At baseline, higher NT-proBNP was associated with poor physical functioning, more severe heart failure but less anxiety. Higher NT-proBNP at baseline also significantly predicted lower levels of anxiety at all follow-up visits. When adjusted for age, this prediction remained significant for baseline, 1, 6 and 12 months. Repeated measures ANOVA comparing the lowest to the three highest NT-proBNP quartiles (i.e. ≤ 86 ng/l vs. > 86 ng/l) further revealed a trend (p=.055) for a time*NT-proBNP interaction and a significant (p=.018) interaction of time*NT-proBNP*sex. In subgroup analyses by sex, the time*NT-proBNP interaction was significant (p=.023) in women (N=59), suggesting elevated baseline anxiety and poor improvement in patients with low baseline NT-proBNP, but not in men (N=250).

Our results indicate that in CAD patients NT-proBNP is not only associated with more severe disease but also with less anxiety and that this effect is independent of age. It seems that patients who are not able to up-regulate (NT-pro)BNP despite their cardiac disease experience more enduring anxiety than patients with higher levels of (NT-pro)BNP. Subsequent research will need to determine why some of the effects were limited to women. In conclusion, BNP (like ANP) seems to not only play a role in the physiological regulation of blood pressure, but also in emotion regulation.

## 144) Abstract 1398

### ATTACHMENT, SOCIAL SUPPORT AND CARDIOVASCULAR HEALTH

Grace M. McMahon, BA (PhD Candidate), Stephen Gallagher, PhD, Eoin Brown, BA (PhD Candidate), Ann-Marie Creaven, PhD, Psychology, University of Limerick, Limerick, Ireland

**Background:** The quality of our social relationships can impact both our physiological and psychological health through buffering against the negative effects of stress. In particular, literature suggests that the emotional and tangible support available to a person during times of stress (i.e., social support) operates through biobehavioural pathways including cardiovascular reactivity. However, despite inconsistent findings in the social support literature, to date, research has failed to incorporate attachment as an alternative framework in examining the association between social relationships and health.

**Methods:** Ninety healthy young adults completed psychometrically-validated measures of social support and attachment within a laboratory-based setting. Measures of cardiovascular reactivity, blood pressure, heart rate (HR), cardiac output (CO) and total peripheral resistance (TPR) were continuously monitored throughout a standardised stress testing protocol which included a baseline and an acute stress session.

**Results:** Correlational analyses demonstrated that there was no significant association between social support and cardiovascular reactivity. However, significant associations between attachment and cardiovascular reactivity were evident, specifically in terms of avoidant attachment styles. Results found that avoidant attachment was negatively associated with TPR (r = -.23, p=.029) and positively associated with HR, (r = .21, p=.049). These associations withstood adjustment for support and a range of potential confounds (e.g. age and sex).

**Conclusion:** These results suggest that perhaps one of the ways in which attachment may influence health is through cardiovascular reactivity to stress. Here we found that it was an insecure avoidance attachment and not secure attachment that was associated with stress reactivity.

## 145) Abstract 1380

### INDIVIDUAL DIFFERENCES IN EMOTION REGULATION: IMPLICATIONS FOR CARDIOVASCULAR REACTIVITY TO STRESS

Siobhán M. Griffin, B.Ed in Education and Ps, Siobhán Howard, Ph.D, Psychology, Mary Immaculate College, Limerick City, Limerick, Ireland

Previous research examining the influence of habitual emotion regulation on cardiovascular reactivity to stress has been somewhat mixed. Some studies report positive associations with physiological reactivity, while others found negative associations. This research reports on a laboratory-based study in a sample of 40 young adults. Participants completed two consecutive speech tasks, separated by a resting recovery period. The emotional dimension of the speech task was experimentally manipulated, with a neutral speech task and a negative emotion task completed by all participants; order of this was counter-balanced across the study. The Emotion Regulation Questionnaire (ERQ) was used to assess habitual emotional regulation. Blood pressure, heart rate, cardiac output and total peripheral resistance were measured using the Finometer; a continuous hemodynamic monitor. General linear model analysis found that individual differences in emotion regulation lead to distinct profiles of hemodynamic responding. This provides support for the hypothesis that emotion regulation is an important factor in stress reactivity and recovery.

## 146) Abstract 1633

### THE RELATIONSHIP BETWEEN HEART RATE VARIABILITY AND MARKERS OF INFLAMMATION: A META-ANALYSIS

DeWayne P. Williams, M.A., Psychology, The Ohio State University, Columbus, Ohio, Julian Koenig, Dr. sc. Hum., Department of Psychiatry and Behavioral Sciences Medicine, Heidelberg University, Heidelberg, Thibautstraße 6, Germany, Michael M. Vasey, PhD, Psychology, The Ohio State University, Columbus, Ohio, Baldwin M. Way, PhD, Psychology, The Ohio State University, Columbus, OH, Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, Ohio

The inflammatory reflex is known as the body's primary defense against infection and has been implicated in a number of diseases. The magnitude of the inflammatory response is important, as an extreme or insufficient response can be differentially harmful to the individual. Converging evidence suggest that the autonomic nervous system (ANS) directly regulates the inflammatory reflex. Heart rate variability (HRV) can be separated into components that primarily reflect parasympathetic (PNS) or vagal activity (i.e., indices of vagally mediated HRV | vmHRV) and a combination of both SNS and PNS branches of the ANS. Given the physiological relation between the vagus and inflammatory processes, one would expect to find higher vmHRV (greater PNS or vagal activity) to be associated with lesser markers of inflammation markers via the cholinergic anti-inflammatory pathway. However, research on relationships between indices of HRV, especially vmHRV, and markers of inflammation are mixed and too often counterintuitive. Therefore, the present meta-analysis estimates the general direction and strength of the relationship between several indices of HRV and inflammatory markers, with an emphasis placed on indices of vmHRV. A systematic search of the literature yielded 2,283 studies that were screened for duplicates (removed) and inclusion eligibility (must include one index of both HRV and inflammation). Of the 177 studies eligible for inclusion, only 51 included a statistical index of the degree to which the HRV and inflammatory were related; additional data requests are being sent and will appear in a follow-up report. Multiple random-effects models showed that all significant associations between markers of HRV and markers of inflammation were negative. In this regard, associations between indices of vmHRV – such as high frequency (HF; 0.15-0.4 Hz) HRV – and inflammatory markers were particularly strong and consistent. In sum, the present meta-analysis highlights the importance of the ANS, specifically the PNS, in regulating inflammation. We propose that indices of HRV, specifically vmHRV, can be used to proxy the flexibility and integrity of the neurophysiological pathway responsible for adaptively regulating inflammatory processes.
147) Abstract 1462

RESTING HRV IS ASSOCIATED WITH EX-GAUSSIAN
METRICS OF INTRA-INDIVIDUAL REACTION TIME
VARIABILITY

Derek P. Spangler, PhD, DeWayne P. Williams, M.A., Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, OH Intra-individual variability (IIV) in reaction time (RT) performance has been associated with executive and neural dysfunctions that are central to many cognitive disorders. Similarly, cognitive impairments have been negatively related to high-frequency heart rate variability (HRV; a metric of cardiac vagal control). Despite their conceptual overlap, only a few studies have examined associations between HRV and IIV. The aim of the current study was to investigate relations of HRV to IIV parameters derived from ex-Gaussian modeling and traditional whole-distribution approaches. Participants (N = 84; 60 women; Mean age = 18.9, SD = 1.6) completed a 5-minute resting period while electrocardiography was collected. Resting HRV was calculated as the root mean square of successive differences (RMSSD) of interbeat intervals. RTs from a subsequent Stroop color-word task were used to estimate whole-distribution metrics and ex-Gaussian parameters of IIV (sigma: IIV due to fast responses; tau: IIV caused by slow responses). Results replicated an effect size from our previous study, in which RMSSD was negatively correlated with the standard deviations of RTs for men's incongruent trials, ρ(22)=-.273, p=.244. As indicated by regression analysis, RMSSD was negatively associated with tau for incongruent trials (β = -.278, p=.012), and positively associated with tau for congruent trials (β = .222, p=.034). Results suggest that high cardiac vagal control relates to effective regulation of attentional lapses and instability in response selection. These findings are consistent with theories of regulatory flexibility in which inhibitory control is modulated to fit environmental demands. Findings are discussed in reference to patterns of stress regulation and cognitive control that have implications for psychological and neurological health.

148) Abstract 1322

EFFECTS OF NOREPINEPHRINE INFUSION WITHOUT AND
WITH ALPHA-ADRENERGIC BLOCKADE ON
COAGULATION PARAMETER LEVELS IN HEALTHY MEN

Petra H. Wirtz, PhD, Biological Work and Health Psychology, University of Konstanz, Konstanz, Baden-Wuerttemberg, Germany, Claudia Zuccarella-Hackl, PhD, Biological and Health Psychology, University of Bern, Bern, Bern, Switzerland, Ulrike Ehlert, PhD, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Zurich, Switzerland, Roland von Kanel, MD, Neurology, Bern University Hospital, Bern, Bern, Switzerland

**Background:** Mental stress induces reliable increases in coagulation parameters including fibrinogen or D-dimer, but underlying mechanisms are not fully understood. While stress-induced D-dimer increases correlate with norepinephrine (NE) secretion, a potential role of noradrenergic mechanisms remains unclear. Here, we investigated in humans, whether a NE-stress-reactivity mimicking NE-infusion with and without alpha-adrenergic blockade by phentolamine would induce changes in different coagulation parameters.

**Methods:** In a single-blind placebo-controlled within-subjects design, 18 healthy men (33-64 years) took part in three different experimental trials varying in terms of substance infusion with a 1-min first infusion followed by a 15-min second infusion: saline-infusion (trial-1), NE infusion (5microg/min) without alpha-adrenergic blockade (trial-2), and with phentolamine-induced non-selective blockade of alpha1- and alpha2-adrenergic receptors (trial-3). Blood samples were collected immediately before, and several times after substance infusion to measure fibrinogen, FVIII:C, and D-dimer.

**Results:** As compared to placebo-infusion (trial-1), NE-infusion without alpha-adrenergic blockade (trial-2) induced higher fibrinogen, D-dimer, and FVIII:C reactivity (p's <.032). Alpha-adrenergic blockade (trial-3) reduced NE-infusion-induced increases in FVIII:C (p=.16), while increases in D-dimer remained significant (p=.044) and

increases in fibrinogen became of borderline significance (p=.06).
Trials 2 and 3 did not differ in any coagulation parameter (p's >.31).

**Conclusions:** We found that NE-infusion stimulates coagulation activity and that this stimulation was in part inhibited by non-selective alpha-adrenergic blockade by phentolamine. This suggests that the mechanisms underlying stress-induced coagulation activity increases may involve NE and alpha-adrenergic receptors.

149) Abstract 1644

LONELINESS, CARDIOVASCULAR AND NEURO-
ENDOCRINE REACTIVITY TO ACUTE PSYCHOLOGICAL
STRESS: A SYSTEMATIC REVIEW

Eoin G. Brown, PhD Student, Ann-Marie Creaven, PhD, Stephen Gallagher, PhD, Psychology, University of Limerick, Limerick, Ireland

**Objective:** Loneliness has been linked to a higher risk of cardiovascular disease. One of the proposed mechanisms linking loneliness and cardiovascular disease is physiological reactions to acute stress. However, the findings of loneliness and acute stress induced physiological reactivity research (e.g., sympathetic nervous system and hypothalamic-pituitary-adrenal axis responses) are not universal, a likely consequence of methodological differences across studies. Therefore, to improve our understanding of the interaction between loneliness and stress reactivity, greater clarity is needed. The purpose of this review was to assess the current evidence linking loneliness to cardiovascular and endocrine reactivity to acute stress.

**Method:** The authors searched a series of electronic reference databases (PsycARTICLES, PsycINFO, Medline, CINAHL Plus, EBSCOhost (all databases except those previous), PubMed, SCOPUS, Web of Science and Science Direct), up to October 2016, for relevant studies using established guidelines.

**Results:** Following initial assessments, 13 studies were included in the review and of these, the majority (8) examined sympathetic nervous system responses. Overall, 7 studies found positive associations between loneliness and stress reactivity; that is higher loneliness was predictive of increased physiological responses. However, for 2 studies being lonely was associated with reduced reactivity, possibly indicating a blunted response. Furthermore, in 4 studies, there were no relationships observed. Analysis of stressors types and study design appear to underlie these divergent findings.

**Conclusions:** Most of the studies reported here provide evidence for the proposed mechanism linking loneliness to cardiovascular health via stress reactivity. The current review suggests that loneliness is associated with exaggerated responses, rather than blunted responses to acute stress. Based on the best available evidence, higher levels of loneliness predict increased cardiovascular reactivity to acute stress. However, the evidence for endocrine reactivity is more mixed.

150) Abstract 1259

DESYNCHRONISATION OF THE AUTONOMIC NERVOUS
SYSTEM IN MOTHER-CHILD-DYADS DURING SSP:
INFLUENCE OF MALTREATMENT AND NEGLECT

Eva Roder, Dr. med., Psychosomatische Medizin und Psychotherapie, Franziska Köhler-Dauner, M.A., Kinder- und Jugendpsychiatrie/Psychotherapie, Sabrina Krause, cand. Dr., Anna Appelganz, medical student, Ines Richter, medical student, Psychosomatische Medizin und Psychotherapie, Universitätsklinik, Ulm, Baden-Württemberg, Germany, Linda Miller, student of psychology, Stephanie Dobler, student of psychology, Klinische und biologische Psychologie, Universität, Ulm, Baden-Württemberg, Germany, Edit Rottler, statistician, Harald Gündel, professor, Psychosomatische Medizin und Psychotherapie, Ute Ziegenhain, professor, Kinder- und Jugendpsychiatrie/Psychotherapie, Christiane Waller, professor, Psychosomatische Medizin und Psychotherapie, Universitätsklinik, Ulm, Baden-Württemberg, Germany

**Introduction:** Stress caused by childhood maltreatment (CM+) may have broad effects on autonomic nervous system (ANS) regulation.
There is a higher risk for those individuals to maltreat their own children (transgenerational cycle of maltreatment). In the study, Meine Kindheit – Deine Kindheit´ (TRANS-GEN) we investigate stress reactivity of the ANS in mothers and their children depending on maltreatment of the mother (CM+) or absence of maternal maltreatment (CM-).

**Methods:** We used a method, that we established, to measure sympathetic and parasympathetic nervous system activity parallely in mothers and their one-year-old children. Heart rate (HR), respiratory sinusarrhythmia (RSA) and preejection-period (PEP) were measured by electrocardiogram (ECG) and impedance cardiogram (ICG) during a standardized stressful situation consisting of separation and reunion episodes: SSP (Strange Situation Paradigm, Ainsworth, 1970).

**Results:** In episode 7 – child alone in the room, strange person coming into the room – we observe differences between mother and child: mothers are reacting with a decreasing sympathetic ANS response. Children in contrast show an increase in stress response. Furthermore there are significant differences between (CM+) and (CM-) mothers in the parasympathetic branch. Moreover (CM+) mothers infants have significantly higher RSA data in this episode than (CM-) mothers infants.

**Discussion:** We find relevant effects of neglect and maltreatment during childhood on the ANS. We also observe for the first time a variation in infants ANS that suggests to be passed on into the next generation by (CM+) mothers. Further studies on children of (CM+) mothers, when growing up, can show, if these changes in ANS predict resilience or vulnerability with regard to physical or mental diseases of these infants.

## 151) Abstract 1616

### RELAXING MUSIC STABILIZES HEMODYNAMICS AND ELICITS OXYTOCIN SECRETION IN PREHYPERTENSION

James Halbert, MS, GPI-Pediatrics, Debra VanTuyll, PhD, Communication, Carl Purdy, MS, Music, Ayman Al-Hendy, MD, Michael Diamond, MD, OBGYN, Augusta University, Augusta, Georgia, Julian Thayer, PhD, Psychology, Ohio State University, Columbus, Ohio, Gaston Kapuku, MD/PhD, GPI-Pediatrics and Medicine (Cardiology), Augusta University, Augusta, Georgia

**Objectives:** Prehypertension increases the risk of developing cardiovascular disease (CVD). Relaxing music may lower blood pressure (BP) and heart rate (HR), and therefore, decrease the risk of CVD. We also examined whether music promotes secretion of oxytocin which regulates social behavior.

**Methods:** Participants were 14 prehypertensive individuals aged 20 to 50 years. The protocol consisted of 2 visits (experimental & control). Each visit consisted of 20 minutes baseline (subjects quietly watched movie during this time) and 10 minutes of a stressor exposure (e.g., mental arithmetic). Following baseline rest, subjects listened to music for 30 minutes during the experimental visit. Because some research shows the frequency to which instruments are tuned influences response to that music, the team used original music written specifically for this project and varied the pitch to which instruments were tuned. The instruments were tuned between 440 Hz and 432 Hz, and the frequencies changed every 10 minutes. Participants were randomly selected to be part of group A (432Hz-440Hz-432Hz) or group B (440Hz-432Hz-440Hz). During the control visit subjects watched a movie then participated in a mental arithmetic challenge. The visit order of experimental and control was changed for different study participants. Repeated-measures analysis of variance (ANOVA) with two repeated measures [Music vs. no music and phase (baseline, music, and mental stress)] was used to examine the effects of relaxing music on the physiological parameters. The PROCESS add-on module to SPSS was used to estimate the effect of music on oxytocin secretion.

**Results:** At experimental visit BP (128±11/77±7 vs. 127±10/75±8 mmHg, respectively) and HR (71±7 vs 70±7 beats/min) were similar during baseline and music phases. Mental arithmetic significantly increased BP and HR (all ps<0.01). No changes were observed in

relation to music schedule A or B. Blood levels of Oxytocin were similar between rest and stress (65±19 pg/l vs. 71±19 pg/l, ns). Music elicited an increase of oxytocin (84±35 pg/l) but did not reach statistical significance.

**Conclusion:** Listening to relaxing music stabilizes hemodynamics irrelevant of tuning systems. A trend toward oxytocin increase was shown, suggesting that music has a greater social effect than quietly resting.

## 152) Abstract 1389

### THE ASSOCIATION BETWEEN RESTING CARDIAC VAGAL TONE AND RUMINATION: GENDER AS A MODERATING FACTOR

Gina M. Gerardo, B.S., DeWayne P. Williams, M.A., Psychology, Ohio State University, Columbus, Ohio, Julian Koenig, Dr. sc. hum., Section for Translational Psychobiology in Child and Adolescent Psychiatry and the Department of Child and Adolescent Psychiatry, University of Heidelberg Centre for Psychosocial Medicine, Heidelberg, Heidelberg, Germany, Derek P. Spangler, Ph.D., Julian F. Thayer, Ph.D., Psychology, Ohio State University, Columbus, Ohio

Resting vagally-mediated heart rate variability (vmHRV) is recognized as an index of emotion regulation (ER) abilities, such that those with lower resting vmHRV show more difficulties in ER compared to individuals with higher resting vmHRV. A recent study showed that gender moderated this association, such that women showed a stronger relationship between resting vmHRV and self-reported difficulties in ER compared to men. Importantly, poorer ER abilities are typically associated with more maladaptive ER strategies (e.g., rumination). As such, a recent report illustrated that resting vmHRV was associated with greater brooding (maladaptive – sulking) and depressive (maladaptive – sadness and despair) rumination, but not significantly associated with reflective (adaptive – analytical thinking) rumination. However, research has not yet investigated how gender may moderate this link between resting vmHRV and various forms of rumination. The current study sought to examine this in a sample of 289 participants' (168 women, 121 men, mean age of 20 ± 2 years). While attached to an electrocardiogram, participants first completed a 5-minute resting-baseline period where resting vmHRV was assessed using root mean square of successive differences. Participants then completed the Ruminative Responses Scale, designed to assess total ruminative tendencies, in addition to three subscales to assess the aforementioned forms of rumination. Controlling for important covariates, gender did not significantly moderate the relationship between vmHRV and total rumination, depressive rumination, or brooding rumination (each p > .1). However, gender significantly moderated the association between vmHRV and reflective rumination (ΔR² = .01, B = -1.63 (.81), [-3.22, -.04], r<sub>partial</sub> = -.120, p = .044). Conditional analyses showed a significant negative association between vmHRV and reflective rumination in women (B = -1.58 (.51), [-2.57, -.58], p = .002), but not men (B = .16 (.61), [-1.05, 1.05], p = .79). This pattern of data is similar to aforementioned gender differences in the association between resting vmHRV and ER abilities, and extends them to the domain of ER strategies (i.e., rumination). Overall, the current results suggest that the relationship between resting vmHRV and rumination, particularly when adaptive, may be more complex when considering gender as a moderating factor.

## 153) Abstract 1455

### THE RELATIONSHIP BETWEEN HEART RATE VARIABILITY AND THE NEED FOR AFFECT: A FOCUS ON GENDER DIFFERENCES

Nicholas P. Joseph, B.S, DeWayne P. Williams, M.S, Psychology, The Ohio State University, Columbus, OHIO, Asia Bowman, A.M, Psychology, University of Chicago, Illinois, Chicago, Julian Koenig, Dr. sc Hum, Psychiatry, Heidelberg, Heidelberg, Heidelberg,
Germany, Derek Spangler, Ph.D, Julian Thayer, Ph.D, Psychology,
The Ohio State University, Columbus, OHIO

The need for affect (NA), defined as the motivation to approach, and
not avoid, emotion inducing situations (both positive and negative).
Interestingly, women report greater approaching of emotions while men
report more avoiding of emotions compared to their respective
counterparts. In our previous research, we showed a relationship
between lower resting high frequency heart rate variability (HF-HRV),
a marker of emotion regulation abilities, and the approaching, but not
avoiding, of emotional experiences (via respective subscales).
However, research has not yet examined how the relationship between
resting HF-HRV and the need to approach and avoid emotions may
differ between men and women given these aforementioned gender
differences in ER and NA. The present study sought to investigate this
in 82 participants (56 women, 26 ethnic minorities, mean age = 19.18,
SD = 2.07) who first completed a 5-minute baseline-resting period,
followed by the 26-item NA Scale designed to index overall motivation
to approach emotions. Subscales include the need to approach (13
items) and avoiding (13 items) emotional experiences. Heart rate data
were recorded via an electrocardiogram, and resting HF-HRV was
assessed during a 5-minute baseline period, and calculated in
accordance with Task Force (1996) Guidelines. Correlation results
showed a significant negative relationship between resting HF-HRV
and the approaching of negative emotions for women (r =.430, p =
.001), but not for men (r = -.119, p=.545). In contrast, results showed a
negative relationship between resting HF-HRV and avoiding of
negative emotions for men (r = -.367, p=.055) but not for women (r =
.090, p=.526). No significant relationships were found between resting
HF-HRV and total NA. The current investigation provides a novel
finding: the motivation to approach and avoid emotions are
differentially related to resting HF-HRV between men and women.
Given the current findings, it is possible that this gender-based
differential relationship between resting HF-HRV and the
approaching/avoiding of emotional experiences may be a motivation
factor underlying gender differences in ER processing; however, future
research is needed to these notions directly.

154) Abstract 1448

THE RELATIONSHIP BETWEEN TRAUMA EXPERIENCE AND REDUCED AUTOBIOGRAPHICAL MEMORY AND THE MODERATING INFLUENCE OF HEART RATE VARIABILITY

Nicole Feeling, M.A., Briana R. Brownlow, B.A., Psychology, The Ohio
State University, Columbus, OH, Crystal R. Slane, B.A., Psychology,
The University of Virginia, Richmond, Virginia, Brandon L. Gillie,
Ph.D., Sports Medicine, University of Pittsburgh Medical Center,
Pittsburgh, PA, Matthew L. Free, B.A., Michael W. Vasey, Ph.D.,
Julian F. Thayer, Ph.D., Psychology, The Ohio State University,
Columbus, OH

While reduced autobiographical memory specificity (AMS) – a
memory bias in which autobiographical events are recalled in an over-
general manner – is associated with Depression and Post Traumatic
Stress Disorder (PTSD), its relationship to trauma experience in
nonclinical samples has not been established. Disparate findings from
previous research suggest that moderators might have a role in the
relationship between trauma experience and AMS. Resting high
frequency heart rate variability (HF-HRV) is negatively associated with
PTSD and is positively associated with greater cognitive control. Prior
research has indicated that when a nonclinical sample is placed under
cognitive load, resting HF-HRV acts as a moderator in the relationship
between depressive symptoms and AMS, such that their negative
association is strongest at low HF-HRV. The present study investigated
the impact of HF-HRV and cognitive load as moderators of the link
between trauma experience and reduced AMS in a nonclinical student
population. Participants (n=300) completed an online questionnaire
battery including the Life Events Checklist for DSM-5 (LEC), an
inventory assessing experience of traumatic events. This was followed

by a lab session in which HF-HRV was collected via electrocardiogram
during a 5-minute resting baseline condition, followed by the
Autobiographical Memory Test (AMT), a measure of AMS.
Participants were randomly assigned to cognitive load conditions. A
three-way interaction analysis controlling for gender and depression
scores showed a significant interaction between number of traumas
reported on the LEC, resting HF-HRV, and load condition on number
of categorical memories reported on the AMT (R²Δ = .021, β=-1.22,
(standard error = .49), p=.013). Thus, in the higher load condition
only, individuals with lower HF-HRV and greater trauma experience
displayed lower AMS. These findings suggest that HRV and cognitive
load impact the association between experience of trauma and reduced
AMS in nonclinical populations. Individuals who have experienced
trauma are most likely to display lower AMS when they have low HF-
HRV and are additionally put under cognitive load. As individuals
who've experienced trauma are also likely to be individuals
experiencing stress and are likely to display low HRV, these findings
are especially relevant to understanding reduced AMS in trauma
samples.

155) Abstract 1391

TYPE D PERSONALITY AND CARDIOVASCULAR REACTIVITY TO ACUTE STRESS: A META-ANALYTIC REVIEW OF STUDIES USING ACTIVE TASKS

Siobhan Howard, PhD, Psychology, Mary Immaculate College,
University of Limerick, Limerick, Munster, Ireland, Nina Kupper, PhD,
Johan Denollet, PhD, Center of Research on Psychological and
Somatic disorders, Tilburg University, Tilburg, Noord-Brabant,
Netherlands

**Background:** Type D personality has been related to negative outcomes following cardiac events, with cardiovascular reactivity to stressors posed as a potential mechanism of effect. However, studies on Type D and cardiovascular reactivity have reported mixed findings. This meta-analysis examined if Type D personality is reliably associated with cardiovascular reactivity to stress in healthy individuals. We also aimed to determine the direction of any effects, and to examine both gender and social context of the stressor as potential moderators.

**Methods:** Electronic databases were searched for studies with non-clinical samples that employed a resting baseline period followed by a stress-task period. Comprehensive Meta-Analysis was used to calculate pooled effects sizes, with Hedges's *g* calculated for each measure.

**Results:** Type D personality was not associated with cardiovascular reactivity unless 1) social context of the stress task and 2) gender are considered. In fact, patterns of cardiovascular reactivity differed as a result of these moderating variables. Social stress tasks tended to be associated with lower systolic blood pressure reactivity in Type Ds (Hedges's *g* = -.36), while asocial stress tasks were associated with lower heart rate (Hedges's *g* = -.33) and total peripheral resistance (Hedges's *g* = -.40) reactivity in Type Ds. When gender is considered, women showed lower diastolic blood pressure reactivity to asocial tasks (Hedges's *g* = -.92) while men showed elevated heart rate (Hedges's *g* = .51) and cardiac output (Hedges's *g* = .58) reactivity.

**Conclusions:** These findings highlight the importance of considering gender and social context of laboratory stressors in cardiovascular reactivity studies and Type D personality. Failure to consider these moderating factors in previous research may explain the reporting of mixed findings in relation to Type D personality and cardiovascular reactions to stress in healthy individuals.

**Funding:** This research was supported by an Irish Research Council New Horizons Award, REPRO/2015/39
156) Abstract 1434

EVALUATING THE IMPACT OF DELAYS IN SALIVA SAMPLING COMPLETION ON CORTISOL AWAKENING RESPONSE VALUE USING A NEW MOBILE TOOL

Cheng K. Fred Wen, MPH, Preventive Medicine, University of Southern California, Los Angeles, CA, Marc J. Weigensberg, M.D., Pediatrics, Stefan Schneider, Ph.D, Center for Self-Report Science, Center for Economic & Social Research, Bas A. Weerman, , Center for Economic and Social Research, Donna Spriujt-Metz, MFA, Ph.D., Psychology, Preventive Medicine, Center for Economic and Social Research, University of Southern California, Los Angeles, CA

**Background:** Delays in salivary cortisol (SC) sampling may yield misleading cortisol awakening response (CAR) data. Verifying the sampling times in the field, however, is challenging. Existing technologies such as sensor-equipped bottles provide estimates of time of initiation of sampling, but leave the timeliness of sampling completion unassessed. A mobile app, “ZEMI” was developed for SC collection in the field, enabling assessment of SC sampling completion.

**Methods:** 17 youth completed a 3-day field SC collection protocol both before and after a stress reduction intervention pilot study. Participants were given Salivette tubes, a bottle of cotton-plugs equipped with a sensor to detect when bottle was opened (MemsCap), and a smartphone with the ZEMI app installed. Participants were blinded to the MemsCap. Study staff personalized waking alarms on ZEMI for each participant so that ZEMI prompts participants to collect a saliva sample upon waking, 30 mins post-waking, and at around 8PM. At the sound of each alarm, they were asked to take 1 cotton-plug from the bottle, place it in their mouth for 2 mins, place the soaked cotton-plug in a labeled tube, upload a picture of the collected sample via ZEMI, and then answer 5 questions about their stress. Individual CAR slopes were calculated according to Almeida et al 2009. The effect of delays in sampling completion was assessed by comparing the mean CAR slopes for days when the time difference between MemsCaps open-time and time of picture taken was <5 mins $\approx$5 mins using analysis of variance (ANOVA).

**Results:** See Table 1 for participant characteristics. The average time difference between MemsCaps open-time and time of picture taken was 29.9±10.7 mins. There was a marginally significant difference in least-square mean CAR slopes between samples that were completed within 5 mins of MemsCap-opening time (slope=-0.004 ug/dL/minutes) vs. more than 5 mins (slope=0.055, *p*=0.084 ug/dL mins).

**Conclusions:** Timeliness of SC sampling completion may impact the resulting CAR values, indicating the importance of assessing verified sampling completion time. ZEMI is the first mobile application to obtain verified timing of SC sample collection completion from participants and can improve the validity of ambulatory SC assessment.

<table><thead><tr><th></th><th>(n=17)</th></tr></thead><tbody><tr><td>Age (years of age ±SD)</td><td>17.2±1.0</td></tr><tr><td>Gender</td><td>41.7</td></tr><tr><td>Ethnicity-Hispanic (%)</td><td>94.1</td></tr><tr><td>Ethnicity-Asian (%)</td><td>5.9</td></tr><tr><td># of Saliva Samples Collected</td><td>19±3</td></tr></tbody></table>

157) Abstract 1144

THE INFLUENCE OF SAFETY AND SECURITY NEEDS ON SELF-PERCEPTION OF PHYSICAL HEALTH IN GENDER MINORITIES LIVING IN AN UNDER-RESOURCED REGION OF THE SOUTHERN UNITED STATES

James A. Griffin, MS, Christopher F. Drescher, PhD, Psychiatry & Health Behavior, Thomas M. Toomey, BA, Educational Innovation Institute, Elizabeth D. Eldridge, PhD, Lara M. Stepleman, PhD,

Psychiatry & Health Behavior, Medical College of Georgia, Augusta, Georgia

Gender minorities (e.g., transgender, genderqueer and gender nonconforming individuals) experience significant disparities related to physical and mental health conditions in the United States. Gender minorities often have unique health needs related to the use of hormone replacement therapy and gender affirming surgeries, yet there is limited health insurance coverage for these interventions and, even when coverage exists, the availability of culturally competent care is sparse outside of large urban centers. Additionally, the gender minority community is more likely to face financial stressors and violence compared to the general population, which in turn can lead to or worsen an array of health conditions. The present study assesses the contributions of critical psychosocial stressors experienced by gender minorities in the Central Savannah River Area (CSRA) of Georgia and South Carolina to self-perceptions of overall health. Perceived health is an adequate proxy for various health biomarkers (e.g., blood pressure, body mass index, metabolic and immune markers) in underserved populations (Dowd & Zajacova, 2010) and is predictive of future disability and morbidity (Idler & Kasl, 1995). Participants from a gender and sexual minority health needs assessment in the CSRA completed a questionnaire including questions assessing perceptions of safety, current financial situation, and perception of overall health. The subsample utilized in the current study included a total of 60 gender diverse individuals (34% female-to-male, 28% male-to-female, 27% genderqueer, 1% intersex, 10% other-identified) between the ages of 18 and 73 ($M_{age}$ = 30) were included in the current study. A multiple regression analysis (Adjusted $R^2$ = .303) indicated that both perceived safety ($\beta$ = -.197, *p* < .01) and financial situation ($\beta$ = -.224, *p* < .01) were significant, independent predictors of low perceived health. These findings suggest that physical safety and economic assurances are critical sources of stress for gender minorities in under-resourced areas of the US, such as the CSRA, with the potential for devastating effects on health. The fundamental needs of gender minorities in under-resourced areas should be a high priority for health providers and advocates for these communities.

158) Abstract 1173

THE RELATIONSHIP BETWEEN ANGER, CARDIO-VASCULAR DISEASE, AND LAW ENFORCEMENT OFFICERS

Elizabeth D. Eldridge, PhD, Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, Bruce R. Wright, MD, Department of Psychology, Washington State University, Pullman, WA, Sterling McPherson, PhD, Clinical Sciences, Washington State University College of Medicine, Spokane, WA, Lara M. Stepleman, PhD, Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, Candace Fanale, M.S., Department of Psychology, Washington State University, Pullman, WA, Dennis Dyck, PhD, Psychology, Washington State University, Spokane, WA

Research has indicated relationships between law enforcement officers (LEOs), psychosocial factors, and cardiovascular disease (CVD) risk. LEO populations may be at increased risk for aggression and anger suppression, which has been linked to clinical and subclinical cardiac outcomes. Anger may help explain the increased risk in LEOs for CVD mortality and morbidity, as well as subclinical atherosclerosis. In this study, the relationship between occupational status, anger, and CVD markers was examined. The study utilized archival data from the Spokane Heart Study, which longitudinally measured CVD risk factors in initially healthy participants. Participants were categorized into two groups: LEO group (N = 105) and demographically matched non-LEO group (N = 65). Analyses performed included hierarchical regressions, basic mean testing, and structural equation modeling. Results indicated that LEOs and non-LEOs did not differ on measures of externalized anger, t = -.62, *p* = .54, or internalized anger, t = -.15, *p* = .88, nor did the groups significantly differ in coronary artery calcification (CAC), t = 1.15, *p* = .25, or C-reactive protein (CRP) levels, t = -1.63, *p* = .10.
However, LEO status was significantly associated with body mass index (BMI), with LEOs having higher BMIs than non-LEOs, r(170) = .26, p = .001. Regardless of occupational status, the structural equation model revealed that higher levels of externalized anger predicted lower levels of CAC (β = -.17, p < .05). Conversely, higher levels of internalized anger were associated with higher levels of BMI, r(170) = .16, p = 0.34, and low-density lipoprotein (LDL), r(162) = .19, p = .01. While LEO status did not predict higher levels of anger in this sample, the non-significant results offer interesting implications given recent media coverage of aggressive police behaviors. Additionally, despite research suggesting that BMI tends to increase with age, findings from the current study suggest that LEO occupational status may present additional risk for increased BMI, even at younger ages. Furthermore, regardless of occupational group, results suggest that some properties of behaviorally expressed anger may be protective, while higher levels of internalized anger might be more detrimental to health.

## 159) Abstract 1278

### NEGATIVE MOOD IMPACTS PHYSICAL ACTIVITY AND NUTRITION IN AN ADOLESCENT AND ADULT IMMIGRANT AND REFUGEE POPULATION

Eleshia J. Morrison, PhD, Matthew M. Clark, PhD, Psychiatry and Psychology, Mark L. Wieland, MD, MPH, Primary Care Internal Medicine, Jennifer A. Weis, RN, MAN, Center for Translational Science Activities, Marcelo M. Hanza, BA, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, Sonja J. Meiers, PhD, Department of Nursing, Winona State University, Rochester, MN, Christi A. Patten, PhD, Psychiatry and Psychology, Jeff A. Sloan, PhD, Paul J. Novotny, MS, Health Sciences Research, Biostatistics and Informatics, Leslie A. Sim, PhD, Psychiatry and Psychology, Mayo Clinic, Rochester, MN, Julie A. Nigon, BA, N/A, Hawthorne Education Center, Rochester, MN, Irene G. Sia, MD, MSc, Division of Infectious Diseases, Mayo Clinic, Rochester, MN

**Background:** Immigrants to the United States typically arrive healthier than the general population; however increased time in the US is associated with an escalation of negative health behaviors and health conditions. Negative mood is associated with poorer health behaviors in the general population; a relationship that is understudied in immigrant populations. The present study is an examination of baseline mood, physical activity (PA), and nutritional behaviors in a sample of immigrant and refugee families (recently published in Morrison et al., 2016), taken from a parent prospective interventional study (the Healthy Immigrant Families (HIF) study; Bronars et al, 2016) to improve health behaviors in this population. Methods: Adolescent (n=78) and adult (n=65) family members completed a health behavior survey using a community-based participatory research (CBPR) approach. Single-item measures assessed mood and physical well-being (poor to excellent); items from the Food Behavior Checklist assessed nutritional behaviors; the kinetic activity monitor (KAM) accelerometer provided an objective measure of PA; and the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) assessed self-efficacy and social support for PA and nutritional behaviors. Group differences classified by high/low mood were compared using Wilcoxon tests for continuous variables and chi square tests for categorical variables. Results: Adolescent participants had a mean age of 13.5 years, were 51% female, and 53% were US-born; those who were foreign-born reported a mean of 6.8 years residing in the U.S. Adult participants had a mean age of 39.1 years and were 71% female. Those who were foreign-born (90%) reported a mean of 14.2 years residing in the U.S. Adolescents with positive mood (77%) consumed less regular soda, and demonstrated more total minutes, greater intensity, and greater social support for PA (all ps < .05). Adults with positive mood (72%) reported more snacking on fruits/vegetables, greater self-efficacy for PA, and better physical well-being (all ps<.05). Discussion: Negative mood was associated with low PA level and poor nutritional behaviors in adolescent and adult immigrants and refugees. Designing community-based programs offering strategies for mood

management and healthy lifestyle change may be efficacious for immigrant populations.

## 160) Abstract 1255

### THE PREVALENCE OF SCHOOL DIFFICULTIES IN THE MENTAL HEALTH OF IMMIGRANT PORTUGUESE CHILDREN

António Pedro, PhD, Psychology, Universidade Autonoma Lisboa, Lisboa, Lisboa, Portugal

Children with developmental disorders, sons of Portuguese immigrant parents in France, focus they're symptoms in school learning, unlike the children of French parents, in which prevail family relationship difficulties.

This study was conducted over 4 years at the Children's Psychiatric Center XIII district of Paris, with 248 children consultants, of which 62 sons of Portuguese parents, compared to 186 children of French parents, with average age of 9.26 and 8.73 years respectively. For this we analyzed the Portuguese immigrants children dossiers, compared to triple the French children, and matched for age and sex. Two initial evaluation questionnaires were used, one on psychiatric history of the child and the family, the other on population demographic data. Consulting teams realized from the first consultation, that the children of Portuguese parents, significantly differed from the French, by the severity of academic failure and language disorders. Most of them suffer from language problems, including mutism, delayed speech, articulation disorders and difficulties related to bilingualism. In this context, academic failure is most common in children born in Portugal and immigrated with his parents, coming to develop later specific developmental disorders related to the acquisition of the French language. The language disorders are diagnosed more often in children already born in France.

### Conclusion

The learning difficulties of immigrant Portuguese children, are a characteristic of the migratory experience of families, as opposed to the control group whose symptoms lie more in the parent-child relationship. These results confirm other studies on Portuguese immigrant children (Nunes, F. 2014 INYI Journal). This study confirms that Portuguese immigrants children in France are not bilingual, but practice semi linguism. Teaching in the mother tongue presents itself as a preventive measure for the development of these children, in the context of bilingual school learning.

The professionals of mental health services should access the mother tongue of these children. Collected data of clinical experiences reports allow us to place the hypothesis that children of immigrants suffer not only from difficulties related to languages but that these symptoms equate to a childhood depression.

## 161) Abstract 1312

### PROSPECTIVE EFFECTS OF IQ ON INTERLEUKIN-6 AMONG OLDER ADULTS

April B. Scott, B.S., Rebecca G. Reed, PhD, Suzanne C. Segerstrom, PhD, Psychology, University of Kentucky, Lexington, KY

**Background:** Previous research suggests that cognitive ability is negatively correlated with the proinflammatory cytokine interleukin (IL)-6 among older adults. However, interpretation of such findings has been limited by contemporaneous measurement of cognitive function that can itself be affected by ill health or inflammation (e.g., executive function, processing speed). Therefore, interpretations in which cognitive ability reduces systemic inflammation and vice versa are equally viable.

**Objective:** The current study investigated the relationship between cognitive ability and IL-6 in older adults using a measure that captures "premorbid" IQ, that is, estimated full-scale IQ that is resistant to any age- or inflammation-related changes.
**Method:** Community-dwelling, healthy, nonsmoking older adults (N=120, M age=74) were assessed for estimated IQ at baseline using the North American Adult Reading Test and had blood drawn up to 10 times semiannually (n=799). Multilevel models were used to test the prospective effect of IQ on subsequent IL-6 (measured on an ELISA platform and log10-transformed for analysis). Extreme values associated with acute infection (n=12) were dropped from analysis.

**Results:** In a model including only IQ, each 15 points higher IQ was associated with 0.2 SDs lower log IL-6 (p = .092). When age, BMI, statin medication, and a time effect that accounted for relationships between IL-6 and likelihood of drop-out were included, each 15 points higher IQ was associated with 0.23 SDs lower log IL-6 (p = .045).

**Conclusion:** Inflammation and cognitive function can affect each other. In the present analysis, effects of cognitive function on inflammation were isolated by using a measure of "premorbid" cognitive function. IQ may reduce inflammation through its relationship with better problem-solving, better health behavior, higher socioeconomic position, or better general physiological makeup

## 162) Abstract 1114

### RESILIENCE, WORK ENGAGEMENT AND STRESS REACTIVITY IN A MIDDLE-AGED MANUAL WORKER POPULATION.

Anna C. Whitaker, PhD, Julie K. Black, BSc(Hons), Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK, George M. Balanos, PhD, Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom

Work stress is a growing problem in Europe. Together, the negative physiological effect of stress on health, and increasing age doubles the risk of developing cardiovascular disease. Therefore, identifying older workers who may be at risk of work-related stress, and its physiological effects, is key to promoting their health and wellbeing in the workforce. The present study examined the relationship between perceived psychological resilience and work-related factors (work engagement and sickness presenteeism) and the physiological response to acute psychological stress in older manual workers in the UK. Thirty participants, mean (SD) age 54.9 (3.78) years reported perceived levels of resilience, work engagement, and presenteeism using standardized questionnaires. Cardiovascular measurements (heart rate (HR) and blood pressure (BP)) and salivary cortisol were used to assess their physiological response to an acute psychological stress task. Resilience was not correlated with work-related factors. However, workers with high HR reactivity reported higher levels of presenteeism (p = .03) and lower levels of work engagement (p = .001) than those with lower HR reactivity. Participants with lower resilience displayed somewhat higher HR reactivity compared to those with higher resilience (p = .07). This suggests a potential pathway by which poorer resilience and higher work stress might contribute to the risk of future cardiovascular disease.

## 163) Abstract 1539

### DIFFERENTIAL RELATIONS AMONG INFLAMMATION AND SLEEP, MEMORY AND MOOD IN HEALTHY AFRICAN AMERICANS AND WHITE YOUNG ADULTS

Stacey N. Doan, PhD, Psychology, Claremont McKenna College, Claremont, Ca, Thomas E. Fuller-Rowell, PhD, Human Development and Family Studies, Auburn University, Auburn, Alabama

Increased levels of Interleukin-6 have been linked to cardiovascular disease, type 2 diabetes and functional decline (Harris, Ferrucci, Tracy, Corti, Wacholder, Ettinger et al., 1999). Research examining ethnic health disparities has suggested the possibility that stigmatized minorities groups may be more susceptible to the consequences of biological dysregulation due to differential exposure to adversity (Hogue, 2002). A few studies have investigated the Weathering Hypothesis (Geronimus, Hicken, Keen & Bound, 2006), by examining

associations among inflammatory biomarkers and a range of psychological and health factors with finding relations between inflammatory biomarkers and worst outcomes in AAs, but not EAs (Blair, Porter, Lebleicioglu, & Christian, 2015; Gruenewald, Mujahid, Ryff, Albert & Williams, 2010; Christian, Glaser, Porter and Iams, 2013). To date however, no study has investigated these associations in a relatively young and healthy sample and simultaneously investigated the associations across a spectrum of variables. In studying young, healthy participants, associations between inflammatory biomarkers and health outcomes may be nonexistent, because levels of physiological dysregulation may be too low to reach a critical threshold. On the other hand, if we were to find that the effects were present for one group rather than the other, even during a relatively healthy developmental period, the data would support the Weathering Hypothesis. The sample included 133 students (Mage = 18.8 yrs., SD = 0.9; 41% AA, 57% female). IL-6 was assessed by enzyme linked immunosorbent assay with a detection range of 0.16 to 10.0 pg/ml. Working memory was behaviorally assessed and participants reported on sleep and depression using standardized measures (Pittsburg Sleep and Beck Depression Inventories). Results for two of the three outcomes were consistent with our hypothesis that IL-6 would be associated with worse outcomes for AA than for Whites. Specifically, using bootstrapping to test for moderation, we found that for AAs, IL-6 was associated with more sleep problems (B = -2.56, SE = .67, *p* = .001, CI [1.3, 3.8], see Figure 1), and worst working memory for AA (B = -1.90, SE = .60, *p* = .002, CI [-3.04, -.73], but not Whites. The substantive finding held even after controlling for a range of demographic variables and health behaviors.

<figure><img src="image_20.png" /><figcaption>Figure 1: Race moderations the relations between IL-6 and Sleep Problems</figcaption></figure>

## 164) Abstract 1080

### PRE-EXISTING SMALLER DLPFC VOLUME CONTRIBUTES TO POST-TRAUMATIC GROWTH AFTER A DISASTER IN CHILDREN

Atsushi Sekiguchi, MD, PhD, Adult Mental Health, National Institute of Mental Health, NCNP, Kodaira, Tokyo, Japan, Yuka Kotozaki, PhD, School of Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan, Thyreau Benjamin, Mr, TOMMO, Hikaru Takeuchi, PhD, Susumu Yokota, PhD, IDAC, Tohoku University, Sendai, Miyagi, Japan, Kohei Asano, Dr, Kokoro Research Center, Kyoto University, Kyoto, Kyoto, Japan, Michiko Asano, Dr, Global Center for Advanced Research on Logic and Sensibility, Keio University, Mita, Tokyo, Japan, Yuko Sassa, PhD, Rui Nouchi, PhD, Yasuyuki Taki, MD, PhD, Ryuta Kawashima, MD, PhD, IDAC, Tohoku University, Sendai, Miyagi, Japan

Regional gray matter volume (rGMV) changes due to a stressful event were observed in children, suggesting no hippocampal volume
reduction (McCrory 2011), cerebellum volume reduction (De Bellis 2006; Bauer 2009), and mixed patterns of prefrontal cortex (PFC) volume (Carrion 2009; Carrion 2010; De Brito 2013). On the other hand, despite a psychological distress, positive psychological changes could occur after experiencing a stressful event, which were defined as posttraumatic growth (PTG) (Tedeschi 1996; Cryder 2006). Although the neurological characteristics related to posttraumatic stress in children have been well investigated, those associated with PTG remained unclear. We aimed to identify the rGMV changes as a pre-existing factor of PTG after the 2011 Japanese earthquake in children. We hypothesized that rGMV in the right DLPFC have a significant association with PTG, based on the previous findings in young adults (Nakagawa 2016).

Of the MRI database in our institute (Taki 2013), we analyzed data from 66 normal children (age = 12.0 ± 2.3 yrs, 34 males). A written informed consent was obtained from each child and their parent. We used T1-weighted images to assess their gray matter volumes obtained before the earthquake. Also, we assessed degree of their posttraumatic growth after the earthquake using Japanese version of posttraumatic growth inventory (PTGI-J). To find the rGMV alterations as a pre-existing factor of PTG, we applied a voxel-based morphometry analysis on SPM8 employing rGMVs before the earthquake as target variables, and PTGI-J scores after the earthquake as explanatory variables, treating sex, age, total gray matter volume, and intervals between acquisition of brain imaging data and that of PTG scores as covariates. Statistical threshold was set at p < 0.05 for the ROI of the right DLPFC (small volume correction; svc).

We found a significant negative correlation between PTGI-J scores and rGMV in the right DLPFC (p<0.05, svc). We found no significant positive correlation between PTGI-J scores and rGMV in the DLPFC. The findings demonstrate that the smaller DLPFC volumes are pre-existing factors for the posttraumatic growth after a stressful event in normal children. The results indicate that an early maturation of the right DLPFC play an important role in the psychological developments after a stressful event.

## 165) Abstract 1544

### ASSOCIATION BETWEEN MINDFULNESS TENDENCY ASSESSED BY FIVE FACET MINDFULNESS QUESTIONNAIRE AND REGIONAL GRAY MATTER VOLUME IN A JAPANESE POPULATION

Hiroki Murakami, PhD, Psychology, Oita University, Oita, Oita, Japan, Ruri Katsunuma, MRes, Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan, Kentaro Oba, PhD, Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan, Kazuo Mishima, PhD, MD, Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan, Yoshiya Moriguchi, PhD, MD, Medical affairs, Lundbeck Japan K. K., Minato-ku, Tokyo, Japan

Mindfulness is the practice of focusing complete attention on experiences occurring in the present moment with a nonjudgmental and accepting attitude. Mindfulness is considered the third wave of cognitive behavior therapy and is accepted as being effective for improving emotional regulation. Research on mindfulness tendency to date has investigated brain structures and their effects on mindfulness, which has suggested that particular brain areas, the anterior insular being foremost, are related to mindfulness tendency and its effects. Only a few studies on mindfulness have been conducted in Eastern countries although the concept was originally developed in the East. Our previous studies in Japan have also elucidated an association between mindfulness tendency and the anterior insula, although the sample size of 19 participants was too small to ensure definite conclusions. Therefore, in the current study, we investigated associations between mindfulness tendency assessed by the Japanese version of the Five Facet Mindfulness Questionnaire (FFMQ) and regional gray matter volume in 48 Japanese participants by utilizing

optimized voxel-based morphometry. Results corroborated previous studies by confirming the association between right (Z=3.16) and left (Z=3.07) anterior insula with mindfulness tendency.

## 166) Abstract 1507

### EFFECTS OF MINDFULNESS-BASED STRESS REDUCTION (MBSR) ON PTSD SYMPTOMS AND BRAIN RESPONSE TO TRAUMATIC REMINDERS OF COMBAT IN OPERATION ENDURING FREEDOM/OPERATION IRAQI FREEDOM (OEF/OIF) COMBAT VETERANS WITH POSTTRAUMATIC STRESS DISORDER (PTSD)

J. Douglas Bremner, M.D., Psychiatry and Radiology, Sanskriti Mishra, M.D., Carolina Campanella, Ph.D., Majid Shah, M.D., Nadeem Afzal, M.D., Psychiatry, Emory University School of Medicine, Atlanta, GA, Nicole Kasher, B.S., Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, Sarah Evans, B.S., Negar Fani, Ph.D., Psychiatry, Emory University School of Medicine, Atlanta, GA, Amit Shah, M.D., Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, Collin Reiff, M.D., Psychiatry, Emory University School of Medicine, Atlanta, GA, Lori Davis, M.D., Psychiatry and Behavioral Neurobiology, Alabama Health Sciences - Birmingham, Birmingham, Alabama, Viola Vaccarino, M.D., Ph.D., Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, James Carmody, Ph.D., Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Mass.

Mindfulness-Based Stress Reduction (MBSR) is an effective intervention for a number of mental conditions. The purpose of this pilot study was to assess the effects of MBSR on PTSD and brain correlates of combat stress in returning veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Twenty-six veterans with combat-related PTSD were randomized to receive either eight weeks of once a week MBSR session or a Present Centered Group Therapy (PCGT) control condition. Nine subjects finished MBSR and 8 SGCT. Subjects underwent assessment of PTSD symptoms with the Clinician Administered PTSD Scale (CAPS) and positron emission tomography (PET) imaging of the brain with a High-Resolution Research Tomograph (HRRT) during exposure to Iraq combat-related and neutral slides and sounds before and after the intervention. There were significant reductions in PTSD symptoms as measured by the CAPS in the MBSR (CAPS score 56 (29 SD) pre- and 28 (20 SD) post-intervention, p<0.05)) but not in the PCGT group (CAPS score 51 (14 SD) pre- and 43 (14 SD) post-intervention (p=NS)). These effects persisted at six months. MBSR treated patients had increased anterior cingulate and inferior parietal lobule and decreased insula and precuneus function in response to traumatic reminders compared to the PCGT group. This study shows that MBSR is a safe and effective treatment for PTSD. Furthermore, MBSR treatment is associated with changes in brain regions that have been implicated in PTSD and are involved in extinction of fear responses to traumatic memories as well as regulation of the stress response.
<figure><img src="image_21.png" /></figure>

Areas of increased activation when viewing traumatic pictures and sounds vs. neutral pictures and sounds, MBSR > Traditional Supportive Therapy. Increased activations in Anterior Cingulate and Subcollosal Gyrus.

## 167) Abstract 1174

### BRAIN FUNCTION PREDICTS PROGRESSION OF BLOOD PRESSURE

J. Richard Jennings, PhD, Psychiatry, Alicia Heim, BS, Rehabilitation, Lei Sheu, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA, Matthew Muldoon, MD, Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, Christopher Ryan, PhD, Psychology, University of California San Francisco, San Francisco, CA, H. Michael Gach, PhD, Radiology, Washington University at St. Louis, St. Louis, Missouri, Peter Gianaros, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA

At midlife 40 percent of Americans have hypertension and higher blood pressure (BP) relates to lower cognitive function. Research to date has not shown that lowering BP reverses or prevents early cognitive decrements or later dementia suggesting that BP per se may not directly impair cognitive function. We hypothesized that cognitive function and brain blood flow responses to laboratory challenges would predict progression of BP.

Midlife adults (n=154, mean age=49, 45% male) with pre-hypertensive levels of BP (systolic>=120 mmHg and <140 or diastolic >=80 and <90) received neuropsychological testing and assessment of regional cerebral blood flow (rCBF) response to mental challenges before and after a 2 year period.

Neuropsychological factors were extracted for verbal and logical memory (Memory), Executive Function, Working Memory, Mental Efficiency, and Attention. A pseudo-continuous arterial spin labelled perfusion magnetic resonance imaging sequence was employed to compare processing related to control and active phases of 2 Back Memory and Multi Source Interference Tests. Based on principal components analysis, rCBF areas previously associated with BP were grouped into composites for frontoparietal, frontostriatal, and insular-subcortical areas. Multiple regression models assessed BP after two years as a function of initial BP, initial cognitive scores, and initial rCBF responses (as well as sex, race, education, and body mass).

Working memory performance (standardized beta=-.280, se=.114, p=.02) and the frontostriatal rCBF response (standardized beta = .252, se=.105, p=.02) significantly predicted follow-up BP. Initial BP failed to significantly predict subsequent cognitive performance or rCBF. These results provide initial support for the hypothesis that changes in brain function precede or are concomitant with the progression of BP toward hypertensive levels in midlife.

## 168) Abstract 1622

### BODY MASS INDEX AND FUNCTIONAL IMPAIRMENT AMONG TREATMENT-SEEKING SMOKERS: THE EXPLANATORY ROLE OF ANXIETY SENSITIVITY

Brooke Y. Kauffman, B.S., Lorra Garey, M.S., Charles Jardin, M.S., Psychology, University of Houston, Houston, Texas, Norman B. Schmidt, Ph.D., Psychology, Florida State University, Tallahassee, Florida, Michael J. Zvolensky, Ph.D., Psychology, University of Houston, University of Texas MD Anderson Cancer Center, Houston, Texas

Obesity is a common public health concern in the United States. Data indicate that obesity is associated with impairment of functioning in a number of life areas. However, there is limited understanding of how an individual's body mass index (BMI) may influence an individual's functional impairment as captured by social, occupational, and family life. The current study sought to test whether anxiety sensitivity mediated the relation between BMI and functional impairment among treatment seeking smokers. Participants were 420 (46.9% females; M<sub>age</sub> = 38 years, SD = 13.42) treatment-seeking, adult smokers recruited as part of a larger study designed to evaluate the efficacy of a transdiagnostic panic-smoking cessation treatment relative to a standard smoking cessation treatment. The current study was conducted within a structural equation modeling allowing for the test of both the direct association of BMI with functional impairment, as well as the indirect association through anxiety sensitivity. Anxiety sensitivity and functional impairment were represented as latent constructs with three indicators each, while BMI was represented as a manifest variable. Results indicated that BMI was not directly associated with functional impairment. However, higher BMI was associated with greater levels of anxiety sensitivity, greater anxiety sensitivity, in turn, was associated with greater functional impairment (b = 0.01, SE = .00, 95 % CI = [.001, .018]). This finding remained significant after adjusting for participant sex, negative affectivity, tobacco dependence, psychopathology, and medical conditions. Such results provide novel empirical evidence that, among smokers, BMI may be a risk factor for functional impairment indirectly through anxiety sensitivity. Overall, such findings could potentially inform the development of personalized interventions among this particularly vulnerable segment of the smoking population.

## 169) Abstract 1055

### CHANGE IN ADIPOSITY FOLLOWING LONG-TERM TREATMENT WITH SELECTIVE SEROTONIN REUPTAKE INHIBITORS IN ADOLESCENTS AND YOUNG ADULTS.

Chadi Calarge, MD, Psychiatry, Baylor College of Medicine, Houston, TX, James Mills, MS, William Coryell, MD, Psychiatry, University of Iowa, Iowa City, IA

**Background:** Major depressive disorder (MDD) is associated, prospectively, with obesity. To what extent this may be accounted for by antidepressant treatment has not been well investigated.

**Methods:** Fifteen to 20 year-old participants who were unmedicated or within one month of starting a selective serotonin reuptake inhibitor (SSRI) were enrolled in a longitudinal study examining the skeletal effects of SSRIs. Medication adherence was assessed using pharmacy records and self-report. Every four months, anthropometric measures were obtained following standard procedures. Every eight months, dual-energy x-ray absorptiometry was used to measure visceral adipose tissue (VAT). Sex-age-ethnicity-adjusted body mass index (BMI) Z-scores were generated. Mixed regression analysis examined predictors of longitudinal change in BMI z score and VAT.

**Results:** A total of 264 participants (60% female, mean age: 18.9±1.6 years) contributed 805 DXA scans over an average 1.5±0.8 years of follow up. The mean duration of exposure to SSRIs was 0.16±0.31 years, during the study. After adjusting for baseline age, sex, physical
activity, and time in the study, the score on the inventory for depressive symptomatology and on the Beck Anxiety Inventory, but not a diagnosis of MDD or the score on the Beck Depression Inventory, were inversely associated with change in BMI z score (p=0.0003 and p<0.04, respectively). In contrast, the duration of exposure to SSRIs as well as the cumulative dose during the interim period between DXA scans were both positively associated with change in BMI z score (p

**Conclusions:** In this longitudinal study, exposure to SSRIs but not depressive morbidity was associated with increased adiposity in adolescents. Interventions are needed to attenuate this adverse event in order to reduce long-term cardiovascular risk.

## 170) Abstract 1213

### WHICH BIOPSYCHOSOCIAL VARIABLES CONTRIBUTE TO THE INCREASED RISK OF SUBSEQUENT WEIGHT CHANGE IN DEPRESSION?

Nadine P. Paans, Msc, Mariska Bot, Phd, Deborah Gibson-Smith, Msc, Psychiatry, VU University Medical Center, Amsterdam, Noord Holland, The Netherlands, Philip Spinhoven, Phd, Psychology, Leiden University, Leiden, Zuid Holland, The Netherlands, Ingeborg Brouwer, Phd, Marjolein Visser, Phd, Health Sciences, VU University, Amsterdam, Noord Holland, The Netherlands, Brenda W. Penninx, Phd, Psychiatry, VU University Medical Center, Amsterdam, Noord Holland, The Netherlands

Depression appears to be longitudinally associated with both subsequent weight gain and loss. However, little is known about the biopsychosocial variables that contribute to these increased risks. This study aims to investigate which explanatory variables contribute to the relationship of major depressive disorder and depressive symptom severity with weight change over a period of 4 years.

Data of 1858 adults between 18-65y who participated in the Netherlands Study of Depression and Anxiety was used. At baseline, depression was measured with a DSM-based psychiatric interview as well as with a depressive symptom measure. 4-year weight change was classified as weight loss (>5% loss), weight stable and weight gain (>5% gain). Nineteen baseline psychological (personality, cognitive vulnerability), lifestyle (activity, smoking, alcohol use) and biological (autonomic nervous system, inflammation, leptin) variables as well as psychiatric medication and course were considered as possible explanatory variables in statistical mediation analysis.

In sociodemographic adjusted models, major depressive disorder and depressive symptoms were associated with subsequent weight gain but not weight loss over a period of 4 years. None of the psychological, lifestyle and biological variables or psychiatric course could - even partly - explain the increased weight gain risk in depression.

Our results did confirm a larger 4-year weight gain in depression, but surprisingly none of the various hypothesized psychological, lifestyle and biological explanatory variables, nor psychiatric course, did explain part of this link. Future research should explore other potential factors that may be responsible for the increased risk for subsequent weight gain in depression, e.g. factors like an unhealthy dietary pattern or eating style, or underlying intrinsic factors such as genetics.

## 171) Abstract 1446

### PREDICTORS OF TREATMENT OUTCOME IN PATIENTS WITH EATING DISORDERS

Marzio E. Sabbioni, MD, Patrick Figlioli, PhD, Daniel Horat, MD, Anne Lise Jordi, MD, Marcel Fuerer, MD, Psychosomatic and Psychotherapeutic Medicine, Lindenhofspital, Bern, Bern, Switzerland

Patients with severe eating disorders are offered a multimodal in-patient/day clinic treatment. We assessed the treatment outcome and explored possible predictors of treatment outcome.

From 6/2006 until 8/2016 436 patients (mean age 24.5, 25.4 ± 9.5; 95.1% female) were treated as in-patients and/or in the day clinic of the Department of Psychosomatic and Psychotherapeutic Medicine of a

non-profit private hospital for an eating disorder. Outcome data were available at the end of treatment for 293 (66.9%) of the patients.

All patients were assessed at the beginning and at the end of treatment with the SF36 (Short Form 36 Quality of Life Questionnaire), BSCL (Brief Symptom Checklist), HADS (Hospital Anxiety and Depression Scale), and EDI-2 (Eating Disorder Inventory). The assessment at the beginning included also the IIP-D (Inventory of interpersonal difficulties), PSSI (Inventory of personality style and disorders), FAPK (German Questionnaire for the Assessment of Psychosomatic Disease Processes).

46.08% reached a good treatment outcome defined as a Total score of the EDI at the end of treatment below the 70th percentile of an unselected female population. 16% had a poor outcome with a Total EDI Score at the end being higher than at the beginning. 38% of the patients showed an improvement of the Total EDI score, however the value of the score continued to be over the 70th percentile at the end of treatment.

The following factors were significant (p<.05) positive predictors of a good outcome:

Living in more urban area, having high scores in the "Emotional Role Functioning" scale of the SF36 and in the "Relation to Reality" scale of the FAPK,

The following factors were significant (p<.05) negative predictors of a good outcome:

Having high scores in the "Drive for Thinness", "Ineffectiveness" and "Impulse Regulation" scales of the EDI-2, high scores in the "Anxiety" scale of the HADS, high score in the "Depression" scale of the BSCL, high Total Score of the IIP-D and high scores in the "Spontaneous - Borderline" trait of the PSSI.

Patients with eating disorders tended to have a better outcome if they showed less psychopathology at the beginning. The data supports the strategy to initiate an intensive treatment early in the course of an eating disorder and not to wait until the psychopathology gets worse.

## 172) Abstract 1395

### USING A WEARABLE CAMERA TO EXAMINE THE OBESOGENIC QUALITY OF THE HOME ENVIRONMENT IN EARLY CHILDHOOD

Stephanie Schrempft, PhD, Department of Epidemiology and Public Health, University College London, London, -, United Kingdom, Cornelia van Jaarsveld, PhD, Department for Health Evidence & Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, -, The Netherlands, Abigail Fisher, PhD, Department of Epidemiology and Public Health, University College London, London, -, United Kingdom

**Objective:** To examine whether a wearable camera called 'SenseCam' can be used to examine the 'obesogenic' home environment (comprising food, physical activity, and media-related influences) in early childhood, and whether it is a useful tool for validation of self-report measures.

**Methods:** Participants were 15 primary caregivers of young children (mean age 4 years) who completed the Home Environment Interview (HEI) by telephone. One to two weeks after completing the HEI, participants wore the SenseCam during waking hours while at home for an average of 4 days. A semi-structured interview was carried out after the wearing period to assess participants' experience of wearing the camera. The SenseCam images were visually inspected and coded using The Oxford and CLARITY-DCU SenseCam browser. Intraclass correlation coefficients (ICCs) (for continuous variables) and percent agreement, kappa statistics, and proportion of positive and negative agreement (ppos, pneg) (for categorical variables) were used to compare the SenseCam images and HEI responses.

**Results:** SenseCam captured almost all features assessed in the HEI, but with varying level of detail. Features that were rarely or never captured included availability of tinned and frozen foods, and the presence of satellite TV. It was not possible to fully capture mealtime frequency and child eating while watching TV, due to there being a single wearer
and limited wear period. Validity estimates were varied (ICCs = 0.00 – 0.97; percent agreement = 33 – 100; kappa = -0.19 – 0.76; ppos and pneg = 0.00 – 1.00), but generally moderate to high. Lower agreement was reported for food variety, except for fresh vegetables, and the number of computers in the home. SenseCam was generally acceptable to participants, although there were some reservations.

Conclusion: This study found that a wearable camera can be used to examine and validate aspects of the obesogenic home environment in early childhood. Further research should aim to replicate the validity estimates.

## 173) Abstract 1366

### CHRONICITY OF MATERNAL EXCESS ADIPOSITY ASSOCIATED WITH SUBOPTIMAL BREASTFEEDING DURATION

Misty Hawkins, PhD, Emily D. Fry, BS anticipated, Natalie G. Keirns, BS, Caitlin E. Smith, BS, Sarah Rhoades-Kerswill, PhD, Psychology, Oklahoma State University, Stillwater, OK

**Background:** Exclusive breastfeeding (EBF) for the first 6 months of life with continued total BF (TBF) for 12 months is medically recommended. This recommendation is based on documented benefits of BF for mothers and infants. However, women with excess adiposity have lower rates of BF than their normal weight peers, and the obstacles are not clear. In particular, the potential impact of the timing of maternal excess adiposity is unknown. We examined whether chronicity and onset of excess adiposity was related to BF duration among a large sample of women who had attempted to breastfeed. **Method:** 1,901 mothers were recruited via snowball sampling and completed an online survey about their BF and weight history. EBF and TBF duration was calculated continuously (months) and dichotomously for EBF (0=< 6 months; ≥6 months) and TBF cut-offs (0=< 12 months; ≥12 months). Participants self-reported chronicity and onset and were categorized such that higher values indicate greater chronicity and earlier onset as: 0=Never Overweight, 1=Intermittent Overweight/Post-pubertal Onset, 2=Intermittent Overweight/Pre-pubertal Onset, 3=Chronic Overweight/Post-pubertal Onset, 4=Chronic Overweight/Pre-pubertal Onset. Regressions were used to examine the relationship between obesity timing and BF variables after adjusting for maternal age, race, delivery type/term, hypertension, post-partum depression, and pacifier use. **Results:** Results revealed that 52% of the sample met the ≥ 6 month EBF cut-off, whereas 56% met the ≥ 12 month TBF cut-off. An estimated 80% reported intermittent excess adiposity, whereas 11% endorsed chronic excess adiposity, and 7% never had excess adiposity. Linear regressions indicated that the obesity timing variable was associated with EBF (β=-0.10, p<.001) with a trend for TBF (β=-0.04, p=.054) duration. Those with chronic excess adiposity had lower BF duration in months (EBF M=4.1±4.3; TBF M=11.2±8.0), especially compared with those who had never been overweight (EBF M=5.6±4.8; TBF M=12.2±7.2) (see Figures 1 & 2).

**Conclusions:** Chronic and earlier onset excess adiposity had adverse effects on breastfeeding success and duration, especially for EBF. Compared to their normal weight peers, breastfeeding women with a history of excess adiposity may require additional medical and/or psychosocial intervention in order to meet medically recommended cut-offs.

<figure><img src="image_22.png" /><figcaption>Figure 1: Exclusive Breastfeeding Duration Across Different Groups of Obesity Chronicity and Onset.</figcaption></figure>

*Note.* Dashed line represents medically recommended duration for exclusive breastfeeding: ≥ 6 months.

<figure><img src="image_23.png" /><figcaption>Figure 2: Total Breastfeeding Duration Across Different Groups of Obesity Chronicity and Onset</figcaption></figure>

*Note.* Dashed line represents medically recommended duration for total breastfeeding: ≥ 12 months.

## 174) Abstract 1315

### ELEVATED LEVELS OF SELF-STATE DISCREPANCIES AMONG CHILDREN WITH FUNCTIONAL SOMATIC SYMPTOMS ARE NOT RELATED TO FAMILY FUNCTIONING

Tamar Silberg, PhD, Hila Drucker, MA, Psychology, Bar Ilan University, Ramat-Gan, Israel, Israel, Maya Gerner, PhD, Psychology, Sheba Medical Center, Ramat-Gan, Israel, Israel, Eti Berant, PhD, Psychology, Interdisciplinary Center Herzliya, Herzeliya, Israel, Israel, Jana Landa, MD, Amichai Brezner, MD, Rehabilitation medicine, Sheba Medical Center, Ramat-Gan, Israel, Israel

**Background:** functional somatic symptoms (FSS) are common in pediatric medical settings. These symptoms are often persistent, costly and may be disabling for the children and their families. Many factors have been related to FSS, including dysfunctional family patterns and child's physical or psychological vulnerability. According to self-discrepancy theories (SDT), self-state discrepancies (ideal, undesired, ought) are associated with emotional distress. Among children, especially in families with dysfunctional patterns, such emotional distress may result in somatic symptoms. Thus, the current study's purpose was to examine the relationship between familial patterns and child's levels of self-state discrepancies, as they relate to the appearance and persistence of FSS.

**Methods:** our sample included 46 mother-child dyads, 23 children diagnosed with FSS and 23 children with orthopedic problems (and their mothers). Both mothers and children completed the *Child Somatization Inventory* (CSI) and the *Integrated Self-Discrepancies Index* (ISDI). Mothers also completed the *Family Assessment Device* (FAD-12) to assess level of family functioning.

**Results:** children in the FSS group had higher levels of symptom intensity compared to those in the orthopedic group. In addition, mothers of children in the FSS group reported significantly higher levels of family dysfunction compared to mothers in the orthopedic
group. Mothers and children in the FSS group reported higher levels of discrepancies for both ideal and ought self-states compared to their counterparts in the orthopedic group. No significant differences between the two groups were found for the undesired self-state discrepancies. No significant correlations were found between the different self-states discrepancies and the level of family dysfunction.

**Conclusions:** the current study strengthens the theoretical approaches regarding dysfunctional familial patterns among children with FSS. However, the elevated levels of self-state discrepancies found in the current study were not related to family symptomatology. To our knowledge, this is the first study to associate between self-state discrepancies and the presence of FSS. Integrating SDT and FSS may enable professionals to untangle some of the emotional discomfort and reduce levels of somatoform symptoms in clinical populations.

## 175) Abstract 1208

### IMPEDANCE CARDIOGRAPHY IN HEALTHY CHILDREN AND CHILDREN WITH CONGENITAL HEART DISEASE: IMPROVING STROKE VOLUME ASSESSMENT

*Ineke Nederend, MSc, Biological Psychology, VU Amsterdam, Amsterdam, Nederland, Nederland, Arend D. Ten Harkel, MD, PhD, Pediatric cardiology, LUMC University Medical Center, Leiden, Zuid Holland, Leiden, Nico Blom, Professor, Department of pediatric cardiology, LUMC University Medical Center, Leiden, Zuid Holland, Netherlands, Gary Berntson, Professor, Department of Psychology, Ohio State University, Columbus, Ohio, Eco J. De Geus, Professor, Biological Psychology, VU Amsterdam, Amsterdam, Noord Holland, The Netherlands*

*Introduction* Stroke volume (SV) and cardiac output (CO) are core measures in the clinical evaluation of cardiac patients and are also frequently required for research purposes. Impedance cardiography (ICG) is a non-invasive way to continuously measure SV and CO. However, spot-electrode based SV estimation by the use of the frequently employed Kubicek formula is not yet optimal. Partly, this is due to the fact that the original development of the technique was done using band-electrodes. Also, ambiguity in scoring of the characteristic B- C- and X-points in the ICG distorts SV estimation. The aim of this study was to improve SV scoring derived from a spot-electrode based ICG in a pediatric population of both healthy and diseased children.

*Methods* 128 healthy volunteers and 66 patients 9.9±3 years after repair of their congenital heart disease (closing of a ventricular septal defect or correction of a coarctation of the aorta) were recruited to participate. Healthy volunteers were divided into a discovery set (70%) and a replication set (30%). First, scoring methods for ambiguous ICG signals were optimized in a discovery set of healthy children by testing the agreement of the B- C- and X-points in the ICG with simultaneously measured opening of the aortic valve, maximal flow in the aorta and closing of the aortic valve using transthoracic echocardiography (TTE). Second, the Kubicek equation was optimized using SV measured by TTE. Finally, validity of the new ICG-based SV assessment was tested in the replication set of healthy children and in a group of pediatric cardiac patients.

*Results* SV assessment by ICG strongly improved from ICC=0.33 before correction to ICC=0.72 after replacing baseline thorax impedance ($Z_0$) in the Kubicek formula by $Z_{0-corrected}$ estimated as: 7.337 – 6.208 * dZ/dt<sub>min</sub>, where dZ/dt<sub>min</sub> is the amplitude of the ICG signal. Assessment was always worse in patients compared to the healthy controls.

*Conclusions* We advise to adjust the Kubicek equation for SV estimation by replacing $Z_0$ for $Z_{0-corrected}$ when using spot electrodes. Stroke volume assessed by the use of ICG is non-inferior to other modalities available and therefore usable in paediatric populations. Additionally, it has the advantage of measurement in an ambulatory setting, which may increase clinical relevance.

## 176) Abstract 1589

### CHILDREN'S CORTISOL AND EXTERNALIZING STRESS SYMPTOMS ARE PREDICTORS OF ADIPONECTIN EVOLUTION OVER TWO YEARS.

*Nathalie Michels, PhD, Isabelle Sioen, PhD, Annelies De Decker, MsC, Public Health, Ghent University, Gent, OV, Belgium, Carola van Aart, MSc, Public Health, Ghent University, Ghent, OV, Belgium, Stefaan De Henauw, PhD, Public Health, Ghent University, Gent, OV, Belgium*

**BACKGROUND** Adiponectin is an anti-inflammatory, insulin-sensitizing and energy-regulating adipocytokine. Consequently, the link between psychosocial stress and inflammatory diseases like the metabolic syndrome might be partially explained by lower adiponectin levels in stress. Nevertheless, the stress-adiponectin association has seldom been tested and no clarity exists about the directionality.

**METHODS** In the Belgian ChiBS study, serum adiponectin and stress levels were measured in 348 children (5-10y) at baseline and in 168 of them after 2-year follow-up. Psychosocial stress was reported with the Strengths and Difficulties Questionnaire (parental report on emotional, peer, and conduct problems), negative emotions (anger, sadness, anxiety) and negative events. In addition, salivary cortisol diurnal patterns were available from 2 days with each 4 samples. Longitudinal linear regression analyses were performed including step-wise adjustment for age, sex, socio-economic status, body fat%, physical activity and snack frequency.

**RESULTS** Despite some positive cross-sectional associations, high daily cortisol output (beta=-0.285), anger (beta=-0.233) and conduct problems (beta=-0.182) were associated with less adiponectin increase over time, in most cases independent of the tested confounders. The other directionality was not significant: no longitudinal prediction of stress by adiponectin.

**CONCLUSION** In healthy children, daily cortisol output and externalizing stress symptoms were negative predictors of adiponectin evolution. These findings highlight the health-compromising effects of psychosocial stress.

## 177) Abstract 1542

### CHRONIC PSYCHOSOCIAL STRESS IN CHILDREN AND GUT HEALTH: GUT BARRIER FUNCTION, FECAL SHORT-CHAIN FATTY ACIDS AND BACTERIAL COMPOSITION.

*Nathalie Michels, PhD, public health, Tom Van de Wiele, PhD, Microbial ecology and technology, Stefaan De Henauw, PhD, MD, Public Health, Ghent University, Gent, OV, Belgium*

**Objectives:** The mechanisms underpinning the association between chronic stress and gut health are poorly understood. We investigated the relationship of stress measures with bacterial produced short-chain fatty acids, bacterial composition and gut barrier function.

**Methods:** In 113 Belgian children (8-16y old), a fecal sample, hair sample and questionnaire data were collected. Biological measures of stress included hair cortisol (most proximal 3cm) and 5-minute heart rate variability (high frequency HRV). Self-report measures of stress included emotional problems and negative events. Fecal calprotectin was determined as a marker of intestinal inflammation and an indirect indicator of gut barrier integrity. Fecal short-chain fatty acids (butyrate, propionate, acetate, valerate, isobutyrate, isovalerate) were measured with gas chromatography. After DNA extraction and PCR, samples were sequenced by Miseq Illumina. Linear regression analyses were adjusted for sex, age, socio-economic status, BMI, fiber intake and protein intake.

**Results:** Emotional problems were significantly associated with higher butyrate (β=0.263), valerate (β=0.230), isovalerate (β=0.231) and isobutyrate (β=0.233). Heart rate variability reflecting higher parasympathetic activity was related to lower valerate levels (β=-0.217). Hair cortisol was not associated with the short-chain fatty acids. None of the stress measures and none of the fecal short-chain fatty acids were significantly related to fecal calprotectin. Preliminary sequence data showed some stress differences, but data will be final by the congress date.
**Conclusions:** In healthy children, the impact of chronic stress is manifested more obviously in terms of short-chain fatty acids than in intestinal inflammation measured by calprotectin. The rather counterintuitive associations with butyrate point to the need for further research on gut microbiome composition. In addition, we are recruiting children with clinical depression to contrast that clinical population with the current 'healthy' population to hopefully detect more clear-cut differences.

## 178) Abstract 1168

### METABOLIC RISKS IN ADOLESCENTS AT RISK FOR BIPOLAR DISORDER

Lawson R. Wulsin, MD, Thomas Blom, PhD, Robert McNamara, PhD, Psychiatry, University of Cincinnati, Cincinnati, OH

**Background:** Bipolar disorder is associated in mid-life with increased cardiometabolic risks, increased rates of diabetes and heart disease, and excess premature mortality. We recently reported increased metabolic dysregulation in a sample of early bi-polar patients, relative to a demographically similar healthy comparison group. To investigate whether metabolic dysregulation precedes the onset of bipolar disorder, we compared selected metabolic measures in two at-risk groups of adolescents and a healthy comparison group.

**Methods:** We compared six metabolic measures (systolic BP, diastolic BP, heart rate, weight, BMI, and omega 3 index) in three groups of adolescents of mostly similar age, sex, and race distributions: 1) "High risk" offspring with one bipolar parent and a personal history of a depressive episode (N=67), 2) "At risk" offspring with one bipolar parent and no personal history of a depressive episode (N=54), and 3) "healthy comparison" offspring with no parental history of bipolar disorder and no personal history of depression (N=54). We calculated differences across metabolic measures by ANOVA controlling for age and sex.

**Results:** Clinically and statistically significant differences were observed for weight (p=0.03 for high risk vs comparison) and omega 3 index (p<0.01 for high risk vs comparison), with a trend for BMI (p=0.16). In contrast to our expectations, heart rate was significantly lower in the high risk group vs the comparison group (p=0.02).

**Conclusions:** Adolescents at high risk for bipolar disorder were significantly heavier than the comparison group. Their significantly lower omega-3 index also suggests metabolic dysregulation in this high risk group may be due to dietary factors. Longitudinal follow-up data may identify whether these metabolic dysregulations are associated with higher rates of onset of bipolar disorder in the high risk and at risk subgroups.

## 179) Abstract 1220

### EMOTIONAL JUDGEMENT IN ADULTS WITH AUTISM SPECTRUM DISORDER; AN fMRI STUDY USING A NOVEL PARADIGM

Alice H. Brooke, MBChB, Bilyana Brignell, MBBS, Sarah Garfinkel, PhD, Hugo Critchley, DPhil, Neil Harrison, PhD, Psychiatry, Brighton and Sussex Medical School, Brighton, East Sussex, United Kingdom

**BACKGROUND** Difficulty recognising the emotional and social cues of others is an important feature of Autism Spectrum Disorder (ASD). Whilst autistic patients do not show learning impairment in non-social domains, they often fail to understand emotional context within the environment, leading to impoverished social abilities. Previous neuroimaging studies have shown differing amygdala response to emotional stimuli in individuals with ASD. Interestingly, both hypo and hyper-activation have been noted. Whether there is a consistent differential activation of select brain regions in ASD patients following exposure to emotional stimuli is currently unknown.

**METHODS** 21 patients over 18 with a diagnosis of ASD were recruited, alongside 21 control participants matched for age, sex and IQ. All participants underwent fMRI. Whilst in the scanner they were shown a modified version of Simon Baron-Cohens' 'Mind in the Eyes' Task, originally developed as a test of adult Theory of Mind. This consisted of a series of cropped face stimuli, in which only the eye region was visible. Participants were asked to estimate the emotion shown and approximate age of each pair of eyes seen, out of four available choices.

**RESULTS** Results showed brain activation across all subjects throughout the task in areas known to be involved with facial recognition and emotional processing, including the occipital cortex, fusiform face area, superior frontal gyrus, putamen, and the superior temporal sulcus. There was no statistically significant interaction between the autism or control group with regard to correctly assessing age vs. emotion. However, ASD patients showed amygdala hypoactivation during assessment of emotion when compared to control participants.

**CONCLUSIONS** This was a novel fMRI study with a unique paradigm. Unlike previous studies, the stimuli were identical across all conditions of the task, with the only change being the attentional focus. Our findings correlate with previous neuroimaging studies with regard to brain activation during face perception and emotional processing. Most significantly, the autism group showed a differential neural response when asked to make an emotional judgement. Although small, this study provides further evidence to support the theory of amygdala hypoactivation in response to emotional stimuli in the ASD population.
<figure><img src="image_24.png" /></figure>

180) Abstract 1613
HOW DO ALEXITHYMIA AND INTEROCEPTION RELATE TO BINGE DRINKING?

Sophie J. Betka, PhD, Gaby Pfeifer, Research Fellow, Sarah N. Garfinkel, Senior research fellow, Hielke Prins, MPhil, Neuroscience, Brighton and Sussex Medical School, Brighton, east sussex, england,

Rod Bond, Professor, Psychology, University of Sussex, Brighton, east sussex, england, Henrique Sequeira, Professor, Neuroscience, University of Lille 2, lille, hauts-de-france, France, Theodora Duka, Professor, Experimental Psychology, University of Sussex, Brighton, east sussex, england, Hugo Critchley, Professor, Neuroscience, Psychiatry, Brighton and Sussex Medical School, Brighton, east sussex, england

Alexithymia describes a dysfunction of emotional experience that is commonly expressed among individuals with addiction and alcohol abuse disorders. Alexithymic individuals are characterized by difficulties in identifying and describing their emotions. This impairment is linked to the development and maintenance of addiction. Moreover, an emergent theory suggests alexithymia is itself secondary to a failure of interoception (sensitivity to internal bodily signals).

The present study tested for hypothesized contributory roles of alexithymia and dysfunctional interoception in the expression of binge drinking. Alexithymia, subjective interoceptive sensitivity ('interoception sensibility'), and binge drinking scores were quantified using the Toronto Alexithymia Scale, the Body Perception Questionnaire and the Alcohol Use Questionnaire respectively, in a normative sample (N=445). Regression and bootstrapping mediation analyses were used to test the hypothesis that alexithymia mediated the association between interoceptive experience and binge drinking.

Alexithymia, interoceptive sensibility and binge drinking scores were all positively correlated. Mediation analysis revealed alexithymia fully mediated the relationship between interoceptive sensibility and binge drinking, such that the predictive effect of interoceptive sensibility on binge drinking became non-significant when controlling for alexithymia.

These results indicate that alexithymia is associated with subjective hypersensitivity to internal bodily sensations. Moreover, our findings support the theoretical proposal that alexithymia is an expression of impaired interoceptive processes that may lead to maladaptive coping strategies, including binge drinking. Our observations extend a growing literature emphasizing the importance of interoception and alexithymia in addiction, which can inform the development of new therapeutic strategies.

181) Abstract 1558
ASSESSING THE LONGITUDINAL DIAGNOSTIC CONSISTENCY AND ACCURACY OF THE BECK DEPRESSION INVENTORY II IN CARDIAC PATIENTS

Darren A. Mercer, PhD(c), Psychology, McGill University, Montreal, Quebec, Canada, Kim L. Lavoie, PhD, Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada, Blaine Ditto, PhD, Psychology, McGill University, Montreal, Quebec, Canada, André Arsenault, MD, Médecine Nucléaire, Hôpital Jean-Talon, Montreal, Quebec, Canada, Simon L. Bacon, PhD, Exercise Sciences, Concordia University, Montreal, Quebec, Canada

Objective: Depression represents an independent risk factor for cardiovascular disease morbidity and mortality, yet primary care screening utilizes inconsistent methodologies that often have been validated with non-cardiac populations. This study aimed to explore psychometric properties of the Beck Depression Inventory-II (BDI-II) in cardiac patients, to assess its stability across a six year period, and to identify potential cutoff values for depressive disorders.

Methods: A sample of outpatients referred for stress testing at the Montreal Heart Institute was recruited (n = 380). Patients were administered the PRIME-MD, a brief psychiatric screening interview, by a graduate student or trained research assistant, to assess the presence of a DSM-IV-TR mood disorder (MD). Patients also completed the BDI-II on the day of their stress test. At a year six follow-up, patients were re-administered the PRIME-MD by telephone, and completed the BDI-II questionnaire by mail. Analyses used SPS 9.3, with the Harris (2010) ROC Macro.

Results: Based on PRIME-MD criteria, 77% of the patients did not present with MD at either time point, while 3.4% had MD across both
time points. 11% had MD at baseline, but not follow-up, while 9% did not have MD at baseline, but did at follow-up. BDI-II scores at baseline (M=8.23, SD=6.98) and year six (M=7.94, SD=7.46) showed moderately-strong correlation (r=.64). ROC curves to assess performance accuracy of BDI-II at identifying MD were constructed for baseline and year six values. Though curves were similar, baseline did have a slightly smaller area under the curve (0.75) than year six (0.84). In figure 1, sensitivity and specificity scores are graphed along BDI-II scores, with the intercept point representing the BDI-II cut-off score with maximal sensitivity and specificity. Calculated cutoff scores were 8.4 at baseline, and 10.5 at year six.

Conclusions: Despite a large portion of the sample (20%) experiencing changes in MD status between baseline and year six, the psychometric properties of the BDI-II remained relatively consistent, suggesting it may represent a stable screening tool for use with cardiac patients. Though results suggest a cutoff score of 8 to 10 may optimize both sensitivity and specificity, it should be noted that different cutoffs may be used in clinical practice if additional sensitivity or specificity is required.

<figure><img src="image_25.png" /></figure>

<figure><img src="image_26.png" /></figure>

## 182) Abstract 1285

# THE BLURRED DIAGNOSTIC LINE OF CATATONIA AND NEUROLEPTIC MALIGNANT SYNDROME IN PSYCHOSOMATIC MEDICINE

Michael A. Millstone, M.D., Psychiatry, Mary A. O'Dowd, M.D., Psychosomatic Medicine, Howard L. Forman, M.D., Addiction Consultation Service, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

Introduction: Historically the diagnoses of catatonia and neuroleptic malignant syndrome (NMS) are thought of as distinct medical conditions. Catatonia has symptoms such as abnormal psychomotor activity, abnormal verbal communication, and negativism. While NMS, in the context of neuroleptic use, consists of hyperthermia, autonomic instability, rigidity, and altered sensorium. Through a psychosomatic medicine (PM) case report and a literature review, we wish to explore the overlapping findings of catatonia and NMS which may represent a diagnostic challenge to clinicians.

Case Presentation: The patient is a 60 year old male, with a diagnosis of schizophrenia, who was medically hospitalized for lethargy. Approximately 4 weeks prior to hospitalization, the patient was started on haloperidol. On evaluation by the PM service, the

patient appeared to be in a catatonic state. And while the patient's physical exam and lab findings were abnormal, his vitals were found to be stable. The PM service recommended holding his neuroleptic. On hospitalization day 5, the patient had improved physical exam and lab findings, but was not displaying improved mental status findings on exam. On hospitalization day 7, the patient was given a low dose trial of haloperidol. The patient within hours had concerning acute changes in mental status and lab findings. The patient's neuroleptic was held and his mental status soon after improved. On hospitalization day 10, the patient was started on lorazepam and within hours had improved mental status findings. On hospitalization day 15, the patient was deemed safe for discharge by the PM service.

Discussion: Catatonia is a recognized psychiatric diagnosis, while NMS is a medical condition where neuroleptic use is the primary cause of its diagnostic clinical findings. But in the case presented above, the patient appears to have elements of both. The patient had been started on a high potency neuroleptic prior to his presentation and restarted on it while hospitalized. In both instances, he clinically worsened displaying partial findings traditionally observed in NMS. Yet, the patient presented in a catatonic state and responded to a treatment for catatonia. Upon a review of the literature and the case presentation above, it appears likely that neuroleptic induced catatonic states represent a stage in a spectrum between catatonia and NMS.

## 183) Abstract 1557

# ASSESSING THE INFLUENCE OF MIGRANT STATUS ON SELF-RATED HEALTH AND MENTAL HEALTH OUTCOMES: A CROSS-SECTIONAL STUDY OF ARAB AMERICANS IN MICHIGAN

Sanjana Pampati, B.S., B.A., Epidemiology, Zaineb Alattar, B.S., Health Behavior & Health Education, University of Michigan, Ann Arbor, MI, Madiha Tariq, MPH, Public Health Manager, Arab Community Center for Economic and Social Services (ACCESS), Dearborn, MI, Carlos Mendes de Leon, PhD, Epidemiology, University of Michigan, Ann Arbor, MI

Objective: The U.S. Census Bureau estimates that 1.9 million Americans are of Arab descent, with Michigan hosting the second greatest number of Arab Americans. A growing body of research indicates that refugees, immigrants, and immigrant-born children are either directly or indirectly subject to a host of pre- and post-migration stressors that can influence their mental health and overall wellbeing. This study examines how resident status, classified as refugee, immigrant, or U.S. born Arab, affects self-rated health, depression and anxiety.

Methods: Data were collected from Dearborn, Michigan at a community organization that provides health and social services to Arab Americans (n=275). Of these, 55 were U.S.-born, 153 self-identified as immigrants and 67 as refugees. All participants completed an English (44%) or Arabic-language (56%) questionnaire covering demographics, health conditions, mental health, and risk behaviors. The sample was 62% female and the mean age was 38.66 (±14.60) years.

Results: In linear regression analysis adjusting for age and sex, refugee status was significantly associated with lower self-rated health (p=0.0002), greater depression scores (p=0.0003), and greater anxiety scores (p=0.05) compared with U.S. born Arab Americans. There were no significant differences between immigrants and U.S. born Arab Americans in any of these outcomes. After further adjustment for marital status and duration of living in the U.S., refugee status remained significantly associated with self-rated health (p=0.02) and depression (p=0.01). After further adjustment for education, refugee status was marginally associated with poorer self-rated health (p=0.07), but remained significantly associated with higher depression scores (p=0.02).

Conclusion: In this convenience sample of Arab Americans from South-Eastern Michigan, those reporting refugee status appeared to have poorer self-rated and mental health in comparison to immigrants
and U.S. born Arab Americans. With the growing refugee population in the United States and worldwide, more systematic efforts are required to examine the magnitude and determinants of their physical and mental health challenges.

### 184) Abstract 1234

#### STRESSFUL LIFE EVENTS AND HEALTH: THE DIFFERENTIAL IMPACTS OF TRAIT REAPPRAISAL AND SUPPRESSION ON CARDIOVASCULAR FUNCTIONING, INFLAMMATION, AND PSYCHOLOGICAL DISTRESS

Lydia G. Roos, BS, Health Psychology Program, University of North Carolina at Charlotte, Charlotte, North Carolina, Maren Coffman, PhD, School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, Jeanette M. Bennett, PhD, Department of Psychology, University of North Carolina at Charlotte, Charlotte, North Carolina
Exposure to stressful life events (SLEs) is known to negatively impact both psychological and physical health. Prior research has indicated a link between trait emotion regulation strategies and psychological wellbeing, as well as physiological response to acute stress in a laboratory. However, the effects of trait emotion regulation strategies and SLEs on physiological functioning and psychological distress at rest are unknown. As part of a larger study comparing immune functioning of healthy smokers and nonsmokers, we examined the interactive effects of two emotion regulation strategies and number of SLEs on blood pressure, resting heart rate (HR), heart rate variability (HRV), C-reactive protein (CRP), perceived stress, and depressive symptoms. Using Model 1 of the PROCESS Macro for SPSS, moderation analyses controlling for smoking status, age, sex, and BMI surprisingly yielded no significant interactions between exposure to SLEs and suppressive emotion regulation for any outcome. The same analyses for reappraisal revealed significant interaction effects for exposure to SLEs and reappraisal in predicting resting HR (ΔR²=.07, p<.05), HRV (ΔR²=.08, p<.05), CRP (ΔR²=.10, p<.01), perceived stress (ΔR²=.11, p<.05) and depressive symptoms (ΔR²=.02, p<.10), but not blood pressure (NS). Overall, reappraisal, but not suppression, moderated the relationship between SLEs and health differentially by system. When exposed to fewer SLEs, higher reappraisal seems to have beneficial impacts on perceived stress, depressive symptoms, and CRP. Conversely, higher reappraisal appears to be more taxing on the cardiovascular system at low SLE occurrence compared to those with lower reappraisal. In response to more SLEs, however, low reappraisers' HR increased and HRV decreased, resulting in levels similar to those with higher reappraisal. Additionally, as exposure to SLEs increased, participants higher in reappraisal had greater CRP and perceived stress. No effect existed for lower reappraisers, whose levels were elevated regardless of SLE exposure. Thus, at rest, trait reappraisal may only be psychologically and immunologically protective with lower SLE occurrence. Findings contribute to the understanding of how reappraisal and suppressive emotion regulation strategies impact psychological health and physiological functioning at rest.

### 185) Abstract 1533

#### DISTRESS AND COPING IN ADJUSTMENT TO RECENT HIV INFECTION DIAGNOSIS

Isabel Nabais, Drª, Graça Gonçalves, Drª, Sérgio Dinis, Dr, Psychology, Luís Caldeira, Dr, Infectious Diseases Department, Centro Hospitalar Lisboa Norte, Lisboa, Lisboa, Portugal, Silvia Ouakinin, Prof., Psychology, Faculdade de Medicina de Lisboa, Lisboa, Lisboa, Portugal

**Objectives:** To evaluate psychological dimensions, including coping, prior psychiatric conditions and other comorbidities which interfere with adjustment to a recent HIV infection diagnosis.

**Methodology:** Participants completed Distress Thermometer, Brief Symptom Inventory (BSI), Hospital Anxiety and Depression Scale (HADS) and Brief Cope (BC). Sociodemographic data well as

clinical data were also recorded. Results were analyzed with IBM Statistical Package for Social Sciences 20 (SPSS).

**Results:** Preliminary sample consists of 30 HIV+ outpatients recently admitted at the Infectious Diseases Clinic at Hospital de Santa Maria (Lisbon). Their age ranges between 23 and 75 years (mean 40.1, +- 12.9) and 83.3% are males. Education was 12 years or more in 58,6%, and 52,4% were engaged in a stable relationship.

HADS mean scores were 5.45 (+4,8) for Depression, 7.7 (+4,7) for Anxiety and, concerning Distress Thermometer, the mean score was 6.2 +- 3.7. Mean scores for BSI dimensions near clinical significance were 1,09 (+- 0,75) for Paranoid Ideation, 0,99 (+- 0,87) for Depression, 0,99 (+- 0,67) for Obsession-compulsion and 0,92 (+- 0,61) for General Symptoms Index. The coping dimensions presenting the highest mean scores were: Acceptance (2,98), Active Coping (2,90) and Planning (2,81).

Correlations pattern highlight a positive association between BC dimension Denial and BSI Somatization (0,654), Interpersonal Sensitivity (0,590), Phobic Anxiety (0,604), Paranoid Ideation (0,497) and Psychoticism (0,604), as well as HADS Anxiety (0,59) and Depression (0,49). BC Dimension Reorganization showed a negative significant correlation with HADS Depression (-0.443). Distress Thermometer, HADS Anxiety (0,571) and Depression (0,556), BSI Somatization (0,606) and BSI Depression (0,527) were also positively correlated.

In a Linear Regression model, using HADS scales as independent variables and Brief Cope dimensions as the dependent ones, the predictive model attained statistical significance for HADS Depression scale (R Square = 0.802, Sig = 0.030).

**Discussion:** Results suggest a significant relation between specific coping styles and depression levels – namely, Denial and Reorganization. These results stress the relevance of evaluation and early intervention in more vulnerable patients, in order to prevent psychopathological symptom barriers to HIV treatment management.

### 186) Abstract 1265

#### SYSTOLIC BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH DEPRESSION AND ACCELERATED COGNITIVE DECLINE OVER 10 YEARS: THE 3C DIJON MRI STUDY

Phillip J. Tully, PhD, Christophe Tzourio, MD, Population Health, Stephanie Debette, MD, Neurology, University of Bordeaux, Bordeaux, Aquitaine, France

**Background:** Accumulating evidence links blood pressure variability (BPV) with white matter hyperintensities (WMH) and stroke. The longitudinal association between BPV with cognitive function and depression remains unexplored.

**Methods:** Prospective cohort study of 2870 participant's age 65 years (median age 73 years, 63.8% female) without dementia. Serial clinic visits assessed blood pressure, cognitive function, depression disorder, and depressive symptoms. A brain magnetic resonance imaging (MRI) substudy was performed in 1275 persons to examine possible interactions between BPV and WMH.

**Results:** Symptomatic late onset depression and systolic BPV interaction terms were associated with cognitive decline on the Isaac Set Test (slope -5.89; 95% CI -9.63 to -2.15, p = .002), Benton Visual Retention Test (slope -1.11; 95% CI -2.04 to -.18, p =.02), Mini Mental State Examination (slope -.99; 95% CI -1.97 to -.02, p = .046), and Finger Tapping Test (slope -.03; -.06 to .00, p = .05) but not Trail Making Test B/A. The MRI substudy demonstrated that systolic BPV was associated with cognitive decline via interactions with depression and total WMH volume, but this was not dependent on either deep or periventricular WMH volumes.

**Conclusions:** The interaction between systolic BPV with depression and WMH volume was associated with accelerated cognitive decline. The findings raise the possibility that agents lowering systolic BPV could mitigate cognitive decline via reduced WMH burden in elderly populations.
## 187) Abstract 1176

# THE RELATIONSHIP BETWEEN MOOD AND ANXIETY DISORDERS AND CARDIOVASCULAR RISK: THE ROLE OF RUMINATION

Tamara Bailey, BSc, Psychology, Clinical Psychology, Fielding Graduate University, Los Angeles, California, Cristina Ottaviani, PhD, Psychology, Sapienza University, Rome, Lazio, Italy, David Shapiro, PhD, Psychology, University of California Los Angeles, Los Angeles, California, Leila Shahabi, PhD, Psychology, UCLA, Los Angeles, California

## The Relationship Between Mood and Anxiety Disorders and Cardiovascular Risk: The Role of Rumination

Cardiovascular disease (CVD) is the leading cause of death in adults in the United States. Given that approximately only 50% of new CVD cases can be predicted by currently known risk factors, much effort has been devoted to identifying other potential risk factors. Perseverative cognition (PC), mainly present in Major Depressive Disorder (MDD) and Social Anxiety Disorder (SAD) in the form of rumination, has been recognized as playing a role in the development of CVD. This study compares data on the role of PC in the interaction between SAD, MDD, and increased CV risk in 18 SAD subjects, 18 MDD subjects, and 18 healthy controls. Ambulatory heart rate (HR) and variability (HRV) of subjects was recorded for 24hrs while concurrently reporting their thoughts, moods, and activities via electronic diaries every 25-35min during waking hours. Random regression models were performed. Data for 16 SAD subjects has been acquired with 2 subjects yet to be recorded and analyzed. Compared to controls, MDD subjects reported more episodes of PC. In both groups, PC required more effort to be inhibited and interfered more with ongoing activities compared to mind wandering (MW) (ps < 0.0001). This cognitive rigidity corresponded with autonomic inflexibility, with rumination characterized by lower HRV (p < 0.0001) compared to MW. A worse mood was reported by MDD patients compared to controls, independent of their ongoing cognitive process. However, controls showed the highest mood worsening during PC compared to being on task and MW. HRV during rumination correlated with self-reported somatic symptoms on the same day and with several dispositional traits. MDD subjects showed lower HRV during sleep, which correlated with hopelessness rumination. Results showed PC is associated with autonomic dysfunctions in both healthy and MDD subjects. Unlike previous studies that artificially induced PC in the laboratory, this study's use of ecological momentary assessment enabled the interception of this phenomenon without losing its main characteristics of automaticity and spontaneity.

**Keywords:** perseverative cognition, rumination, mind wandering, heart rate, heart rate variability, ecological momentary assessment, ambulatory monitoring, social anxiety disorder, major depression disorder.

## 188) Abstract 1608

# EXAMINING PAIN AND HAZARDOUS DRINKING AMONG LATINOS IN PRIMARY CARE: EMOTION DYSREGULATION AS A POTENTIAL EXPLANATORY MECHANISM

Daniel J. Paulus, M.A., Jafar Bakhshaie, M.D., Psychology, University of Houston, Houston, Texas, Joseph Ditre, Ph.D., Psychology, Syracuse University, Syracuse, New York, Andres Viana, Ph.D., Psychology, University of Houston, Houston, Texas, Monica Garza, Ph.D., Jeanette Valdivieso, D.O., Melissa Ochoa-Perez, M.D., Chad Lemaire, M.D., Behavioral Health, Legacy Community Health, Houston, Texas, Michael Zvolensky, Ph.D., Psychology, University of Houston, Houston, Texas

**Method:** Participants were 252 low-income Latino adults ($M_{age}=38.7$ years, $SD=10.8$; 86.1% female; 95.2% reported Spanish as first language) attending a primary health care clinic in a large southwestern city in the United States. Participants completed self-report measures of pain, emotion dysregulation, and alcohol use. Analyses were conducted using PROCESS for SPSS (Hayes & Preacher, 2013), which estimates indirect effects of a predictor (X) on a

criterion (Y) via an intermediary variable (M). The indirect effect (ab) is computed as the product of path a (the effect of X on M) and path b (the effect of M on Y). Bootstrapping with 10,000 re-samplings was conducted to detect significance of the indirect effects.

**Results:** There were significant indirect effects of pain intensity via emotion dysregulation and pain-related disability via emotion dysregulation in relation to hazardous drinking. The indirect effect was small for pain intensity via emotion dysregulation and medium for pain-related disability via emotion dysregulation. Effects were evident after controlling for sex, marital status, education, and years in the United States. Post-hoc tests found similar indirect effects in relation to alcohol consumption and alcohol-related problems ranging in size from small to medium. Alternative models examined 'reverse' indirect effects (i.e., emotion dysregulation via pain and pain via hazardous drinking, respectively) and were statistically rejected.

**Conclusion:** Findings provide novel insight that among Latinos in primary care, emotion dysregulation is a possible explanatory factor underlying pain and alcohol use associations. Future work could evaluate treatments targeting emotion regulation among Latinos in primary care.

## 189) Abstract 1221

# AFFECTIVE IMPAIRMENT IN CHRONIC LOW BLOOD PRESSURE

Stefan Duschek, PhD, Alexandra Hoffmann, MSc, Psychology, UMIT - University for Health Sciences Medical Informatics and Technology, Hall in Tirol, Tirol, Austria, Gustavo A. Reyes del Paso, PhD, Psychology, University of Jaén, Jaén, Jaén, Spain

Physical complaints such as faintness, dizziness, cold limbs and headaches have been well-established in chronic low blood pressure (hypotension). This study investigated the occurrence of adverse emotional states and the symptoms of depression in this condition. As autonomic dysregulation, particularly diminished sympathetic tone, is believed to be involved in the etiology of hypotension, the impact of different facets of autonomic cardiovascular control on mood and depressive symptoms was also explored. Forty individuals with chronic hypotension and forty normotensive control persons were presented with the Mood Scale and Beck Depression Inventory. Stroke volume, cardiac output, pre-ejection period, Heather index and aortic peak blood flow velocity were recorded under resting conditions as indices of beta-adrenergic inotropic drive. Respiratory sinus arrhythmia and baroreflex sensitivity were additionally obtained. Hypotensive individuals scored markedly higher on both questionnaire scales than controls, indicating an adversely affected emotional state and more severe depressive symptoms. In the entire sample, cardiac output, Heather index, and aortic peak blood flow velocity correlated negatively with the questionnaire scores; according to regression analysis, the Heather index explained the largest proportion of test score variance. Although hypotension does not constitute a serious medical condition, the findings of an adverse affective state and increased burden with depressive symptoms corroborate the view that it can have a considerable impact on wellbeing and quality of life. The correlations of the beta-adrenergic indices with the questionnaire scales indicate that cardiac sympathetic regulation plays a key role in the psychophysiological mediation of hypotension-related mood impairment.
## 190) Abstract 1280

### ASSOCIATIONS BETWEEN THE FIBROMYALGIA DIAGNOSTIC CRITERIA OF THE AMERICAN COLLEGE OF RHEUMATOLOGY (ACR 2010) AND CENTRAL SENSITIZATION TO PAIN, PAIN SENSITIVITY, CLINICAL PAIN, AFFECTIVITY, FATIGUE AND INSOMNIA

Carmen M. Galvez Sánchez, MSc., Pablo De La Coba González, MSc., Gustavo A. Reyes del Paso, Dr., Psychology, University of Jaén, Jaén, Jaén, Spain

Twenty-four women with FM were assessed with the WPI, SS, State-Trait Anxiety Inventory, Beck Depression Inventory, McGill Pain Questionnaire, Perceived Stress Questionnaire, Fatigue Severity Scale and Oviedo Sleep Questionnaire. Pain threshold and tolerance and central sensitization (by the use of a temporal summation protocol) were measured by pressure algometry. Associations were analyzed by Pearson correlations and multiple linear regressions.

Results showed significant positive correlations between WPI and SS scores and clinical pain (especially the sensorial component), anxiety (especially trait-anxiety), perceived stress, depression, fatigue, and insomnia. SS scores, specifically waking unrefreshed and cognitive symptoms, were inversely associated with pain threshold and tolerance. No associations were obtained with central sensitization as measured by the summation procedure. Regression analysis showed that insomnia was the main predictor of both the WPI and SS scores.

We conclude that the ACR (2010) FM Criteria are associated with several symptoms domains of FM and some item of the SS scale especially with pain sensitivity. However, they do not index the suggested underlying pathophysiology of FM (central sensitization processes). It is suggested that the WPI and SS scales, as self-reported measures, may include a negative affect component that might artificially increase the intensity and frequency of self-reported symptoms.

**Keywords:** Fibromyalgia, pain, affectivity, central sensitization, diagnostic criteria.

## 191) Abstract 1056

### EXPOSURE TO LOW-WAVELENGTH LIGHT DOES NOT INFLUENCE ACUTE PAIN SENSITIVITY BUT DOES INCREASE RATINGS OF PERCEIVED STRESS

Daisy Vargas, High School Diploma, Neuroscience, Smith College, Northampton, Massachusetts, Sarah Murphy, High School Diploma, Wangchen Tsering, High School Diploma, Timothy Toninga, B.S., Neuroscience, Beth Mechlin, Ph.D., Psychology, Earlham College, Richmond, IN

Low-wavelength blue light has an alerting effect on circadian pathways, and may increase levels of norepinephrine and serotonin. These neurotransmitters are implicated in mood and pain processing. Previous studies have suggested that phototherapy (exposure to low-wavelength light) may enhance mood in some individuals. Given the link between mood and pain sensitivity, this study investigated the influence of low-wavelength blue light on reports of stress and acute pain. Thirty-seven individuals (21 females, 16 males) were randomly assigned to sit with the light on (experimental group; n = 18) or off (control group; n = 19) for 20 minutes. During this time period they relaxed and colored for 10 minutes, then filled out a demographic questionnaire, the Perceived Stress Scale, and a pain history questionnaire. The pain history questionnaire asked participants to rate their perception of past physical pain (i.e. sharp, blunt, cold or hot) by using a slider to rate the pain on a scale from 0 - 100. After the questionnaires, participants underwent the cold-pressor pain task, during which their pain threshold, tolerance, intensity, and unpleasantness ratings were assessed. Analyses indicated that exposure to the light did not influence pain threshold, tolerance, intensity, or unpleasantness ratings (all ps > .10). Similarly, light exposure did not influence scores on the pain history questionnaire. However, participants who were exposed to the light reported higher levels of

perceived stress than people not exposed to the light, $t(34) = 2.17, p = 0.037$. The data also indicated that a significant positive correlation exists between a participant's responses to physical pain history questionnaire and their acute pain perception. Participants who reported feeling more pain in previous instances, rated the cold pressor task as more intense ($r = .36, p = .044$) and unpleasant ($r = .50, p = .004$). The results of this ongoing study indicate that exposure to low-wavelength light does not influence pain sensitivity, but may influence perceptions of stress. Additionally, perception of pain may be influenced by past painful experiences. Further research on these issues is warranted.

## 192) Abstract 1486

### THE RELATIONSHIP BETWEEN FIBROMYALGIA AND DISSOCIATIVE EXPERIENCES IS MEDIATED BY SYMPTOMS OF ORTHOSTATIC INTOLERANCE

Jessica A. Eccles, BM BCh MRCPscyh PhD, Daron Aslanyan, Medical Student, Neil A. Harrison, MB BS MRCP MRCPsych PhD, Neuroscience, Kevin A. Davies, MB BS MA MD FRCP, Clinical and experimental medicine, Hugo D. Critchley, MBChB DPhil FRCPsych, Neuroscience, Brighton and Sussex Medical School, Falmer, East Sussex, UK

**Background:** Non-musculoskeletal difficulties are common in Fibromyalgia and impact significantly on quality of life, including problems such as 'brain fog.' Interestingly high rates of dissociative experiences are reported in Fibromyalgia. Additionally, patients with Fibromyalgia may experience dysautonomia, particularly associated with orthostatic intolerance (e.g. PoTS). Fibromyalgia and dysautonomia are both associated with disorders of connective tissue, joint hypermobility.

**Methods:** 21 patients with Fibromyalgia (20 female; mean age 41.86 yrs) were recruited alongside 22 healthy controls (16 female; mean age 44 yrs). All completed the ASQoLS autonomic dysfunction scale, which includes orthostatic intolerance measures and the Dissociative Experiences Scale. Assessment for joint hypermobility/EDS-HT was performed using Brighton Criteria. Statistical comparison between groups was performed using independent samples t test. Mediation analyses were conducted according to the method of Baron and Kenny.

**Results:** The Fibromyalgia group reported greater (mean, SEM) dissociative experiences (48.67, 9.99) than the control group (18.14, 2.72, $p=0.005$) and greater symptoms of orthostatic intolerance (41.90, 4.93) than controls (8.64, 1.0, $p= 0.001$). After adjusting for gender, the relationship between fibromyalgia and dissociation, ($r= 0.391, p=0.011$) remained significant. Additionally adjusting for symptoms of orthostatic intolerance rendered this relationship non-significant ($r=0.175, p=0.281$), suggesting full mediation (Fig 1). Interestingly all three variables (Fibromyalgia, dissociative experiences and orthostatic intolerance) correlated significantly with the presence of joint hypermobility syndrome/EDS-HT.

**Discussion:** This is the first study, to our knowledge, to explore mediators of the relationship between fibromyalgia and dissociation, with the finding that dissociative experiences are fully mediated by symptoms of orthostatic intolerance. Both patients with fibromyalgia and PoTS frequently report brain fog. It maybe this is related to dissociation. This study would suggest such symptoms are mediated by autonomic dysfunction, which is related to underlying abnormalities of connective tissue, and offers possibility for treatments of often debilitating symptoms. Further study, including formal autonomic function testing, is underway.
<figure><img src="image_27.png" /></figure>

All correlations adjusted for gender

## 193) Abstract 1390

### ESTABLISHING A NEW SCREENING TOOL FOR PEDIATRIC SOMATIZATION FOR PHYSICAL THERAPISTS IN CLINICAL SETTING

Etzyona Eisenstein, MSc pt, Pediatric Rehabilitation Department, sheba medical center, Ramat-Gan, Israel, Israel, Sharon Barak, PhD, Physical Education, Kaye Academic College of Education, Beer-Sheva, Israel, Israel, Maya Gerner, PhD, Pediatric Rehabilitation Department, sheba medical center, Ramat-Gan, Israel, Israel, Jana Landa, MD, The sackler school of Medicine, Tel Aviv University, Tel aviv, Israel, Israel

**Introduction:** Functional Somatic Symptoms (FSS) affects many children and adolescents. Typically, the patient's complains do not coincide with the information gathered during the physical evaluation process. Treating these children is one of the most frustrating impediments for the physical therapists (PT). In addition, working with children presenting FSS requires a specific and different treatment approach (e.g., multidisciplinary treatment), compared to other children with physical disabilities. Therefore, it is important for PTs to identify indicative signs of FSS. **Purpose:** to establish a new screening tool for pediatric FSS, Pediatric Somatoform Screening – Physical Therapists (PedS-PT) for PTs in clinical setting. **Methods:** The PedS-PT was developed based on clinical experience and the literature pertaining to behavioral presentations of children with FSS (e.g., behavioral lability, lack of trust, "La Belle Indifference"). The scale's total score ranges from 0-11, with higher scores indicating higher FSS behavioral presentations. All participating children were diagnosed with FSS by a physician, prior to their admission to our pediatric rehabilitation center. The Peds-PT was completed by experienced pediatric PTs following the first two PT sessions. The PedS-PT internal consistency was investigated by Cronbach's alpha (α) coefficient. Overall reliability was assessed by intraclass correlation coefficient (ICC). The frequency of each FSS symptom was calculated and compared using Chi Square test. **Results:** Participated in this study 21 children with FSS (mean age: 13.46 ± 3.21; 16 females) with mean FSS duration of 6.92 ± 7.02 months. On average children presented six FSS behavioral presentations (range: 3-9 presentations). Out of the 11 items, in three items the distribution of answers ("Yes/No" FSS behavioral presentations) was significantly different (p < 0.05) (e.g., "intensification of symptoms during therapy session) (Chi Square=3.85). Peds-PT internal consistency was acceptable (Cronbach's alpha= 0.772). ICC was moderate (0.550). **Conclusion:** The Peds-PT scale was found to be acceptable as a screening tool. Development of such a screening scale requires further examination. The tool is currently in the process, based on the results of this preliminary study.

## 194) Abstract 1207

### PERCEIVED MORAL VALUE INCREASES PAIN SENSITIVITY

Philippe T. Gilchrist, Ph.D., Public Health & Primary Care, Thea Schei, M.Phil., Simone Schnall, Ph.D., Psychology, University of Cambridge, Cambridge, Cambs, United Kingdom, Whitney Scott, Ph.D., Institute of Psychiatry, King's College London, London, Middlesex, United Kingdom

A large body of research indicates that cognitive appraisal processes are central to pain. Little is known, however, about the influence of moral value on pain, or how pain is affected by social context. It was hypothesized that appraisals of moral value would affect pain experience and expression. Sixty-nine healthy adults completed the Moral Identity Scale (MIS), an initial cold-pressor test (CPT 1), and the McGill Pain Questionnaire (MPQ). Next, participants were randomly assigned to either a high or low perceived moral value condition, manipulated by instructions from a confederate. Both instructions were similar in structure and length, though it was emphasized that the study was "important to help improve treatments for those who suffer from pain" in the high moral value condition. Next, the confederate left the room and the participant and experimenter (blind to condition) continued with the second CPT (allegedly to establish "reliability of measurement"), and completed the MPQ. Facial pain behaviour was coded (blind to condition) during the 5-seconds of hand removal from the CPTs. The primary analysis included a 2 (high vs. low MIS) x 2 (high vs. low moral value condition) x 2 (CPT 1, CPT 2) general linear model for the MPQ. High moral value resulted in a relative increase in total pain as well as sensory pain in particular, F(1,61) = 7.84, p = .007, n2p = .114; F(1,62) = 7.88, p = .007, n2p = .117, respectively. Similarly, there was also a significant condition x MIS interaction for facial pain behaviour, F(1,62) = 8.25, p = .006, n2p = .117. Specifically, participants in the high moral value condition showed a relative increase in facial pain behaviour, but only among those with low MIS. Results suggest moral value may increase pain sensitivity, perhaps through the influence of what we describe as an embodied instrumentality heuristic (Labroo & Kim, 2009). Painful experiences with a prosocial goal may lead to greater pain sensitivity. In conclusion, perceived moral connotation can alter a seemingly objective, low-level sensory process. Practical applications include health-care contexts in which painful procedures can be introduced at varying levels of subjective involvement.

## 195) Abstract 1162

### SUPPORT THAT FLIES UNDER THE RADAR: INDIRECT EFFECTS OF INVISIBLE SUPPORT ON PULMONARY FUNCTION AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aliza A. Panjwani, MA, Psychology, Graduate Center, City University of New York, New York, NY, Joel Erblich, Phd, MPH, Tracey A. Revenson, PhD, MPH, Psychology, Hunter College, New York, NY, Hoda J. Badr, PhD, Medicine, Baylor College of Medicine, Houston, Texas, Alex D. Federman, MD, MPH, Juan P. Wisnivesky, MD, DrPH, General Internal Medicine, Mount Sinai Hospital, New York, NY

**Objective:** Patients with a chronic illness like Chronic Obstructive Pulmonary Disease (COPD) rely on loved ones for social support; however, evidence for the beneficial effects of perceived support is mixed. Emerging research on a novel way of examining support interactions demonstrates that invisible support – support provided outside of the recipient's awareness – is linked with positive psychological outcomes. As research on the dyadic effects of social support on health outcomes is limited, the current study examined if invisible support was predictive of better pulmonary function. Specifically, we hypothesized that effects of invisible support would be mediated by reductions in depressive symptoms and illness perceptions.
**Methods:** Data were collected from 66 patient-caregiver dyads enrolled in a multi-site study of self-management of chronic obstructive pulmonary disease (COPD). Patients completed measures of illness
perceptions (BIPQ), depressive symptoms (PHQ-9) and lung function (Predicted FEV₁). Patients provided information on receipt of social support from caregivers while caregivers reported on provision of support to patients (CISS). Invisible support was calculated using the residual difference between caregiver-reported and patient-reported support.

**Results:** Participants were predominantly women (62% of patients; 75% of caregivers). Based on PHQ-9 cutoff scores, 32% of patients reported mild depression and 36% reported moderate to severe depression. Mean FEV₁ was 0.59 (SD=0.28). Consistent with our hypothesis, there were no direct effects of invisible support on lung functioning, but there were significant indirect effects on FEV₁ (b=-0.075, bootstrap 95% CI: -0.15, -0.03) through reductions in depression and negative illness perceptions.

**Conclusions:** Findings suggest that invisible support may lead to better physical health via improved psychological well-being for patients with chronic diseases like COPD. Dyadic interventions designed to improve support transactions between patients and caregivers may be beneficial in terms of addressing vulnerabilities in chronically ill populations.

## 196) Abstract 1427

# MOTIVATIONS FOR MEDITATING: AN EXPLORATION OF THE MOTIVATIONAL, PERSONALITY AND PRACTICE CHARACTERISTICS OF MEDITATION PRACTITIONERS

Deanna M. Kaplan, MA, Matthias R. Mehl, PhD, Department of Psychology, University of Arizona, Tucson, AZ

Research suggests that meditation can have positive health outcomes in both healthy and clinical populations, but little is known about what motivates people to begin and maintain a meditation practice. Given that the health benefits of meditation are positively associated with participants' adherence and practice time (e.g., Pace et al., 2009), understanding the motivational factors associated with adopting and sustaining a regular meditation practice may have important implications for the implementation of meditation-based interventions. Individuals with any kind of meditation practice (N=401) were recruited from U.S. and international meditation communities to complete an online survey. Participants were asked to describe their meditation practice, their motivations for beginning and continuing to meditate, and completed the Ten Item Personality Inventory (TIPI). Grounded theory was used to identify seven overarching motivations for practicing meditation: health improvement, emotion regulation, thought modulation, personal development, benefiting others, outside influence, and curiosity. Emotion regulation (37%) and health improvement (31%) were the most common reasons for beginning meditation. Personality domains were associated with participants' current practice characteristics and motivations for beginning meditation (e.g., openness was positively associated with retreat experience; neuroticism was positively associated with regular contact with a meditation teacher; conscientiousness and neuroticism were associated with beginning meditation to improve one's health). This research has implications for minimizing attrition and maximizing adherence in meditation-based interventions.

## 197) Abstract 1232

# UNDERSTANDING INTERSECTIONAL PATTERNS OF REPORTING DISCRIMINATION AND IMPLICATIONS FOR HEALTH DISPARITIES.

Lindsey Potter, M.P.H., Biobehavioral Health, The Pennsylvania State University, University Park, PA, Matthew Zawadzki, Ph.D., Psychology, University of California Merced, Merced, CA, Collette Eccleston, Ph.D., Pragmatic Brain Science, Lieberman Research Worldwide, New York, NY, Jonathan E. Cook, Ph.D., Psychology, Shedra A. Snipes, Ph.D., Martin J. Sliwinski, Ph.D., Joshua Smyth, Ph.D., Biobehavioral Health, The Pennsylvania State University, University Park, PA

Experiences of discrimination, and the specific attributions (reasons/sources) as to its cause, predict worse health outcomes and

help explain health disparities. Also, belonging to multiple stigmatized groups ('intersectionality') may uniquely relate to level of mistreatment and attributions of discrimination. Adopting this intersectional approach, we examined the relationship between aspects of social identity and level of perceived mistreatment and attributions for discrimination. A diverse community sample of 292 adults (mean age 55 years; 53% female; 42% Black; 39% HS degree; 68% annual income <$40K) reported amount of mistreatment and attributions of discrimination. Younger (p<.001), Black (p<.001), and those of lower SES (p=.04) reported more mistreatment, but no intersectional effects (interactions) were identified for overall level of discrimination. Regarding attributions, a race by age interaction (p=.04) revealed that Whites were less likely to endorse race as an attribution with higher age, but endorsement was uniformly high for Blacks. Females (p<.001) and Blacks (p<.001) more frequently attributed discrimination to sex. A sex by SES interaction (p=.05) showed a crossover pattern; females were more likely than males to attribute discrimination to age at lower SES, but males were more likely to endorse age at higher SES. A similar crossover age by sex interaction (p=.02) found that young females were more likely than young males to attribute discrimination to education, but older males were more likely to endorse education than older females. A race by SES interaction (p=.05) indicated that Whites, but not Blacks, attributed discrimination to financial causes less frequently at higher SES. These findings suggest that research seeking to understand health disparities related to discrimination may benefit from examining the multiple social identities contributing to discrimination. In particular, our intersectional results were related to attributions for discrimination. Thus, the consequences of belonging to multiple stigmatized groups, and contexts where discrimination is attributed to multiple sources, may have particular relevance for health and well-being (e.g., for tailoring interventions to reduce health disparities).

## 198) Abstract 1459

# SOCIAL MEDIA USE DURING CRISIS: THE UTILIZATION OF FACEBOOK IN RESPONSE TO CAMPUS VIOLENCE

Jitske Tiemensma, PhD, Holly M. Rus, MA, Psychological Science, University of California, Merced, Merced, California

Social media has become an important resource during and after crises. Platform affordances such as real-time information sharing and broad network reach have the potential to facilitate previously unprecedented communication among victims, witnesses, and their associated social network members. However, little is known about how social media is used in response to trauma, and how it may influence (long-term) well-being. Given the reliance on virtual communication during crises, as well as the importance of social support and emotional expression in promoting recovery after trauma, the current study assessed Facebook use for the purposes of seeking information, seeking social support, and expressing emotions in response to the acts of violence carried out at the University of California, Merced in November of 2015. Students (n = 552) reported their uses of Facebook on the day of the attacks and their current depressive and post-traumatic stress disorder (PTSD) symptoms five months after the attacks. Results showed that many students were experiencing psychological distress even after five months. The majority of students reported using Facebook more, and in different ways than normal in response to the events, with most reporting using it to seek information. Although students reported short-term affective change, using the site to seek information, seek social support, or express emotions was not significantly associated with depressive or PTSD symptoms five months later. Findings highlight the lasting impact of campus violence on psychological well-being as well as the function and impact of social media use during crisis.
PARENTING BEHAVIOR AND PERSONALITY AS SIGNIFICANT PREDICTORS FOR THE SEVERITY OF SOCIAL ANXIETY DISORDER

Rupert Conrad, MD, Psychosomatic Medicine and Psychotherapy, Andreas J. Forstner, MD, Institute of Human Genetics, Ingo Wegener, PhD, Department of Psychosomatic Medicine and Psychotherapy, Sabine Staufenbiel, MSc.Psych., Psychosomatic Medicine and Psychotherapy, Johannes Schumacher, MD, Institute of Human Genetics, Franziska Geiser, MD, Stefanie Rambau, Dipl.-Psych., Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, NRW, Germany

The relationship between parenting behavior, temperament and social anxiety disorder in adulthood is far unsettled. In the present study, we investigated this relationship and formulated on the basis of previous studies the following hypotheses: Social phobics (SP) compared to controls remember more parental control, less parental care, show higher harm avoidance as well as lower self-directedness. Abovementioned factors can explain a significant proportion of the severity of social phobia symptoms.

404 SP were compared to 82 healthy subjects. Psychological diagnoses (Structured Clinical Interview-I for DSM-IV), social anxiety symptoms (Social Phobia Inventory), depression (Beck Depression Inventory), parenting behavior (Parental Bonding Questionnaire) and personality (Temperament and Character Inventory) were investigated. SP and controls were compared by analysis of covariance (covariates: age, sex, education, BDI; Bonferroni correction). Based on linear regression parenting behavior and personality were examined as predictors for the severity of social phobia.

SP showed reduced care by father (p <0.001, d = 0.51) and mother (p <0.001, d = 0.37) and an increased control by their mother (p <0.003, d = 0.27). In the personality inventory they also showed decreased scores on novelty seeking (p <0.001, d = 0.65) and self-directedness (p <0.001, d = 0.76) as well as an increased harm avoidance (p <0.001, d = 1.47). The predictors parenting behavior and personality explained 32.7% (adjusted R²) of the variance of the social phobia inventory (control variables age and gender 1%) with maternal care (β = -0.166, p = 0.002), paternal control (β = 0.224, p <0.001), harm avoidance (β = 0.376, p <0.001) and self-directedness (β = -0.164, p = 0.001) as significant predictors.

SP remember high maternal control and low parental care and show a personality profile characterized by high behavioral inhibition and little self-efficacy. Paternal control, low maternal care in conjunction with this personality profile can explain about one-third of the total variance of the severity of social anxiety symptoms. The results underline the importance of parenting behavior and personality for diagnosis and treatment of social anxiety disorder.

THE EFFECT OF EMOTIONAL DISTRESS ON PSYCHOSOMATIC HEALTH MAY DEPEND ON LIFE CIRCUMSTANCES

Nadya Dich, Ph.D., Public Health, University of Copenhagen, Copenhagen, -, Denmark, Marcel Goldberg, MD, PhD, Paris Ouest Medical School, Marie Zins, Ph.D., UFR des Sciences de la santé Simone Veil, Versailles Saint Quentin University, Villejuif, - France

Emotional reactions to major life events are common and appropriate. The hypothesis of the study was that emotional distress (depression, anxiety, perceived stress) has less of a negative effect on psychosomatic health, or may even be health-protective, if it occurs in the context of major life events. To test this hypothesis, we used data from 14 waves (2000-2013) of the French GAZEL cohort study, which sends annual health surveys to the employees of the national gas and electricity company. The sample included 17,348 respondents (27% women, baseline age 47-61).

Each year, participants reported on life events in the previous 12 months, including divorce, bereavement, as well as other major life

changes. The Holmes-Rahe Inventory was used to ascribe a severity score to each event. For each wave, the scores for all events were summed to yield an indicator of a total exposure. Each year participants also reported whether they experienced depression, anxiety, or stress in the past 12 months, as well as a number of health problems. The study focused on frequent colds and flu, headaches and impaired sleep, gastrointestinal complaints, hypertension, and back ache – all of which are thought to have a psychosomatic component. Generalized estimating equations were used to test whether at each wave, the link between depression, anxiety or stress and the above health conditions was moderated by the severity of recent events.

Depression, anxiety or stress was associated with higher likelihood of all of the investigated health conditions. The severity of life events also increased the likelihood of all conditions except hypertension and, in women, headaches. The negative effects of emotional distress and life events on headaches, impaired sleep, and back ache were additive. However, there was an interaction between emotional distress and severity of life events in predicting frequent colds in women and hypertension in men: the link between distress and these conditions was considerably weaker if the distress occurred in the context of major life events. Moreover, if multiple traumatic events occured within the same year, men who did not experience distress during that year had a higher likelihood of hypertension. These results question the validity of the idea that emotional distress is a health risk factor regardless of its cause.

THE SELF-ASSESSMENT KIOSK: OPPORTUNITIES TO EXPLORE BIOPSYCHOSOCIAL HYPOTHESES BY PROVIDING FREE ONLINE ACCESS TO SURVEYS WITH PERSONALIZED FEEDBACK

Robert G. Maunder, MD, Jonathan J. Hunter, MD, Psychiatry, Sinai Health System, University of Toronto, Toronto, Ontario, Canada

An online resource that allows free public access to validated measures of many biopsychosocial health constructs, scores them and provides evidence-based feedback was launched in September 2016. Visitors may use the resource with or without consenting to research. We analyzed the first 5 weeks of data from users of the Self-Assessment Kiosk ("the Kiosk") in order to assess the feasibility of using this database for research. **Methods.** The Kiosk includes measures of physical and mental health diagnoses, illness impact, health goals, mental health symptoms, trauma, coping and interpersonal constructs. Anonymous users complete measures they choose from a menu and are provided with a results report. At its launch, the Kiosk was publicized with emails to colleagues and through Twitter. **Results.** Of 474 home page hits, 438 users indicated that they were visiting for the first time, 269 of these (61%) advanced to the consent page, and 181 of these (67%) consented to research. There were no differences in demographics, physical health or mental health between those who provided or declined consent. Consenting users were largely white (67%), university educated (79%), and female (71%). Significant medical illness was common (43%). The median number of questionnaires completed was 4 (interquartile range 2-7). Users had a mean PHQ9 depression score of 15.8 (SD 5.5, 43% ≥ score of 15) and a median number of adverse childhood experiences of 3 (IQR 1-5). The frequency of questionnaires completed varied from the most popular (depression, anxiety, attachment: 39-45% of users) to the least popular (attention deficit, pain severity, hazardous drinking: 8-22%). **Discussion.** The volume of responses and consent rate suggest that the Kiosk meets a perceived need and is a feasible vehicle for gathering biopsychosocial data. The frequency with which multiple questionnaires are selected suggests that the database will allow testing relationships between biopsychosocial variables as it grows. Users are self-selected and unrepresentative of other populations, so the Kiosk will be more valuable for exploration and hypothesis-generation than for hypothesis testing. Early adopters are likely to include colleagues (who received notices at launch) as users, a bias which may decrease
over time. Data will be updated to reflect the first 5 months of Kiosk experience in February 2017.

## 202) Abstract 1153

# ADVERSE LIFE EVENTS IN CHILDHOOD AND BODY MASS INDEX TRAJECTORIES FROM ADOLESCENCE TO EARLY YOUNG ADULTHOOD.

Leonie K. Elsenburg, MSc, Nynke Smidt, PhD, Epidemiology, University Medical Center Groningen, Groningen, Groningen, The Netherlands, Hans W. Hoek, MD, PhD, Psychiatry, Parnassia Psychiatric Institute, The Hague, Zuid-Holland, The Netherlands, Aart C. Liefbroer, PhD, Sociology, Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW), The Hague, Zuid-Holland, The Netherlands

**Background:** Little is known about differences in body mass index (BMI) development between children from adolescence to early young adulthood. Whether the accumulation of adverse life events, such as disease or death of a family member and parental divorce, is related to differences in BMI development is also unclear.

**Objective:** To investigate (1) whether there are different classes of BMI development trajectories from adolescence to early young adulthood and (2) whether these classes are related to the number of adverse life events children experienced.

**Methods:** Data are from the TRAILS (Tracking Adolescents' Individual Lives Survey) cohort study, following Dutch adolescents from 10-12 to 21-23 years. At all five assessment waves, height and weight were objectively measured. At T1, adverse events between birth and T1 were measured with a parent interview. At T3 and T5, adverse events between T1 and T3 and between T3 and T5 were measured with a semi-structured interview (Event History Calendar) with the adolescent. An adverse events score was calculated per wave. Growth Mixture Modeling was used to identify different BMI trajectory classes (n=2218). In conditional Growth Mixture Models, gender, socio-economic status (SES), ethnicity, pubertal status and adverse events score at T1 were initially included as covariates (n=2105). In a second step, the adverse events scores between T1 and T3 and T3 and T5 were additionally included (n=1178).

**Results:** Three distinct BMI trajectory classes were identified; a 'normal weight' class (75.1%), a 'late onset overweight' class (20.1%) and an 'early onset overweight' class (4.8%). Higher SES and lower pubertal status were associated with a lower likelihood of being in the 'late onset overweight' class (OR=0.501, p<0.001 and OR=0.539, p<0.001, respectively) and the 'early onset overweight' class (OR=0.457, p<0.001 and OR=0.498, p<0.001, respectively) in comparison to the 'normal weight' class. Boys were less likely than girls to be in the 'late onset overweight' class (OR=0.659, p=0.026) than the 'normal weight' class. The number of adverse life events children experienced was not related to BMI trajectory class membership.

**Conclusions:** Three trajectories of BMI development can be distinguished from adolescence to early young adulthood. Accumulation of adverse life events is not related to a specific BMI trajectory.

<figure><img src="image_28.png" /></figure>

## 203) Abstract 1453

# INCREASES IN SUBJECTIVE SOCIAL STATUS DURING A 12-WEEK WALKING INTERVENTION PREDICT HEALTH IMPROVEMENTS IN MIDDLE-AGED AND OLDER WOMEN

Ashley M. Geiger, MA, William K. Goodman, MA, Claire E. Elling, MA, Caroline Kaye, BA in progress, Rachel Kriegsman, BA in progress, Jutta M. Wolf, PhD, Psychology, Brandeis University, Waltham, MA

Subjective social status (SSS) assesses one's perceived position in a social hierarchy, most often within the U.S. or one's community. Typically measured on a 10-rung ladder, prior studies have found that perceived status strongly predicts health, with each step down in SSS predicting incremental increases in health risks. However, little is known about the stability of SSS ratings over time and how status among closer comparison groups, such as friends, predicts health.

Participants were 47 women (mean age = 60.13 years±6.56) taking part in a 12-week physical activity intervention for middle-aged and older women. At weeks 1 and 12, participants self-reported on perceived chronic stress, depressive symptoms, and SSS using the MacArthur ladders (community and U.S.) and modified ladders for status among neighborhood, family, and friends.

Repeated-measures ANOVAs revealed that across the 12 weeks, perceived stress and depressive symptoms decreased (F(1, 46)=11.44, p=.001; F(1, 46)=5.26, p=.026, respectively). Status relative to neighborhood (F(1, 46)=5.87, p=.019) and community (F(1, 46)=6.26, p=.016), but not friends or family, increased (both p > .19; trend increase in US status: F(1, 46)=3.81, p=.057). However, increases in status among friends were associated with decreases in stress (F(1, 43)=3.75, p=.059, ηₚ²=.080) and depressive symptoms (F(1, 43)=2.97, p=.092, ηₚ²=.065). Increase in community status was linked with trend-level decreases in perceived stress (F(1, 43)=3.46, p=.070, ηₚ²=.074) and increase in neighborhood status predicted decreases in depressive symptoms (F(1, 43)=3.09, p=.086, ηₚ²=.067).

In the context of a 12-week walking study, some domains of SSS are more stable than others, with improvements emerging for more distal reference groups (neighborhood, community), rather than more proximal social networks (friends, family). This suggests that different domains of SSS capture distinct information about an individual's perception of their social standing, highlighting the value of measuring status among a variety of social groups. Improvements in status among closer social groups translated into health-relevant changes, suggesting that status in these domains may be understudied predictors of stress and mental health. Future studies should explore interventions to improve health by helping an individual to increase perceived social standing.
## 204) Abstract 1631

### CONGRUENCE BETWEEN ECOLOGICAL MOMENTARY ASSESSMENT AND DAILY DIARIES OF COLLEGE STUDENT DRINKING: IMPLICATIONS FOR PREVENTION

Brittney Hultgren, M.S., Biobehavioral Health, Pennsylvania State University, University Park, PA, Nichole Scaglione, Ph.D., Biobehavioral Health and Criminal Justice, Research Triangle Institute, Durham, NC, Danica Slavish, M.S., Biobehavioral Health, Pennsylvania State University, University Park, PA, Rob Turrisi, Ph.D., Biobehavioral Health, Pennsylvania State University, University Park, PA

College student drinking remains a significant public health concern in the United States and can lead to numerous short- and long-term consequences. With the development and availability of smartphones, there have been advances in both in-the-moment data collection (ecological momentary assessment; EMA) and targeted momentary interventions (MI). However, there are several concerns surrounding the use of EMA to collect college drinking data, foremost of which is whether participant intoxication affects EMA compliance and validity of in-the-moment reporting. Thus, the current study investigated: 1) congruence between EMA drinking logs and subsequent morning recall (MR) of drinking events, 2) whether self-reported EMA intoxication levels predicted completion of MR the next morning, and 3) whether self-reported intoxication level during the MR was associated with failure to complete EMA drinking logs the previous night. Participants (N = 84 first-semester college women) used an application on their personal smartphones to complete a 14-day EMA protocol, which included momentary assessments of drinks consumed and level of intoxication at each drinking event, and daily MR of drinking and intoxication levels from the previous day. Zero-order correlations, means and standard deviations were used to compare the EMA drinking logs and the MR diary reports. Multilevel logistic regression was utilized to assess the effect of intoxication on completion of surveys. A total of 950 MR diary entries were collected. Of those occasions where drinking was reported in the MR (n = 224; 23.6%), 189 (84.4%) had at least one EMA drinking log reported the previous night. Nineteen drinking events reported via EMA did not have subsequent MR data. EMA and MR reports of drinks consumed and level of intoxication were significantly correlated most days. Multilevel logistic regressions indicated no significant associations between EMA-reported intoxication and completion of the MR the next day, or between MR-reported intoxication level and completion of EMA drinking logs the previous day. Findings suggest intoxication may not have a large impact on compliance and validity of reporting, and that MI may be a feasible approach before or during students' drinking events to help prevent risky drinking and consequences.

## 205) Abstract 1569

### HYDROXYUREA AND SICKLE CELL DISEASE: USING SOCIAL MEDIA TO UNDERSTAND PATIENTS AND CAREGIVERS PERCEPTIONS OF AN UNDERUTILIZED EVIDENCED-BASED TREATMENT

Aisha Walker, PhD, Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, Charles Jonassaint, PhD MHS, Medicine, University of Pittsburgh, Pittsburgh, PA

Sickle cell disease (SCD) is a genetic blood disorder associated with high morbidity and early mortality. Hydroxyurea (HU) is currently the only evidence-based disease-modifying drug approved for SCD, yet 60% of eligible patients may not receive or adhere to HU therapy. Patient perceptions of HU are an important factor contributing to this underutilization. Social media presents an unique opportunity to understand these perceptions and guide development of interventions for increasing HU uptake.

Therefore, we examined user-generated data obtained from Facebook to understand patient and family perceptions and utilization of HU therapy.

**Methods:** We extracted data from the Sickle Cell Unite Facebook group between Jan 2014 and Nov 2015, which included 145 HU-related posts and 2618 affiliated comments. We developed deductive codes according to previously identified barriers and facilitators from published literature and theory. We used inductive coding to identify new themes. Each message was coded with a positive, negative or neutral valence toward HU.

**Results:** Of the 145 posts, 55% asked a question about HU, and 1,131 comments were received. Analysis of 481 of these comments showed that positive comments were more likely to associate HU with high efficacy, few or minor side effects and better quality of life. Negative comments were more likely to associate HU with lack of efficacy and numerous or harsh side effects. Hair loss or thinning was the most frequently cited side effect. Caregivers were more supportive of HU than patients. Two potential patient barriers not been identified in prior studies were found: 1) patients/caregivers perceived that HU was masking SCD symptoms (e.g. artificially improving blood counts) and making it more difficult for them to receive needed acute care because they don't appear sick; 2) users expressed awareness of HU as a "cancer drug", a fact that deterred uptake. These novel findings suggest that stakeholders may share beliefs in a social media setting that are not being captured by traditional research.

**Conclusions:** This is the first study to use social media data for understanding patient perceptions and uptake of an evidenced-based therapy in SCD. Our social media data revealed a wide range of perceptions regarding HU and we identified two important barriers to HU use that have not been reported in prior research.

## 206) Abstract 1341

### POSITIVE OPINION OF ONE'S BODY FUNCTIONS AND PERCEPTIONS OF MORE POSITIVE APPEARANCE JUDGMENTS BY OTHERS ARE LINKED TO PHYSICAL ACTIVITY IN MIDDLE-AGED WOMEN

Claire E. Elling, MA, William Goodman, MA, Ashley M. Geiger, MA, Idelle Vaynberg, BS (in progress), Dahiana Loaiza, BA (in progress), Psychology, Brandeis University, Waltham, MA, Natalie J. Sabik, PhD, Health Studies, University of Rhode Island, Kingston, Rhode Island, Jutta M. Wolf, PhD, Psychology, Brandeis University, Waltham, MA

**Introduction:** In younger women, body-esteem in general and appearance concerns in particular are consistently shown to drive physical activity behavior. However, very little is known about this dynamic in older women or about the role of body function concerns, which may overshadow appearance concerns later in life. To test this hypothesis, the current study explored the relationship between appearance-versus-function body-esteem and Fitbit-assessed weekly step counts in middle-aged and older women.

**Method:** Sixty-eight women (mean age 59, SD = 6.78 years) taking part in a physical activity intervention study tracked their daily steps for one week with a Fitbit One. Appearance satisfaction, weight satisfaction, and appearance attributions were assessed by the *Body-Esteem Scale for Adolescents and Adults* and body function satisfaction with the *Body-Esteem Scale* (items 18-29).

**Results:** Independent of BMI, with increasing age, women walked less ($r = .21, p = .09$) and were more satisfied with their appearance ($r = .23, p = .064$). However, across all ages, neither appearance satisfaction nor weight concerns were associated with physical activity (all *p*'s > .40). In contrast, for middle-aged participants only, a more positive view of one's body functions as well as perceiving more favorable appearance judgments by others were linked to walking more (*beta* = -.34, *p* = .006; *beta* = -.29, *p* = .018, respectively).

**Conclusion:** The findings suggest that in addition to switching from upward to downward comparisons when judging one's own appearance, older women may adjust their expectations for body function satisfaction and appearance judgments by others toward what is common in their same-aged peers. In lieu of body-esteem factors, more global or objective measures of health may influence activity in older women, as features of normative aging and chronic diseases may limit their activity level. In contrast, in middle-aged women, emerging
body function concerns may not only overshadow their own weight and appearance concerns, but also sensitize them to appearance judgment by others. As such, improving body function may be a particularly relevant motivator to improve health behaviors. These findings emphasize the health-relevance of body-esteem in middle-aged women, and caution against generalizations in predicting or trying to alter health behavior in older adults.

## 207) Abstract 1360

### APPLYING A NEW ANALYSIS TECHNIQUE FOR ADHERENCE TO RECOMMENDED BEHAVIOURS USING MODERN TECHNOLOGY: AN EXAMPLE USING THE INHALER COMPLIANCE AID™ IN PATIENTS WITH COPD

Frank Doyle, PhD, Garrett Greene, PhD, Psychology, Ronan M. Conroy, DSc, Epidemiology & Public Health Medicine, Richard W. Costello, MD, Medicine, Royal College of Surgeons in Ireland, Dublin, D2, Ireland

#### Background

Novel mobile technologies, such as adherence monitors, often have sophisticated data output which requires new statistical approaches. Analysing such data correctly may increase precision of prediction and intervention. The Inhaler Compliance Aid™ (INCA™) is a unique device that can identify not only when a person takes an inhaler, but whether it is taken correctly. INCA™ data can help identify behavioural mechanisms of non-adherence, including different types of inhaler technique error and allow estimation of the amount of drug absorbed.

#### Aim

We employ a novel statistical approach to modelling adherence to inhaled medication in COPD to illustrate the value of more precise devices and analysis.

#### Methods

Data from 204 COPD patients was analysed using a newly-developed statistical procedure, which accounts for the precise effects of dose-timing as well as several types of technique errors. A number of potential psychosocial mediators of adherence were explored.

#### Results

While overall percentage of prescribed doses taken was high (74%, SD 25%), when accounting for timing and technique errors the mean successful adherence rate drops to 23% (SD 29%). Attempted adherence, as measured by dose count, was negatively correlated with health literacy (r=-0.19, 95% CI -0.34 to 0.04), while cognitive ability was negatively associated with technique and timing errors (r=-0.18, -0.35 to -0.03). Anxiety and depressive symptoms were not predictive of adherence. While a standard adherence AUC measure was associated with reduced COPD exacerbations (OR=0.7, 0.51 to 0.89, per SD increase in adherence), adopting the new statistical model demonstrated stronger effects (OR=0.5, 0.36 to 0.75). The new model also predicted optimal drug dosage per person.

#### Conclusions

Our new statistical modelling allows for new insights into biobehavioural data that provides important clinical and research insights. This method allows us to investigate effectiveness of treatments while correcting for confounds due to non-adherence and timing errors.

#### Funding

Irish Research Council #LoveIrishResearch

## 208) Abstract 1227

### STRAIN-REDUCTION INTERVENTION EFFECTS IN DUAL-EARNER HEALTHCARE EMPLOYEES

Leah R. Halper, M.S., Ryan C. Johnson, PhD, Alex Woody, M.S., Psychology, Ohio University, Athens, Ohio, Leslie B. Hammer, PhD, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon

Coinciding with an increase in dual-earner relationships (i.e., relationships where both partners earn money outside the home), work hours have risen, causing individuals to split limited time between work and home/family life (Bray et al., 2013). With greater responsibilities in both domains comes greater probability of conflict (work-family conflict [WFC]; Amstad et al., 2011) for dual-earners. WFC is related to a myriad of negative health outcomes, including higher rates of musculoskeletal pain, disrupted sleep, and poorer mental health, such as increased burnout (e.g., emotional exhaustion), and thus may be a fruitful point of intervention (Hammer et al., 2016). Healthcare employees already experience high levels of strain; therefore, those who are also dual-earners are particularly vulnerable and might benefit most from work-family interventions.

The current study describes a randomized controlled trial examining the effectiveness of an intervention designed to reduce WFC and improve health (Bray et al., 2013), comparing effects on dual-earner occupational caregivers versus non-dual-earner occupational caregivers from a large, long-term healthcare company.

Mixed model longitudinal analyses were used to test the interaction between two level-2 (between-subjects) variables, intervention condition (intervention *n*=324; control *n*=379) and dual-earner status (dual-earners *n*=428; non-dual-earners *n*=207), and one level-1 (within-subjects) variable: time (pre-intervention/6 mo/12 mo). There was a significant three-way interaction (γ=0.51, SE=0.24, *p*<.05). In the intervention condition, WFC decreased more over time for dual-earners compared to non-dual-earners (γ=-0.55, SE=0.26, *p*<.05). Further, the slope for WFC at 12 months was declining significantly for dual-earners in the intervention condition (*p*<.01). Additionally, dual-earners reported more burnout at pre- and 6 months in the intervention (*ps*<.05), but at 12 months, there was no difference between the four conditions (*p*=.24).

The intervention significantly decreased WFC and burnout for dual-earner caregivers. Workplace interventions aimed at reducing WFC may be especially effective for dual-earners balancing their work and non-work lives and, concurrently, their physical and mental health. High-risk industries, such as healthcare, may benefit from paying special attention to this specific population.

## 209) Abstract 1393

### EXECUTIVE CONTROL MODERATES THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND CHRONIC STRESS

Linda Becker, PhD, Chair of Health Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Bavaria, Germany, Stefan Agrigoroaei, PhD, Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Brabant, Belgium, Myriam V. Thoma, PhD, Psychopathologie und Klinische Intervention, University Zurich, Zurich, Zurich, Switzerland, Luke Hanlin, M.Sc., Danielle Gianferante, PhD, Xuejie Chen, M.Sc., Department of Psychology, Brandeis University, Waltham, MA, Nicolas Rohleder, PhD, Chair of Health Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Bavaria, Germany

Chronic stress (CS) has been shown to have negative health consequences, often related with alterations in the cortisol awakening response (CAR). Not much is known about how CS affects cognitive functioning (like executive control performance) that is essential for daily living. One lifestyle factor that is drawing more and more attention is physical activity (PA), because regular PA can reduce stress-associated physiological changes like increased cortisol levels. The goals of our study were to examine 1) whether there is a relation between CS and executive control performance and 2) whether the association between PA and CS is influenced by cognitive performance. Fifty-six healthy subjects (35.4 ± 18.1 years, 28 male, 28 female, BMI: 24.6 ± 3.5 kg/m²) participated. On two days, diurnal salivary cortisol was measured at six time points (0, 30 minutes, 1, 4, 9 and 13 hours after wake-up). The CAR was estimated as Area under Curve relative to increase (AUCi). PA was assessed by means of the
Paffenbarger Activity Questionnaire (PPAQ) as total hours of exercise per week. Error rates in a 45-second backward counting (BC) task and accuracy scores in a Red-Green (RG) task (saying „Go“ when „GREEN“ and „Stop“ when „RED“ is displayed in the congruent and vice versa in the incongruent condition) were used as measures for executive control performance.

Higher AUCi values (steeper CAR increases) were related with higher levels of PA (r = .27, p = .047), with smaller error rates in the BC (r = .27, p = .044), and with better performance in the congruent condition of the RG task (r = .37, p = .026). Furthermore, we found that the association between the amount of regular PA and CS was moderated by the performance in the BC task (β = .491, p = .008, R²total = .513, ptotal = .001, Fig. 1). Lower error rates in the BC task (better executive control performance) reduced the association between PA and CS. No moderating effects were found for the RG task. Taken together, we were able to show that CAR patterns were related with the amount of regular PA and with executive control performance. This is an important step in understanding the long-term health-promoting influence of regular PA on CS and on cognitive functioning. However, the directions are still unclear. Thus, future studies should use longitudinal designs and should employ more objective measures of PA.

<figure><img src="image_29.png" /><figcaption>FIGURE 1: Standardized regression coefficients for direct and indirect effects of regular physical activity and executive control on chronic stress.</figcaption></figure>

## 210) Abstract 1610

# A TEST OF THE STRESS BUFFERING HYPOTHESIS FOR THE NEGATIVE IMPACT OF FINANCIAL STRAIN ON HEALTH-RELATED QUALITY OF LIFE

Lorra Garey, MA, Psychology, Lorraine R. Reitzel, PhD, Department of Psychological, Health, and Learning Sciences, Amber Anthenien, MA, Psychology, University of Houston, Houston, TX, Michael B. Businelle, PhD, Oklahoma Tobacco Research Center, University of Oklahoma, Oklahoma City, OK, Clayton Neighbors, PhD, Michael J. Zvolensky, PhD, Psychology, University of Houston, Houston, TX, David W. Wetter, PhD, Psychology, Rice University, Houston, TX, Darla E. Kendzor, PhD, Oklahoma Tobacco Research Center, University of Oklahoma, Oklahoma City, OK

Financial strain refers to difficulty affording food, clothing, housing, major items (e.g., car), furniture/household equipment, leisure activities, and bills (Pearlin et al., 1981). Unlike traditional, objective measures of socioeconomic status (SES), financial strain represents an undesirable mismatch between income and the combination of expenses and accumulated debt (Peirce et al., 1994) and is applicable to individuals of all SES strata. Theoretical models of stress posit that the chronic stress that develops as a byproduct of financial strain can lead to poorer health outcomes (Frank et al., 2014; Pearlin et al., 1981; Steptoe et al., 2005; Williams et al., 2007). Consistent with the stress buffering hypothesis (Cohen & Wills, 1985; Lakey & Cohen, 2000; Thoits, 2011), distinct facets of perceived social support may mitigate the deleterious effects of financial strain on health. The present study

examined the extent to which appraisal, belonging, and tangible social support ameliorate the effects of financial strain on health-related quality of life (HRQoL). A community sample (n=238, 67.2% female, MAge=43.4 years) completed in-person surveys as part of a larger study of health behaviors. Greater financial strain and less social support were associated with poorer HRQoL. Additionally, both appraisal and belonging support moderated the effects of financial strain on HRQoL components, such that higher appraisal and belonging support were associated with diminished effects of financial strain on HRQoL. Current findings suggest nuanced associations between financial strain and HRQoL, and provide evidence for the deleterious effect of financial strain on HRQoL, the benefit of social support on HRQoL, and the buffering agency of social support dimensions for the negative impact of financial strain on HRQoL. Clinically, current findings underscore the negative impact of financial strain on poor HRQoL and highlight the importance of addressing emotional and belonging social support, particularly among persons experiencing elevated stress related to financial obligations.

## 211) Abstract 1272

# HOW ARE BEHAVIOUR CHANGE INTERVENTION TECHNIQUES LINKED TO THEORY? EVIDENCE FROM LITERATURE SYNTHESIS AND EXPERT CONSENSUS

Marie Johnston, PhD, Medicine, Nutrition & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK, Alexander J. Rothman, PhD, Psychology, University of Minnesota, Minnesota, Ma, Michael P. Kelly, PhD, Public Health and Primary Care, University of Cambridge, Cambridge, England, UK, Marijn deBruin, PhD, Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK, Rachel N. Carey, PhD, Centre for Behaviour Change, UCL, London, England, UK, Lauren Connell, PhD, Behavioral and Social Sciences, Brown University, Providence, RI, Susan Michie, PhD, Centre for Behaviour Change, UCL, London, England, UK

**Background:** Behaviour change interventions typically contain several components, including behaviour change techniques (BCTs) which are the active elements of the intervention. BCTs are chosen to influence the theorised mechanisms of action i.e. the processes via which the intervention acts to change behaviour. However, there is no agreed method of linking BCTs with mechanisms of action as these links are not always clearly reported. Identifying agreed links would be helpful both in designing theory-based interventions and in examining theoretical explanations for the success or failure of interventions.

**Aim:** To identify links between BCTs and mechanisms of action in behavioural theories using evidence from published literature and expert consensus.

**Methods:** Four studies were conducted. In Study 1, links between BCTs and mechanisms of action hypothesised by the authors were identified from 277 intervention papers. Study 2 identified links hypothesised by 105 behaviour change experts. In Study 3, data from Studies 1 and 2 were triangulated and discrepancies discussed by a different group of 16 experts in order to identify agreed links. In Study 4, links between groups of BCTs and theories were identified in a final consensus exercise involving 25 experts.

**Results:** Study 1 identified 2639 BCT- mechanism of action links while Study 2 identified 90 links. Across Studies 1 and 2, 36 links were shared and 185 inconsistencies were identified. These inconsistencies were discussed by Study 3 experts. Final agreed links between (groups of) BCTs and (i) mechanisms of action and (ii) theories were summarised in two heat maps.

**Conclusions:** There is clear consensus that some BCTs are linked with specific mechanism of action and that they are not linked with others. For other possible BCT-mechanism of action links there is less agreement or they have rarely been investigated. These results can be used to inform intervention development, evaluation, and synthesis.
## 212) Abstract 1091

### CAN ARTIFICIAL INTELLIGENCE DETERMINE INDIVIDUALS' SPIRITUAL TYPE ACCORDING TO HAPPY SCIENCE THEORY?

Yoichi Chida, Ph.D., M.D., Human Happiness, Happy Science University, Chosei-gun, Chiba, Japan, Naruki Kamiya, High school diploma, Medical Science, Happy Smile Clinic, Kawsaki, Kanagawa, Japan, Atsushi Tokuno, High school diploma, Koki Narimatsu, High school diploma, Medical Science, Happy Smile Clinic, Kawasaki, Kanagawa, Japan

Numerous publications have shown that spirituality/religiosity can boost mental resilience and alleviate psychiatric illness. In particular, depressive symptoms can be effectively reduced using a novel spiritual group psychotherapy and intercessory prayer based on Happy Science theory, which was developed by Master Ryuho Okawa in Japan as Kofuku-no-Kagaku (literally, "the Science of Human Happiness") in 1986. Happy Science has grown into one of the most influential religious organizations in Japan (ranking first among people who have joined Japanese religious groups), and includes members from over 100 countries worldwide. In this study, drawing on recent advances in artificial intelligence, we examine the validity of using artificial intelligence to assess individuals' "spiritual type" according to Happy Science doctrine. The spiritual types were defined in terms of the seven colors of the spectrum of Buddha's light: yellow (law and compassion), white (love), red (justice and miracles), violet (hierarchical order), blue (philosophy and ideology), green (harmony and nature), and silver (science and the modernization of contemporary culture). We had the neural networks of an artificial intelligence (IBM SPSS Modeler Premium 17.0) learn the sentences of each of the seven colors' "spiritual message" (which were each about 20,000 words). These spiritual messages (Reigen in Japanese) are the words of spirits revealed through Master Okawa's vocal chords. Unlike most mediums, Master Okawa can summon any spirit at will and remain conscious throughout the procedure. We examined the test-retest reliability as well as the validity, which involved using the spiritual messages from individuals with the same color. The present study is expected to show some intriguing results and to lead to the next step in developing an artificial intelligence for evaluating individuals' spiritual type according to Happy Science.

## 213) Abstract 1060

### STRESS, DEPRESSION, AND RISK FOR CARDIO-VASCULAR DISEASE AMONG URBAN INDIANS

Sonia Suchday, PhD, Psychology, Pace University, New York, NY, Rajeev Gupta, MD PhD, Medicine, Krishna K. Sharma, MSc, Research, Fortis Escorts Hospital, Jaipur, Rajasthan, India, Bal Kishan Gupta, MD, Medicine, SP Medical College, Jaipur, Rajasthan, India, Indu Mohan, MD, Research, Fortis Escorts Hospital, Jaipur, Rajasthan, India, Prakash Deedwania, MD, Cardiology, University of California San Francisco, Fresno, CA

Participants were urban residents from 11 cities in India (n=5234; Men=2891; Mean Age=48.36 years) were evaluated as part of a larger study of cardiovascular risk for prevalence of depression and perceived stress due to work, home, or finances and cardiovascular disease risk. Logistic regressions were computed to test associations.

Results indicated that age-adjusted prevalence of depression was: men=23.5%; women=24.7%. Participants who were depressed were more likely to be physically inactive, have a high Waist-Hip Ratio, Low HDL Cholesterol, and diabetes compared to non-depressed participants (p<.05). Participants who reported more stress were less likely to be physically active, truncal obesity, hypertension, low HDL cholesterol, diabetes and metabolic syndrome compared to participants who did not experience a high level of stress (p<.05).

These data represent preliminary evidence from a large-scale epidemiological study that psychosocial factors may be associated with cardiovascular risk among Urban Indian participants. Discussion will include exploring the specific kinds of stress reported and the association of sociodemographic variables associated with depression and stress in this population.

## 214) Abstract 1209

### COGNITIVE PERFORMANCE AND PSYCHOLOGICAL WELL-BEING IN DEMENTIA CAREGIVERS FOLLOWING STRESS REDUCTION TECHNIQUES

Andrew P. Allen, PhD, Dept Psychiatry and Neurobehavioral Science/APC Microbiome Institute, Aoife Ní Chorcoráin, MD, Judy Wall, MA, Centre for Gerontology & Rehabilitation, Anne-Marie Cusack, BA, APC Microbiome Institute, John F. Cryan, PhD, Dept Anatomy & Neuroscience/APC Microbiome Institute, Timothy G. Dinan, PhD, Department of Psychiatry & Neurobehavioral Science/APC Microbiome Institute, Patricia Kearney, PhD, Dept Epidemiology & Public Health, D William Molloy, PhD, Centre for Gerontology & Rehabilitation, Gerard Clarke, PhD, Department of Psychiatry & Neurobehavioral Science/APC Microbiome Institute, University College Cork, Cork, Ireland

**Background:** Caring for a relative with dementia is considered particularly stressful and is associated with numerous adverse health effects. Previous research from our group has indicated heightened depression and impaired cognitive performance in dementia caregivers compared to non-caregiving control participants. The current study aimed to examine the impact of interventions designed to help dementia caregivers manage stress and the caregiving role on cognitive performance and mental well-being of the caregivers.

**Methods:** We examined mental well-being and cognitive performance in dementia caregivers. Caregiver participants were recruited via clinics at St. Finbarr's Hospital, Cork. Participants completed validated tests of stress, anxiety, and depression. Participants also completed cognitive tasks from the CANTAB battery. We employed tests assessing visuospatial memory (paired associates learning task, PAL), working memory (spatial span, SSP), sustained attention (rapid visual information processing, RVP), simple reaction time (SRT) and executive function (Emotional Stroop). Caregivers completed both a carer training program and mindfulness-based stress reduction (MBSR) program. Each program was delivered in a group setting by an experienced instructor and lasted 6-8 weeks.

**Results:** Following both interventions, caregivers had improved performance on the PAL task, which engages the hippocampus, as well as improved performance on RVP, which engages the frontal cortices. Caregiver performance in the other cognitive tests was not affected. However, reported stress, anxiety and depression were not significantly altered following the interventions.

**Conclusions:** Carer training and MBSR may be beneficial in improving cognitive performance across domains which are impacted by the stress of caregiving. A comprehensive physiological phenotyping of dementia caregivers is required to better understand the mechanisms of these effects.

## 215) Abstract 1336

### DEVELOPMENT OF A COMPREHENSIVE STRESS RATING SCALE FOR ECOLOGICAL MOMENTARY ASSESSMENT: ITS WITHIN-INDIVIDUAL PSYCHOMETRIC PROPERTIES

Hiroe Kikuchi, MD, PhD, Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan, Kazuhiro Yoshiuchi, MD, PhD, Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan, Jinhyuk Kim, PhD, Biobehavioral Health, Center for Healthy Aging, The Pennsylvania State University, University Park, PA, Yoshitoshi Tomita, MD, Psychosomatic Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan, Yoshiharu Yamamoto, PhD, Educational Physiology Laboratory, Graduate School of Education, the University of Tokyo, Bunkyo-ku, Tokyo, Japan, Tetsuya Ando, MD, PhD, Psychosomatic Research, National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan

Computerized ecological momentary assessment (EMA) has been applied in psychosomatic medicine with its advantages of ecological
validity and time accuracy. Although paper-based questionnaires have usually been diverted to EMA use, items may be inappropriate for EMA and psychometric properties should ideally be confirmed from both between- and within-individual perspectives by EMA data. In order to develop a comprehensive scale of stress for EMA, we previously proposed scales for psychological demand, interpersonal stress and stress responses, in which items were selected by item response theory through a paper questionnaire survey. The aim of this study was to investigate the within-individual psychometric properties of the scales when conducted in the form of EMA.

The subjects were five women with psychiatric or psychosomatic disorders (five women, age 28-65) and six healthy subjects (five women and one man, age 34-42). They carried a smartphone as a diary for seven days and recorded any stressful events since the last recording and answered the items in the scales at alarms (about every four hours), when going to bed, when waking up and when they felt strongly stressed.

A total of 634 recordings were made by all subjects. As regards within-individual reliability, individual Cronbach's αs were 0.93 (median, 0.74-0.97) for psychological demand, 0.50 (median, 0-0.94) for interpersonal stress and 0.89 (median, 0.70-0.96) for stress responses. As regards within-individual validity, multilevel analysis showed that scores were significantly higher with any stressful events than without in psychological demand (p = 0.002) and stress responses (p < 0.001) and were not in interpersonal stress (p = 0.052). Both psychological demand and interpersonal stress were significantly positively associated with stress responses (p < 0.001).

Although internal consistency of scales for psychological demand and stress responses was good, Cronbach's αs were not large enough for interpersonal stress and it may be attributed to little within-individual variances in some subjects. Within-individual validity was shown to be fair. Further investigation with more subjects would also allow investigation of between-individual psychometric properties. In parallel, implementation of computerized adaptive testing should be considered for more precise estimation with less burden.

## 217) Abstract 1157

# DEPRESSION AS A RISK FACTOR FOR 30-DAY RE-HOSPITALIZATION FOLLOWING ACUTE CORONARY SYNDROMES

Willem J. Kop, PhD, Loes Smeijers, PhD, Jos Widdershoven, MD, PhD, Johan Denollet, PhD, Medical and Clinical Psychology; Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, -, the Netherlands

Background: Early re-hospitalization after hospital admission for major medical conditions is very common, with estimates ranging from 15%-20% in the United States and 7%-10% in Europe. Re-hospitalization within 30 days occurs relatively frequently after acute coronary syndromes. Psychological factors such as depression are associated with an increased risk of recurrent cardiac events, but little is known about the predictive value of depressive symptoms at the time of the index hospitalization for subsequent 30-day re-hospitalization.

**Methods:** A total of 295 patients with acute coronary syndromes (271 myocardial infarction, 24 unstable angina with signs of ischemia) were enrolled in this study (mean age = 62 ± 11 years; 24% women). Depression was measured while patients were admitted in the Emergency Department (First Heart Aid unit) using the Patient Health Questionnaire (PHQ-9), or by an interview-adapted version of the PHQ-9 after discharge. Re-hospitalizations were defined as an admission to the hospital that lasted at least one day; short-term emergency room visits were not counted as re-hospitalization events.

**Results:** Of the 295 patients, 36 (13.3%) were re-hospitalized within 30 days. The reason for re-hospitalizations were as follows: cardiovascular causes (N=11), non-cardiac medical conditions (N=3: COPD (1), general internal medicine (2)), post-admission complications (N=2), planned re-admissions (N=2), cardiac symptoms for which no new ischemia or other cardiac causes could be identified (N=18).

Depression status (PHQ-9>10; N=41,14%) was significantly predictive of 30-day re-hospitalization (OR=2.38, 95%CI=1.02-5.59), adjusting for age and sex. Results for continuous PHQ-9 scores showed a similar pattern (OR=1.07, 95%CI=1.00-1.14). Exploratory analyses indicated that the risk of depression for 30-day re-hospitalizations related to cardiovascular causes was significant (OR=4.4, 95%CI=1.2-16.5) and this risk was higher than for 30-day re-hospitalizations for non-cardiac events (OR=2.5, 95%CI=0.9-7.5).

**Discussion:** Depression at the time of admission for acute coronary syndromes is an important factor to consider in predicting early re-hospitalization. The present finding also indicate that the risk associated with depression is not limited to all-cause re-hospitalizations but also relevant to re-hospitalizations for recurrent cardiac events.

## 218) Abstract 1416

# POSITIVE AFFECT IS ASSOCIATED WITH LOWER SALIVARY C-REACTIVE PROTEIN IN YOUNG ADULTS WITH AND WITHOUT CHRONIC PAIN

Jennifer E. Graham-Engeland, Ph.D, Danica C. Slavish, MS, Joshua M. Smyth, Ph.D, Christopher G. Engeland, Ph.D, Biobehavioral Health, Penn State University, University Park, PA, Sunmi Song, Ph.D, College of Pharmacy, Chung-Ang University, Seoul, Dongjak-gu, South Korea, Nolan McCormick, H.S., Biobehavioral Health, Penn State University, University Park, PA

Emerging evidence suggests that negative affect (NA) is associated with higher, and positive affect (PA) with lower, circulating levels of inflammatory biomarkers. To our knowledge, the association of NA and PA with salivary biomarkers of inflammation has not been examined. Two measures each of NA and PA were utilized: 1) from aggregated daily diary measures of affect (morning and evening ratings averaged across 14 days to create daily-derived [DD] NA and PA, and 2) a baseline measure of affective self-report from the two weeks prior to the start of the daily diary period. We investigated the degree to which these measures predicted salivary C-reactive protein (CRP) and interleukin (IL)-6 in a sample of 139 young adults (58% female), a subset of whom had chronic back pain (n=58). CRP and IL-6 were determined from saliva obtained at the end of the daily diary period. Biomarker data were log-transformed, and all models statistically controlled for age, gender, BMI, and salivary flow rate. Independent regressions revealed that baseline PA and DD PA were each negatively associated with salivary CRP (β=-0.02, p<.01 and β=-0.02, p=.05, respectively). Baseline NA and DD NA were unrelated to inflammatory markers. As temporal dynamics may be important in the connection between affect and plasma cytokines, we verified that results were similar when looking at DD PA and NA from just the first or second week. Chronic pain status did not significantly moderate any results. When both baseline PA and DD PA were entered into the same model, baseline PA (but not DD PA) remained a significant predictor of salivary CRP. The association between baseline PA and salivary CRP remained significant after controlling for potential confounding variables: race, SES, depressed mood, DD pain, and self-reported health (β=-0.02, p<.01). Neither measure of either NA or PA predicted salivary IL-6, perhaps in part because salivary IL-6 is more influenced by oral health. In conclusion, salivary CRP was linked with both baseline PA and DD PA, and the connection between baseline PA and salivary CRP seemed more robust. Surprisingly, CRP was unrelated to either measure of NA. Thus, although salivary CRP may be a useful marker for future studies, additional research with diverse samples is needed to characterize how psychosocial factors and affect relate to both salivary and plasma CRP.