows a back-to-front pattern of maturation. Conclusion: Our results suggest even large, community-based studies are unlikely to reflect the distributions of socio-demographic characteristics of the U.S. population if no explicit sampling strategy is applied. Our empirical study indicates that sample composition is likely to have a meaningful impact in many cognitive neuroscience studies. We explore broader implications for studies of biological mechanisms linking psychosocial factors and health in community-based samples.

## Obesity, the Brain and the Environment

Thursday, March 16 from 3:30 - 4:30 pm

## Abstract 1636

### OBESITY IS ASSOCIATED WITH AGE-RELATED HIPPOCAMPAL VOLUME REDUCTION

Michael V. Stanton, Ph.D., Health Sciences, California State University, East Bay, Hayward, California, Salil Soman, M.D., M.S., Radiology, Harvard Medical School, Boston, MA, J. Kaci Fairchild, Ph.D., Mental Illness Research Education Clinical Center (MIRECC), Stanford University School of Medicine, Palo Alto, CA, Ansgar Furst, Ph.D., Maheen Adamson, Ph.D., Psychiatry, Stanford University / VA

<footnote>*Thickness areas not included because best fitting models in both datasets were effectively linear and declining over time consistent with prior research.</footnote>
Palo Alto, Palo Alto, CA, Peter Bayley, Ph.D., Psychiatry, VA Palo Alto/Stanford University, Palo Alto, CA

**Background:** Recent research in rodents has shown that, over time, obesity may lead to impairments in hippocampal function, which are linked to cognitive deficits. However, little is known about these effects in humans. We sought to understand how obesity might affect hippocampal volume and cognitive function in a sample of Veterans. **Methodology:** Hippocampal volumes were obtained from structural MRI images using Freesurfer segmentation processing. Using multiple regression models, we regressed the volume of the hippocampus and its subfields on an interaction between age and body mass index (BMI), while adjusting for intracranial volume and the presence of post-traumatic stress disorder and depression. **Results:** The sample consisted of predominantly male Veterans with a range of ages (N=110, mean age = 45.32, SD = 10.04, 94 males). Findings revealed that hippocampal volume was predicted by an interaction between age and BMI (p<.05). Follow-up analyses showed reduced left hippocampal volume among older individuals in the obese group. Similar effects were found in left hippocampal subfields including the CA4, DG, subiculum, and pre-subiculum (all p's<.05). Expected deficits in hippocampal-dependent delayed memory task performance were observed in older adults (p<.05). However, these cognitive deficits were not related to obesity. **Conclusion:** Obesity may be associated with an accelerated volume reduction in hippocampal structures with age, although the implications for cognitive function remain unclear.

**Abstract 1349**

THE RELATIONSHIP OF FOOD INSECURITY WITH OBESITY AND DIABETES IN A LOW-INCOME, MIGRANT COMMUNITY ON THE U.S.-MEXICO BORDER

JESSICA L. MCCURLEY, M.S., Clinical Psychology, University of California, San Diego and San Diego State University, San Diego, California, Jesus Naranjo, B.S., Jose Luis Burgos, M.D., Victoria D. Ojeda, Ph.D., Division of Global Public Health, University of California, San Diego, San Diego, California, Adriana Carolina Vargas Ojeda, M.D., Department of Medicine and Psychology, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico, Linda C. Gallo, Ph.D., Department of Psychology, San Diego State University, San Diego, California

Prevalence of obesity and type 2 diabetes are increasing rapidly worldwide. Food insecurity, the limited or uncertain access to adequate nutritious food, is associated with obesity in women in the U.S. and Mexico. Migrants and other low-income individuals living near international borders are at elevated risk for both food insecurity and chronic cardiometabolic conditions due to poor access to medical care, disrupted employment, psychological stress, and lack of family and social support. This study explored associations of self-reported food insecurity with clinically measured diabetes and obesity prevalence in a convenience sample of individuals seeking free medical care in Tijuana, Mexico in 2016. Participants were 140 Hispanic/Latino adults ≥18 years old who spoke Spanish or English. Overweight and obesity were defined as a body mass index (BMI) of 25 and ≥ 30, respectively. Diabetes status was determined by point-of-care hemoglobin A1c (HbA1c) test value over 6.5%. Participants were categorized as food secure, mildly food insecure, or severely food insecure during the prior year, per the validated U.S. Department of Agriculture (USDA) 6-item scale. Participant mean age was 46.7 years (SD = 12.3) and 72.3% were male. The majority (73%) reported history of migration to the U.S., 57.4% reported at least one experience of deportation out of the U.S., and 36.2% reported intent to migrate to the U.S. in the next year. Prevalence of diabetes was 14.3%; 41.4% of participants were overweight, and 17.1% were obese. Prevalence of mild and severe food insecurity was 27.7% and 58.9%, respectively. Adjusting for age and sex, participants with severe food insecurity were over 2.5 times as likely to be obese (AOR = 2.7; 95% CI: 1.1 – 7.1) compared to those who were food secure or mildly food insecure.

Women with severe food insecurity were over 7.5 times as likely to have diabetes (AOR = 7.8; 95% CI: 1.0 – 58.1) versus women with mild or no food insecurity. Food security is a prevalent and potentially modifiable determinant of cardiometabolic risk in migrants living along the U.S.-Mexico border. Interventions that increase access to regular and nutritious foods in migrants, especially women, may reduce risk for obesity and diabetes and decrease individual and public heath costs in migrants' home and destination countries.

**Abstract 1180**

PARENT PERCEPTION AND CHILDHOOD WEIGHT GAIN: PSYCHOLOGICAL, BEHAVIORAL, AND PHYSIOLOGICAL MECHANISMS

Angelina R. Sutin, PhD, Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL

Many children who measure in the overweight body mass index (BMI) category are perceived by their parents to be of normal weight. This misperception is thought to contribute to the prevalence of childhood overweight and obesity because it is argued that parents first need to be aware of their child's weight status to intervene effectively. Parental perceptions of their child as overweight or obese, however, may be more damaging than protective. Using a large longitudinal sample (N=3,557), we show that parent perception of child overweight at age 4 was associated with greater child weight gain between the ages of 4 and 12, an association that replicated in an independent sample of children (N=5,886) measured at ages 9 and 13. In both samples, this association was mediated by the child's own perception of weight and dieting behavior: Children whose parents perceived them as overweight were subsequently more likely to perceive themselves as overweight and engage in more weight loss attempts, which partly explained the association between parent perception and childhood weight gain. In a large cross-sectional sample (N=4,988), we further show that parent perception of overweight was associated with higher child c-reactive protein (CRP), an inflammatory marker associated with weight gain. The association between parent perception and child CRP was independent of the child's BMI, waist circumference, and relevant socio-demographic factors and suggests a physiological mechanism may also contribute to the relation between parent perception and childhood weight gain. Overall, the present research suggests that parent perception of child overweight is more harmful than protective and that psychological, behavioral, and physiological mechanisms may contribute to this association.

**Abstract 1458**

WHEN KNOWING HURTS: SELF-PERCEIVED OVERWEIGHT PREDICTS FUTURE PHYSICAL HEALTH AND WELL-BEING

Michael Daly, PhD, Behavioural Science Centre, University of Stirling, Stirling, Stirlingshire, United Kingdom, Eric Robinson, PhD, Psychology, University of Liverpool, Liverpool, Merseyside, United Kingdom, Angelina Sutin, PhD, College of Medicine, Florida State University, Tallahassee, Florida

Large scale personalized weight feedback programmes have been designed to increase awareness of overweight and prompt weight loss. However, self-identification as being 'overweight' may be counter-intuitively associated with adverse health outcomes. Here we sought to identify whether perceived overweight is prospectively associated with worse health 7 years later. Participants were 3,582 adults drawn from the US National Longitudinal Study of Adolescent to Adult Health (Add Health) and followed up from 2001/2002 to 2008/2009. Health status was evaluated using a measure of self-reported health and a measure of overall physiological dysregulation derived from a set of well-established clinical indicators of cardiovascular, inflammatory and metabolic functioning. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Perceived overweight predicted longitudinal declines in subjective
health (d = -0.22, p <.001), increases in depressive symptoms (d = 0.09, p < .05), and raised levels of physiological dysregulation (d = 0.24, p <.001) 7 years later. Weight gain partially mediated the long-term prospective association between self-identification as overweight and health status as gauged by physiological dysregulation and participant perceptions of physical health (see Table 1). These effects remained strong after controlling for a range of potential confounders including baseline body mass index (BMI) and were observed irrespective of whether self-perceptions of overweight were accurate or inaccurate. The present research suggests that self-identification as overweight may act independently of BMI to contribute to unhealthy profiles of physiological functioning and impaired health over time. These findings underscore the importance of evaluating whether weight feedback interventions may have unforeseen adverse consequences.

<table><caption>Table 1. Self-Perceived Overweight Predicting Subsequent Physiological Dysfunction and Changes in Self-Rated Health and Depressive Symptoms.</caption><thead><tr><th rowspan="2"></th><th rowspan="2">Physiological<br>Dysfunction (z-score)</th><th colspan="3">Self-rated<br>health (z-score)</th><th colspan="2">Depressive symptoms (z-score)</th></tr><tr><th>+ Weight gain</th><th>+ Weight gain</th><th>+ Weight gain</th><th>+ Weight gain</th><th>+ Weight gain</th></tr></thead><tbody><tr><td>Perceived overweight</td><td>.24***<br>(.04)</td><td>.13***<br>(.03)</td><td>.22***<br>(.04)</td><td>.18***<br>(.04)</td><td>.09*<br>(.04)</td><td>.09*<br>(.04)</td></tr><tr><td>Age</td><td>.03***<br>(.01)</td><td>.04***<br>(.01)</td><td>-.02*<br>(.01)</td><td>-.02***<br>(.01)</td><td>.03***<br>(.01)</td><td>.03***<br>(.01)</td></tr><tr><td>Sex (female)</td><td>-.52***<br>(.03)</td><td>-.49***<br>(.03)</td><td>.06<br>(.03)</td><td>-.07*<br>(.03)</td><td>.16***<br>(.03)</td><td>.16***<br>(.03)</td></tr><tr><td>White</td><td>.01<br>(.03)</td><td>.06*<br>(.03)</td><td>.18***<br>(.03)</td><td>.16***<br>(.03)</td><td>-.12***<br>(.04)</td><td>-.12***<br>(.04)</td></tr><tr><td>Education</td><td>-.04***<br>(.01)</td><td>-.03***<br>(.01)</td><td>.07***<br>(.01)</td><td>.07***<br>(.01)</td><td>-.07***<br>(.01)</td><td>-.07***<br>(.01)</td></tr><tr><td>Income</td><td>-.00<br>(.00)</td><td>.00<br>(.00)</td><td>-.00<br>(.00)</td><td>-.00<br>(.00)</td><td>-.00<br>(.00)</td><td>-.00<br>(.00)</td></tr><tr><td>Limiting condition</td><td>.07*<br>(.04)</td><td>.09**<br>(.03)</td><td>-.05<br>(.04)</td><td>-.06<br>(.04)</td><td>.07<br>(.04)</td><td>.06<br>(.04)</td></tr><tr><td>BMI baseline</td><td>.07***<br>(.00)</td><td>.07***<br>(.00)</td><td>-.01***<br>(.00)</td><td>-.02***<br>(.00)</td><td>-.00<br>(.00)</td><td>-.00<br>(.00)</td></tr><tr><td>Weight gain<sup>a</sup></td><td>—</td><td>.10***<br>(.00)</td><td>—</td><td>-.04***<br>(.00)</td><td>—</td><td>-.00<br>(.00)</td></tr><tr><td>Self-rated health</td><td>—</td><td>—</td><td>.39***<br>(.02)</td><td>.38***<br>(.02)</td><td>—</td><td>—</td></tr><tr><td>Depressive symptoms</td><td>—</td><td>—</td><td>—</td><td>—</td><td>.10***<br>(.00)</td><td>.10**<br>(.00)</td></tr></tbody></table>

Note. There were 3,582 participants, 2,017 women & 1,565 men. Standard errors are included in parentheses. <sup>a</sup>Weight gain is BMI at baseline subtracted from BMI at follow-up. * p < .05. ** p < 0.01. *** p < .001.

## Psycho-oncology

Friday, March 17 from 2:45 - 3:45 pm

## Abstract 1328

### BEING HAPPY AND EXPECTING THE BEST: IS PSYCHOLOGICAL WELL-BEING ASSOCIATED WITH FUTURE CANCER RISK?

Claudia Trudel-Fitzgerald, Ph.D., Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, Shelley S. Tworoger, Ph.D., Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, Laura D. Kubzansky, Ph.D., MPH, Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

**Methods:** Women from the Nurses' Health Study cohort who were free of cancer (except non-melanoma skin cancer) at the time they reported levels of well-being were included in the analytic samples. Well-being was assessed with a measure of happiness in 1992 (N=67,358, mean age 58.1 years) and a measure of optimism in 2004 (N=58,867, mean age 69.3 years). Relevant cancer-related risk factors, including demographics, health status (e.g., body mass index, oral contraceptive use), and health behaviors (e.g., smoking) were self-reported or taken

from medical records. A study physician, blinded to the study aims, reviewed medical records of women who reported a cancer diagnosis to confirm new cases. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of incident cancer risk over the course of follow-up (until 2012; 8 to 20 years of follow-up) and included adjustment for baseline potential confounders. Sensitivity analyses also controlled for symptoms of anxiety and depression. Secondary analyses will investigate the same models in relation to specific cancer sites (e.g., breast, colorectal, gynecological, lung).

**Results:** There were 11,752 and 4,756 new cancer cases documented over the course of follow-up in the happiness and optimism samples, respectively. Women who reported moderate or high levels of happiness did not have a significantly lower cancer risk, compared to those with a low level (HR<sub>moderate</sub>=1.03, 95% CI=0.99-1.07; HR<sub>high</sub>=1.02, 95% CI=0.95-1.10). Similar results were obtained with levels of optimism (HR<sub>moderate</sub>=1.06, 95% CI=0.99-1.14; HR<sub>high</sub>=1.06, 95% CI=0.99-1.14). Associations remained null after further adjustment for anxiety and depression symptoms.

**Conclusions:** In midlife women, happiness and optimism were not significantly related to risk of developing cancer up to 8 to 20 years later. This may reflect a true null association; it is also possible that the influence of well-being on cancer risk occurs earlier in life. In fact, 15,062 and 29,963 women were diagnosed with cancer before the 1992 and 2004 baselines, respectively, and were thus excluded from these analyses. Other facets of well-being, such as life satisfaction, should also be considered in relation to cancer risk. Finally, studying specific cancer sites may provide further insight given the heterogeneity of this disease.

## Abstract 1410

### NIGHTTIME DISTRESS AND INTERLEUKIN-6 IN EXPLAINING THE RELATIONSHIP BETWEEN ADJUVANT CHEMOTHERAPY AND SLEEP LATENCY IN MALIGNANT POST-SURGICAL GYNECOLOGIC ONCOLOGY PATIENTS

Chantel M. Ulfig, M.S., Elizabeth L. Kacel, M.S., Laura C. Trinastic, Ph.D., Diego Esparza-Duran, M.S., Shan Wong, M.S., Rachel A. Postupack, Ph.D., Christina McCrae, Ph.D., Clinical and Health Psychology, Gregory S. Schultz, Ph.D., Obstetrics and Gynecology, Deidre B. Pereira, Ph.D., Clinical and Health Psychology, University of Florida, Gainesville, Florida

**Introduction:** Sleep disturbances (e.g. prolonged sleep latency, wake after sleep onset) are prominent concerns for oncology patients, particularly those obtaining chemotherapy. Studies have examined psychological (e.g. distress, depression) and biological factors associated with sleep, yet few have examined potential mechanisms between adjuvant chemotherapy and objective sleep in patients with gynecologic malignancies. Part of a larger randomized controlled trial, the current study sought to examine whether greater post-surgical nighttime distress and greater interleukin-6 (IL-6) mediated a potential relationship between receipt of adjuvant chemotherapy and longer sleep latency among gynecologic oncology patients.

**Methods:** Participants consisted of 48 women (M age=59.06yrs, SD=11.42) with clinically significant sleep disturbances, who underwent surgery for confirmed gynecologic malignancy. Receipt of adjuvant chemotherapy was abstracted via medical records. Nighttime distress was captured through sleep diaries. Inflammation was measured via post-surgical blood draw assayed for serum concentration of IL-6. Sleep latency was assessed via one-night home polysomnography.

**Results:** Path analysis, controlling for age, was conducted examining relationships among chemotherapy, nighttime distress, IL-6, and sleep latency using IBM® SPSS® Amos 24.0. The final path displayed good model fit (χ²(4)=.690, p=.953, NFI=.980, CFI=1.000, RMSEA=.000), explaining 33% of variance in sleep latency. Standardized direct effects of chemotherapy on IL-6, distress, and sleep latency were -.19<sup>a</sup>, .36<sup>b</sup>, and .19<sup>a</sup>, respectively. Direct effects of distress on IL-6 and sleep
latency were .48ᵇ and .33ᵇ, respectively. The direct effect of IL-6 on sleep latency was .15ᵃ. Significance could not be calculated due to missing data.

**Conclusion:** Results aid in understanding the complex relationship between receipt of adjuvant chemotherapy and prolonged sleep latency among gynecologic oncology patients, highlighting both direct (chemotherapy) and indirect (distress and IL-6) effects. Given the medium-large effect between distress and IL-6 and the relatively strong relationship with prolonged sleep latency, psychological interventions should consider targeting nighttime distress in improving sleep and inflammation in gynecologic oncology patients.

ᵃ Small-medium effect size.

ᵇ Medium-large effect size.

### Abstract 1151

## AN INDEX OF VAGAL NEUROIMMUNO-MODULATION PREDICTS LONGER SURVIVAL IN TWO FATAL CANCERS

*Yori Gidron, PhD, Medicine and Pharmacy, Free Univ of Brussels - VUB, Waterloo, Walloon Brabant, Belgium, Marijke De Couck, PhD, Medical psychology, University of Leuven, Belgium, Leuven, Flemish Brabant, Belgium*

**Purpose:** The vagus nerve may slow tumor progression possibly since it inhibits inflammation. This study examined the relationship between a vagal neuroimmuno-modulation (NIM) index and survival in two fatal cancers.

**Method:** Sample 1 included 202 patients with advanced pancreatic cancer (PC), while sample 2 included 71 patients with non-small cell lung cancer (NSCLC). We retroactively derived markers of vagal activity indexed by heart-rate variability (HRV), specifically RMSSD, from patients' electrocardiograms near diagnosis. In sample 1 we examined overall survival while in sample 2, we focused on survival time in deceased patients. The NIM-index was the ratio of RMSSD to C-reactive protein levels (RMSSD/CRP).

**Results:** In a multivariate cox regression, controlling for confounders (e.g., metastasis location), the NIM-index had a protective relative risk (R.R) and 95% confidence interval (95% CI) of R.R = 0.65, 95% CI: 0.52-0.80, p < 0.001 in PC. PC patients with higher NIM survived 106.6 days compared to those with lower NIM (51.05 days, p < 0.001). In NSCLC patients, the NIM-index was positively correlated with survival time (r = 0.32, p < 0.01), independent of confounders (e.g., age, treatments). Again, patients with higher NIM survived more days (475.2) than those with lower NIM (285.1; p < 0.05).

**Conclusion:** These results show that a NIM-index, which considers vagal modulation of inflammation, predicts longer survival in patients with two fatal cancers. The results help to understand neuro-modulation of tumors, provide a new estimation of prognosis and propose testing the effects of vagal nerve activation methods on cancer patients' prognosis.

### Abstract 1156

## WEB-BASED STEPPED COLLABORATIVE CARE INTERVENTION IN THE ONCOLOGY SETTING: LESSONS LEARNED FROM THE PILOT STUDY AND ADVANCES IN TECHNOLOGY

*Jennifer Steel, PhD, David A. Geller, MD, FACS, Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, Kathleen Ell, DSW, Social Work, University of Southern California, Los Angeles, California, Ritambhara Pathak, B.S., Yoram Vodovotz, PhD, Surgery, Lisa H. Butterfield, PhD, Medicine, Surgery, Immunology, Allan Tsung, MD, James W. Marsh, MD, MBA, Yisi Wang, MPH, Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, Michael Antoni, PhD, Psychology, University of Miami Health System, Miami, Florida, Michael B. Spring, PhD, Information Science and Technology, University of Pittsburgh, Pittsburgh, PA*

**Background:** According to the NIH consensus statement the three most common and debilitating cancer related symptoms are pain, fatigue, and depression. Several barriers exist for socioeconomically disadvantaged patients in the palliative care setting to reduce these symptoms and improve quality of life at the end of life.

**Methods:** A total of 271 advanced cancer patients and their spousal/intimate partners were enrolled in the pilot study and 450 advanced cancer patients and spousal/intimate partner dyads are currently being enrolled in the larger scale multisite trial at six sites. Patient outcomes included pain, fatigue, depression, quality of life, and cytokines (i.e., Interleukin (IL)-1 alpha IL-1 beta, IL-2, TNF alpha, IFN gamma, IL-10), and survival. Caregiver outcomes included stress, depression, quality of life as well as biomarkers of inflammation and cardiovascular risk factors.

**Results:** Large effect sizes were observed in patients with clinically significant levels of symptoms on measures of depression, pain, and quality of life in the pilot study. Small to medium effect sizes were observed for biomarkers of inflammation as a result of the pilot study. Although not statistically significant, patients in the intervention arm survived four months longer when compared to patients in the usual care arm. Patient quality of life and depressive symptoms predicted caregiver stress and depression over time. We will describe how the findings of the pilot study and advances in technology are integrated in the new trial. Changes in the website (e.g., layout, interactive CBT tools, use of text-to-voice, audio-visual platforms); inclusion of a web-based trials management system (RedCap); the use of electronic progress notes to assess intervention fidelity (ACCESS); and the use of Vidyo, a HIPAA complaint videoconferencing tool, will be employed to the next iteration of this collaborative care intervention in the oncology setting.

**Conclusions:** Stepped collaborative care interventions are beginning to be employed in the oncology setting. The use of technology complements and extends the scalability of these interventions.

## Racial Discrimination

Thursday, March 16 from 3:30 - 4:30 pm

### Abstract 1411

## PROSPECTIVE HEALTH CONSEQUENCES OF SOCIOECONOMIC DISADVANTAGE ACROSS THE LIFE SPAN: THE MEDIATING ROLES OF DISCRIMINATION AND UNFAIR TREATMENT

*Thomas E. Fuller-Rowell, PhD, David Curtis, MS, David Chae, Sc.D., College of Human Sciences, Auburn University, Auburn, AL, Carol Ryff, PhD, Department of Psychology, University of Wisconsin-Madison, Madison, WI*

**Background:** Gradients in health as a function of social class or socioeconomic disadvantage are a well-documented phenomenon, evident in most societies around the world (Adler & Rehkopf, 2008). Several explanations for the link between socioeconomic disadvantage and health have been examined, including neighborhood quality, health literacy, and subjective social status (Matthews & Gallo, 2011). However, unfair treatment and discrimination have received considerably less attention. This is surprising given that elitist mentalities and pervasive negative stereotypes about the poor are well documented and play a central role theories of social stratification (Bourdieu, 2003; Fiske, 2010; Sennett & Cobb, 1993). Focusing on a national sample of adults, the objective of the current study was to examine the mediating roles of unfair treatment and discrimination in the prospective association between socioeconomic disadvantage and self-rated health.

**Methods:** Participants in the third wave of the Midlife in the United States (MIDUS) study were included in longitudinal analyses