considering the role of unfair treatment in the association between socioeconomic disadvantage and self-rated health over an 17-19 year period (N=2720; 55% female; Mean Age at T1=46 years, SD=11). Two measures of unfair treatment—everyday discrimination and perceived inequality in work—were considered as mediators, and age was considered as a moderator.

**Results and Conclusions:** Socioeconomic disadvantage at the baseline assessment was associated with self-rated health 17-19 years later, controlling for self-rated health at T1 and demographic covariates (B = -.15, *p* < .001). Both measures of unfair treatment significantly mediated this longitudinal association, in total explaining 25% of the effect. With respect to age moderation, partial support was found for the hypothesis that, at younger ages, socioeconomic disadvantage is more strongly associated with unfair treatment, and unfair treatment is more strongly associated with self-rated health. Overall, findings suggest that unfair treatment is an important explanatory variable in the link between socioeconomic disadvantage and health. Furthermore, age moderation findings suggest that future efforts to mitigate the harmful effects of social class discrimination may be most effective if focused on the first half of the life span.

## Abstract 1526

### POSITIVE ASSOCIATION BETWEEN SELF-REPORTED DISCRIMINATION AND HEART RATE VARIABILITY DURING A RACISM RECALL TASK: PRELIMINARY EVIDENCE FOR THE COMPENSATION HYPOTHESIS

Andrew D. Case, PhD, Jaimelee Behrendt-Mihalski, BA, Anna Murphy, BA, Psychology, University of North Carolina at Charlotte, CHARLOTTE, NC, LaBarron K. Hill, PhD, Psychology and Behavioral Sciences, Duke University, Durham, NC

Researchers have long hypothesized that the autonomic nervous system is an important pathway connecting the experience of racial discrimination to poorer health among African Americans. Recent evidence suggests that heart rate variability (HRV), an important biomarker of both physical and mental health, may play an important role in buffering the deleterious effects of racial discrimination. In the current study we present preliminary data supporting the hypothesis that higher HRV among African Americans, and other non-US Black populations, may reflect a compensatory mechanism arising from more frequent exposure to racial discrimination. Blood pressure (BP) and heart rate (HR) data were obtained for N=63, healthy African American young adults (mean age = 21.9 ± 5.5, 66% female) during completion of 5-minute resting baseline, a laboratory-based racism recall task, and a recovery period. Participants also provided demographic information and completed the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV). HRV was assessed using the time domain measure, root mean square of the successive differences between adjacent R-R intervals (RMSSD). Relative to baseline, there were significant increases in BP and RMSSD, as well as a significant decrease in HR during the racism recall task (all *p*'s <.05). In regression models, adjusted for age, gender, body mass index and physical activity, lifetime discrimination emerged as a significant inverse predictor of HR (b = -.35, se = .13, *p* = .008) and positively predicted RMSSD during the racism recall task (b = .02, se = .01, *p* = .024). To our knowledge these are the first data to demonstrate that HRV may actually *increase* during *in vivo* exposure to discriminatory stimuli. Although preliminary, these observations corroborate the putatively compensatory association between the higher HRV observed among African Americans and other non-US Black populations and experiences of racial discrimination. While further research and replication are needed, these findings may have significant implications for efforts aimed toward eliminating racial health disparities in the US and beyond.

## Abstract 1643

### RACIAL DISCRIMINATION AND PHYSIOLOGICAL REACTIVITY: THE MODERATING ROLES OF RACIAL COMPOSITION AND RELIGIOUS ATTENDANCE

Effua E. Sosoo, B.A. Psychology, Enrique W. Neblett, Ph.D., Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC

Previous work has highlighted the relationship between racial discrimination and negative health outcomes (Williams and Mohammed 2009). Though many studies have examined the physical health impacts of racial discrimination, far fewer have examined its physiological impacts. Several studies have suggested that factors such as worry and anticipatory stress may exacerbate the association between racial discrimination and physiological stress responses (Brosschot et al, 2006), yet few studies have focused on factors that may *protect* individuals from the negative impacts of racial discrimination. The present study examined the moderating roles of racial composition and religious attendance in the association between racial discrimination and physiological reactivity (pre-ejection period [PEP] and respiratory sinus arrhythmia [RSA]). Two hundred and eleven African American students attending a southeastern U.S. university listened to subtle, blatant, and neutral racism analogues (Vrana and Rollock, 2002; Jones et al., 1996), in which “perpetrators” were described as either Black or White, and cardiovascular psychophysiology data were acquired continuously. Findings indicated a statistically significant three-way interaction, *F* (8, 1680.20) = 5.11, *p* = .02, between racial discrimination, perpetrator race, and racial composition. Specifically, participants who grew up in neighborhoods comprised of almost all people of other races evidenced greater parasympathetic withdrawal (M = -.80) while listening to the blatant vignette as compared to participants who grew up in predominantly Black, half Black, or mixed race communities (Ms = -.10 - .12, *ps* = .00 - .04), when the perpetrator was White. Findings also indicated a statistically significant two-way interaction, *F* (24, 243.45) = 3.46, *p* < .001, between racial discrimination and religious attendance such that participants who attended church services 2-3 times per month experienced greater sympathetic activation (M = 12.01) to blatant discrimination, as compared to sympathetic withdrawal exhibited by less frequent attendees (M = .88, *p* = .02). These findings highlight the complex ways in which racial composition and religious attendance may shape health consequences of racial discrimination.

### Sex, Mood and the Heart

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

## Abstract 1424

### SEX DIFFERENCES IN PSYCHOPATHOLOGICAL PROFILE AND RISK OF ISCHEMIA AMONG YOUNG PATIENTS WITH RECENT MYOCARDIAL INFARCTION

Viola Vaccarino, MD, PhD, Epidemiology, Emory University School of Public Health, Atlanta, GA, Muhammad Hammadah, MD, Kobin Wilmot, MD, Ibhar Al Mheid, MD, Medicine, Emory University School of Medicine, Atlanta, GA, Lisa Elon, MPH, Biostatistics, Pratik Pimple, MPH, Epidemiology, Emory University School of Public Health, Atlanta, GA, Ernest V. Garcia, PhD, Jonathon Nye, PhD, Radiology, Emory University School of Medicine, Atlanta, GA, Amit Shah, MD, Epidemiology, Emory University School of Public Health, Atlanta, GA, Hawkins Gay, MD, Medicine, Northwestern University, Chicago, IL, Tene Lewis, PhD, Epidemiology, Emory University School of Public Health, Atlanta, GA, Paolo Raggi, MD, Medicine, University of Alberta, Edmonton, AB, Canada, James D. Bremner, MD, Psychiatry, Arshed Quyyumi, MD, Medicine, Emory University School of Medicine, Atlanta, GA
Background. Women with early-onset myocardial infarction (MI) have worse outcomes than men but reasons are unclear. We hypothesized that, among young survivors of an MI, women, more than men, have a higher psychosocial burden when compared with community controls without MI, and are more likely to develop abnormal myocardial perfusion (ischemia) with a mental stress test than men with MI.

Methods. We studied 314 patients (≤60 yrs who were hospitalized for MI in the previous 8 months and 112 community controls matched for sex and age to the MI patients. Patients received ⁹⁹mTcsestamibi myocardial perfusion imaging at rest, with mental (speech task) and with conventional (exercise/pharmacological) stress. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions. Clinically significant mental stress-induced ischemia (MSIMI) was defined as an SDS ≥3, and conventional stress ischemia (CSIMI) as an SDS ≥4.

Results. The sample was 50% female, 59% black, with mean age of 50 yrs for both men and women. Compared with their respective controls, both women and men with MI were more often black, less educated, and with more cardiovascular risk factors. However, women with MI had twice the rate of major depression, four times the rate of PTSD and higher levels of childhood adversities compared with control women, while among men these differences were small and nonsignificant. These factors were also more frequent in women with MI compared with men with MI. In contrast, there were no sex differences in MI-related severity indicators and procedures, and women had actually less severe coronary artery disease. The rate of both MSIMI and CSIMI was twice as high in women with MI as in men with MI (22% vs 11%, p=0.009, and 31% vs 16%, p=0.002, respectively). In multivariable analysis, psychosocial and clinical risk factors did not substantially influence sex differences in rate of inducible ischemia.

Conclusions. The disproportionate rate of stress-related emotional factors among young women with MI may signal either women's vulnerability to these factors as triggers of MI, or women's enhanced emotional response to the MI itself. However, these factors (as well as clinical factors) do not explain the excess risk of ischemia in young women with MI, which likely plays a role in their worse prognosis.

### Abstract 1475

#### SEX-SPECIFIC EFFECTS OF CARDIOVASCULAR REACTIVITY ON MYOCARDIAL ISCHEMIA INDUCED BY MENTAL STRESS

Viola Vaccarino, MD, PhD, Epidemiology, Emory University School of Public Health, Atlanta, GA, Muhammad Hammadah, MD, Kobina Wilmot, MD, Ibhar Al Mheid, MD, Ayman Alkhoder, MD, Nino Isakadze, MD, Oleksiy Levantsevych, MD, Medicine, Emory University School of Medicine, Atlanta, GA, Pratik Pimple, MPH, Epidemiology, Emory University School of Public Health, Atlanta, GA, Ernest V. Garcia, PhD, Jonathon Nye, PhD, Radiology, Emory University School of Medicine, Atlanta, GA, Amit Shah, MD, Epidemiology, Laura Ward, MPH, Biostatistics, Tene Lewis, PhD, Epidemiology, Emory University School of Public Health, Atlanta, GA, James D. Bremner, MD, Psychiatry, Emory University School of Medicine, Atlanta, GA, Paolo Raggi, MD, Medicine, University of Alberta, Edmonton, AB, Canada, Arshed Quyyumi, MD, Medicine, Emory University School of Medicine, Atlanta, GA

**Background:** Mental stress (MS) induced myocardial ischemia (MSIMI) is associated with adverse outcomes in patients with coronary artery disease (CAD). Sympathetic-mediated cardiovascular reactivity is a mechanism of MSIMI. For women, microvascular vasomotion is thought to play a dominant role, but this has not been tested.

**Objective:** To investigate sex differences in hemodynamic workload and peripheral microvascular reactivity to MS and their relationship with MSIMI.

**Methods:** We submitted 680 stable CAD patients (187 women) to ⁹⁹mTcsestamibi myocardial perfusion imaging after MS (public speaking) and conventional (exercise/pharmacological) stress. We

obtained the rate-pressure product (RPP, systolic blood pressure x heart rate) at rest and during MS and calculated the change. We assessed peripheral vasoconstriction as the ratio of arterial wave amplitude during MS to rest using peripheral arterial tonometry of the finger (PAT, Itamar). A lower PAT ratio indicates greater vasoconstriction. We used logistic regression to derive odds ratios (OR) and 95% confidence intervals (CI) for MSIMI. To ease interpretation, RPP change and PAT ratio were dichotomized as high and low values at the median (4439 beats x mmHg/min, and 0.67).

**Results:** The mean (SD) age was 63 (9) in both women and men and there were no sex differences in clinical risk profile. After adjusting for body surface area (BSA), PAT ratio and RPP change with MS were also similar. MSIMI occurred in 85 (16%) of patients and both PAT ratio and RPP change were associated with MSIMI. However, there was an interaction with sex for both PAT ratio (p=0.02) and RPP (p=0.007), such that PAT ratio was associated with MSIMI only in women, while RPP change was associated with MSIMI only in men. After adjustment for clinical risk factors, beta-blocker use and BSA, the OR of MSIMI for low PAT was 5.1 (CI, 1.5-16.9) in women and 1.6 (CI, 0.9-2.8) in men. The OR for high RPP response was 1.5 (CI, 0.6-3.5) in women and 2.6 (CI, 1.5-4.4) in men. PAT ratio and RPP change with MS were not associated with conventional stress ischemia.

**Conclusion:** Women and men have distinct cardiovascular reactivity mechanisms for MSIMI. For women, stress-induced increased vascular resistance, as opposed to stress-induced increased hemodynamic workload, is likely the driving factor for MSIMI, while for men the opposite appears to be true.

### Abstract 1021

#### SOCIAL INHIBITION, EMOTIONAL DISTRESS AND TYPE D PERSONALITY IN PATIENTS WITH CORONARY ARTERY DISEASE

Johan Denollet, PhD, Ivy Timmermans, MSc, Stefanie Duijndam, MSc, CoRPS, Medical and Clinical Psychology, Tilburg University, Tilburg, NB, The Netherlands, Henneke Versteeg, PhD, Cardiology, University Medical Center Utrecht, Utrecht, NB, The Netherlands

**Background:** Type D personality refers to the combination of negative affectivity and social inhibition, and has been related to adverse outcomes in patients with coronary artery disease (CAD). However, relatively little is known about the nature of social inhibition in CAD patients, and how it may increase vulnerability to emotional distress. Therefore, we examined the content and distinctiveness of the social inhibition trait within the Type D framework, and its explanatory value regarding emotional distress in patients with CAD.

**Methods:** Social inhibition and negative affectivity were assessed with the DS14 in 171 patients with CAD. Inhibition markers included interaction anxiety (SIAS10), emotional inhibition (ECQ) and behavioral inhibition (BIS). Vulnerability to emotional distress included measures of depression (PHQ-9), mood (GMS), general anxiety (GAD-7), social phobia (SPS11) and loneliness (UCLA-RS). We analyzed social inhibition using three methodological approaches: *Dimensional* (factor analysis of DS14, inhibition and distress measures), *Continuous* (social inhibition*n*-negative affectivity interaction), and *Categorical* (high/low trait level subgroups).

**Results:** Social inhibition and negative affectivity emerged as two distinct latent traits in factor analysis (*dimensional approach*). After adjustment for the main personality trait effects, the social inhibition*n*-negative affectivity interaction still was significantly associated with higher levels of depression, negative mood, general anxiety, social phobia, loneliness, social interaction anxiety and emotional-behavioral inhibition; all ps <.001 (*continuous approach*). Finally, Type D patients with elevated levels of both negative affectivity and social inhibition reported more depression (p <.001), negative mood (p <.001), interaction anxiety (p =.03) and less positive mood (p =.02), as compared with non-Type D patients (*categorical approach*).
**Conclusions:** Dimensional, continuous, and categorical analyses indicated that social inhibition and negative affectivity are distinctly different components of the Type D construct. Social inhibition was closely related to emotional-behavioral inhibition, and interacted with negative affectivity to explain higher levels of depression, anxiety and loneliness. Overall, these findings suggest that social inhibition may contribute to emotional distress in patients with CAD.

## Abstract 1351

### CRACKING THE CODE: EVERYDAY EMOTION ALTERS VENTRICULAR REPOLARIZATION DURATION IN CORONARY ARTERY DISEASE

Richard D. Lane, M.D., Ph.D., Psychiatry, University of Arizona, Tucson, AZ, Harry T. Reis, PhD, Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, Chiu-Hsieh Hsu, PhD, Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, Wojciech Zareba, MD, PhD, Medicine, Cardiology, University of Rochester Medical Center, Rochester, NY

Background: We previously observed that everyday emotion alters ventricular repolarization duration in Long QT Syndrome (LQTS), a rare genetic syndrome that has been called the “Rosetta Stone” for ventricular tachyarrhythmias. QT interval changes that are too long or too short can contribute to abnormal repolarization dynamics and heightened risk for life-threatening arrhythmias. Due to its simple, well-characterized substrate, factors observed in LQTS may be relevant to sudden cardiac death (SCD) risk in patients with coronary artery disease (CAD), a more complex and variable disease and the most common context for SCD. We therefore examined whether findings in LQTS were also observed in CAD.

Methods: We studied 199 patients with CAD (24% female; mean age 62 yrs), all with no history of serious arrhythmias and half with implanted defibrillators for primary prevention of CAD, and 50 randomly matched (1 to 4 ratio) healthy control subjects (26% female; mean age 60 yrs). Home visits were made in Tucson and Rochester to collect data over three days. Each day a 12-hour Holter recording was completed. Subjects engaged in typical daily activities and were paged 10 times per day at random times. Subjects responded by answering 59 questions using a smartphone pertaining to the 5 minutes preceding the page. Ratings addressed current activities, location, social circumstances, exertion, and 22 emotion terms (rated on a 7-point intensity scale). Holter and smartphone clocks were synchronized for later off-line analysis. Holter data over 5 minute epochs were analyzed for heart rate and QTc (QT interval using the Fredericia correction for heart rate).

Results: As shown in Table 1, within-person analyses controlling for age and gender reveal that QTc is significantly longer during moderate (p<.03) or high (p<.0001) compared to minimal Low Arousal Positive Affect and significantly shorter during moderate relative to low Activated Positive Affect (p<.0001) in CAD patients. No such associations were observed in Older Healthy Controls and these group differences were significant for both variables (p<.01).

**Conclusion:** These findings replicate those obtained in LQTS and suggest that everyday emotions contribute to SCD risk in CAD. The findings provide new clues to detect risk for SCD and suggest that emotion regulation strategies could potentially be protective in those at risk.

<table><thead><tr><th>Variable</th><th>OH</th><th>CAD</th><th>OH vs. CAD</th></tr></thead><tbody><tr><td>LAPA</td><td>1.01±1.17<br>P=0.27</td><td>0.92±0.97<br>P=0.001</td><td>-0.01</td></tr><tr><td>LAPA<br>(p<.05 vs. 0)</td><td>0.94±1.36<br>P=0.56</td><td>0.92±0.98<br>P=0.001</td><td>0.16</td></tr><tr><td>LAPA</td><td>-1.51±1.89<br>P=0.15</td><td>1.02±0.74<br>P=0.01</td><td>0.00</td></tr><tr><td>LAPA<br>(p<.05 vs. 0)</td><td>-0.79±1.26<br>P=0.76</td><td>1.47±0.95<br>P=0.11</td><td>0.24</td></tr><tr><td>LAPA<br>(p<.05 vs. 0)</td><td>0.52±0.94<br>P=0.38</td><td>0.99±0.91<br>P=0.96</td><td>0.43</td></tr><tr><td>LAPA<br>(p<.05 vs. 0)</td><td>0.85±0.81<br>P=0.50</td><td>0.81±0.70<br>P=0.47</td><td>0.72</td></tr></tbody></table>

Effects of emotion on QTc by risk groups. Data values consist of changes in QTc in mean in one emotion context relative to another. Regression coefficient standard error derived from a linear mixed effects model with a random intercept after adjusting for age and gender. APA = activated positive affect; LAPA = low arousal positive affect; ANA = activated negative affect; LAN = low arousal negative affect; (0-1 = low or minimal; 2-4 = moderate; 5-6 = high). OH=older healthy; CAD=coronary artery disease

## Sleep

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

## Abstract 1573

### ASSOCIATION OF POSTTRAUMATIC STRESS DISORDER WITH SLEEP DYSFUNCTION IN MALE VETERAN TWINS

Amit J. Shah, MD, MSCR, Epidemiology, Emory University, Atlanta, GA, Shuyang Fang, MD, MPH, Internal Medicine, Mount Sinai, New York, NY, Pratik Pimple, MBBS, MPH, Tene Lewis, PhD, Epidemiology, Emory University, Atlanta, GA, Jack Goldberg, PhD, Epidemiology, University of Washington, Seattle, WA, Donald Bliwise, PhD, Neurology, Alvaro Alonso, MD, PhD, Epidemiology, Gari D. Clifford, PhD, Biomedical Informatics, Emory University, Atlanta, GA, Martica Hall, PhD, Psychiatry, University of Pittsburgh, Pittsburgh, PA, J. Douglas Bremner, MD, Psychiatry, Viola Vaccarino, MD, PhD, Epidemiology, Emory University, Atlanta, GA

**Introduction:** A hallmark of posttraumatic stress disorder (PTSD) is sleep disturbance. We studied its relationship between current/remitted PTSD and sleep quality subscales in male veteran twins. Additionally, we evaluated the association of poor sleep with specific PTSD symptoms.

**Methods:** We examined 188 male twins recruited from the Vietnam Era Twin Registry. PTSD was assessed using the Structured Clinical Interview with DSM-IV criteria, and classified PTSD as current (within 30 days), or remitted (>30 days ago), PTSD. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI), which assesses subjective sleep quality, latency, duration, efficiency, and disturbance, as well as use of sleep medications and daytime dysfunction. The Clinician Administered PTSD Scale (CAPS) PTSD assessed symptom severity, including re-experiencing (B), avoidance behavior (C), and hyperarousal (D). The insomnia question was excluded from the calculation of criterion D. Generalized estimating equations were used
to adjust for possible confounding due to behavioral/health factors, as well as genetic/familial factors.

Results: The mean (SD) age was 58 (3) years; 12% had current PTSD and 19% had remitted PTSD. The total PSQI score was highest amongst those with current PTSD, with a mean (SD) value of 11.0 (3.8); those with remitted PTSD had a mean score of 7.7 (3.9), and twins with no PTSD had a mean (SD) score of 5.3 (3.6). Using a PSQI cutoff of 5, 91%, 64%, and 39% of twins with current, remitted, and no PTSD, respectively, had poor sleep (p<0.0001). The test was highly significant (p<0.0001) even after adjustment for use of alcohol, coffee, tobacco products, age, education, employment status, and history of major depression. The PTSD and total PSQI association remained significant (p < 0.001) based on the within-pair regression analysis that adjusts for genetic and familial confounding. Individual sleep subscales (figure) showed significant trends for all PSQI subscales. When PTSD criteria B, C, and D were assessed together in a single regression model, only B (re-experiencing) remained significant as a predictor of a high total PSQI score (adjusted p=0.007).

Conclusion: PTSD is strongly associated with poor sleep quality in a dose-response relationship even after adjustment for lifestyle behaviors and family/genetic factors.

<figure><img src="image_43.png" /><figcaption>Figure - Association of PTSD with percentage of veterans with abnormal values of self-reported sleep subscales from the Pittsburgh Sleep Quality Index. An abnormal value was defined as a score of 1 or higher on each subscale.</figcaption></figure>

## Abstract 1015

### TEMPORAL DYNAMICS BETWEEN DAILY AFFECT, PAIN, AND NIGHTLY SLEEP QUALITY IN YOUNG ADULTS

Danica C. Slavish, M.S., Jennifer E. Graham-Engeland, Ph.D., Biobehavioral Health, Lynn M. Martire, Ph.D., Human Development and Family Studies, Joshua M. Smyth, Ph.D., Biobehavioral Health and Medicine, The Pennsylvania State University, University Park, PA

Sleep impairment is a common concern among young adults and longitudinally predicts a variety of poor health outcomes. Among those reporting sleep impairment, pain and mood disturbances are frequently reported concomitant issues. Although these factors likely interact in everyday life, the day-to-day temporal dynamics between these variables are not well established. This research examined directional associations between daily affect, daily pain, and nightly sleep quality, and the potential moderating role of chronic pain status. Participants were 139 young adults (20.57 ± 1.83 years; 58% female), some of whom (n = 58) had chronic back pain. Participants completed a baseline survey and a 14-day daily diary protocol. The daily diary included a morning survey of recent positive and negative affect (PA and NA), current pain severity, and previous night's sleep quality, and an evening survey of recent PA and NA, current pain severity, and daily alcohol use and physical activity. Data were nested as days within people and were analyzed using multilevel modeling. Models statistically controlled for daily alcohol use and physical activity, age, gender, BMI, SES, race, baseline depressed mood, and global self-reported health. Better reported sleep quality (relative to each individual's typical sleep; i.e., person-centered to test the within-person

effect) predicted higher morning PA (β = 0.56, S.E. = 0.18, p = .002) and lower morning NA (β = -0.34, S.E. = 0.09, p = .0003); in contrast, evening affect and pain did not significantly predict that night's sleep quality. Chronic pain status moderated bidirectional associations between daily pain and sleep (but not affect and sleep): Only among those with chronic back pain, better sleep quality predicted lower morning pain (β = -0.10, S.E. = 0.04, p = .03), and lower evening pain predicted better sleep quality that night (β = -0.13, S.E. = 0.04, p = .004). Results held with and without covariates. Findings suggest reported sleep quality may be a more reliable predictor of next-morning affect than evening affect is of that night's sleep quality. For those with chronic pain, there also appears to be a vicious cycle between poor sleep and pain in daily life. These findings extend understanding of the day-to-day relationships between affect, pain, and sleep in a sample of young adults with and without chronic back pain.

## Abstract 1181

### REMNANTS OF THE PAST: CHILDHOOD TRAUMA EXPOSURE AND AGE FIRST TRAUMATIC EXPOSURE RELATE TO POOR SLEEP HEALTH.

Ryan C. Brindle, Ph.D., Psychiatry, University of Pittsburgh, Pittsburgh, PA, Matthew R. Cribbet, Ph.D., Psychological Sciences, Texas Tech University, Lubbock, TX, Laura B. Samuelsson, M.S., Ellen Frank, Ph.D., David J. Kupfer, M.D., Psychiatry, Robert T. Krafty, Ph.D., Biostatistics, University of Pittsburgh, Pittsburgh, PA, Julian F. Thayer, Ph.D., Psychology, Ohio State University, Columbus, OH, Suresh Mulukutla, M.D., Medicine, Daniel J. Buysse, M.D., Martica H. Hall, Ph.D., Psychiatry, University of Pittsburgh, Pittsburgh, PA

Emerging data suggests that over 50% of the population experiences at least one traumatic event in childhood, an alarming rate given that childhood trauma has been related to adverse health outcomes, including premature death. Sleep may represent a potential mechanism through which childhood trauma impacts health. The current study aimed to characterize the relationship between childhood trauma, age of first trauma exposure, and sleep health, a self-report multidimensional measure of sleep. Participants (N = 165; Mean (SD) age = 59.85 (9.06), 109 females) reported trauma exposure using the Trauma History Questionnaire, which captures the type, frequency, and age at which traumatic events occur. Childhood trauma exposure was defined as the total number of event types multiplied by the frequency of each event and was quantified before 18 years of age. Sleep regularity, satisfaction, timing, efficiency, and duration were derived from up to two weeks of daily sleep diary data while alertness was reported using the Epworth Sleepiness Scale (ESS). These six sleep health components were dichotomized using a median split or relevant cut-off values from the literature. Total sleep health was calculated as the sum of the component scores and ranged from 0 (poor) to 6 (optimal). Potential covariates, identified *a priori*, based on their association with trauma and sleep included age, depression, current stressors, interpersonal support, subjective social status (SSS), and body mass index. The relationships between childhood trauma and age of first trauma exposure and sleep health were examined using hierarchical linear regression. In an unadjusted model, increased childhood trauma was associated with poor sleep health, $\beta$ = -0.23, *p* < .001, $\Delta R^2$ = .08. This result withstood adjustment for depression status, current stress, interpersonal support, and SSS, $\beta$ = -0.20, *p* = .005, $\Delta R^2$ = .05. Earlier trauma exposure related to poor sleep health, $\beta$ = 0.09, *p* = .016, $\Delta R^2$ = .08. The observed relationship between increased childhood trauma and poor sleep health aligns with a growing body of evidence linking childhood trauma to adverse health outcomes and suggests that sleep may be a potential mechanism through which childhood trauma impacts health later in life.
## Abstract 1405

### A RANDOMIZED, CONTROLLED TRIAL OF NEUROFEEDBACK TO TREAT CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY (CIPN) LEADS TO IMPROVEMENT IN MULTIPLE SECONDARY ENDPOINTS

Sarah Prinsloo, PhD, Palliative, Rehabilitation, and Integrative Medicine, Diane Novy, PhD, Larry Driver, MD, Pain Medicine, Lois Ramondetta, MD, Gynecological Oncology, Cathy Eng, MD, Gastrointestinal Oncology, Gabriel Lopez, MD, Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, Randall Lyle, PhD, Marriage and Family Therapy, Mount Mercy University, Cedar Rapids, Iowa, Lorenzo Cohen, PhD, Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas

**Background:** CIPN is a common side effect of chemotherapy, leading to impairment in daily activities and diminished quality of life. Neurofeedback (NF) is a brain-training paradigm that induces neuroplasticity to modulate brain activity and we have previously shown it leads to improved CIPN symptoms that were mediated by NF-induced brain changes. **Methods:** Seventy-one (62 female; mean age=63; 52 breast, 8 gynecologic, 11 other; average length of symptoms=24 mos) cancer survivors ≥3 months from completing chemotherapy who reported ≥3 on the NCI's neuropathy rating scale, were randomized to a NF group (n=35) and underwent 20 sessions of electroencephalography (EEG) NF or a wait-list control group (WL; n=36). We used quantitative EEG imaging to determine any EEG patterns unique to CIPN and then provided NF to change aberrant brain signatures. Secondary outcome measures including the MD Anderson Symptom Inventory (MDASI), Short Form 36 (SF-36); Brief Fatigue Inventory (BFI); and Pittsburgh Sleep Quality Index (PSQI) were completed at baseline, at the end of treatment, and 4 months later. **Results:** 89% of the participants who were randomized completed treatment and 100% of participants who started NF completed treatment. Change scores from baseline to end of treatment demonstrate NF lead to significant reduction in cancer-related symptom interference (NF=-5.3 vs WL=-0.5, p=.000); symptom severity (NF=-5.1 vs WL=-0.8, p=.000); fatigue (NF=-3.7 vs WL=-0.8, p=.001), and sleep disturbances (NF=-2.3 vs WL=0.8, p=.030); and improved physical functioning (NF=3.3 vs WL= 1.4, p=.003). Post EEG analyses showed increased alpha and decreased beta after NF, where protocols were based on increasing alpha and decreasing beta, with no changes noted in the WL group. At 4 months, the outcomes followed a similar pattern. **Conclusion:** NF clinically and significantly reduced secondary symptoms associated with CIPN. Further, patients with CIPN were able to change their brain function in the direction specified by the NF protocols.

## Abstract 1041

### BRIGHT LIGHT THERAPY IMPROVES SYMPTOMS OF FATIGUE IN CANCER SURVIVORS WITH CLINICAL FATIGUE: A BLINDED RANDOMIZED CONTROLLED TRIAL

Jillian A. Johnson, PhD, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, Sheila N. Garland, PhD, Department of Psychology and Division of Oncology, Memorial University of Newfoundland, St. Johns, NL, Canada, Linda E. Carlson, PhD, Departments of Oncology and Psychology, University of Calgary, Calgary, AB, Canada, Josée Savard, PhD, Department of Psychology, Université Laval, Laval, QC, Canada, Steven A. Simpson, PhD, MD, FRCPC, Departments of Psychiatry and Oncology, University of Calgary, Calgary, AB, Canada, Sonia Ancoli-Israel, PhD, Department of Psychiatry, University of California, San Diego, San Diego, CA, Tavis S. Campbell, PhD, Department of Psychology, University of Calgary, Calgary, AB, Canada

**BACKGROUND:** Cancer-related fatigue can last for months or years in up to one-third of cancer survivors, and has been identified as a significant contributor to decreased quality of life. Despite its prevalence, it is often under-recognized and under-treated making it an important target for intervention. Bright light therapy has been shown to prevent the worsening of fatigue during chemotherapy in women with breast cancer, and preliminary efficacy was demonstrated for fatigue reduction in a small sample of post-treatment survivors. The objective of this study was to examine the impact of a one-month light therapy intervention on symptoms of fatigue in cancer survivors with clinical fatigue.

**METHODS:** This 4-week blinded RCT recruited post-treatment cancer survivors who met ICD-10 criteria for cancer-related fatigue. Participants were randomly assigned to receive a light therapy device that produced either bright white light (BWL; treatment) or dim red light (DRL; active control). Participants were instructed to use their assigned device daily for 30 mins upon waking for 28 consecutive days. The primary outcome, fatigue, was assessed weekly with the Multidimensional Fatigue Symptom Inventory-Short Form. Secondary outcomes assessed pre- and post-intervention included mood (POMS), depressive symptoms (CES-D), and quality of life (FACT-G).

**RESULTS:** Eighty-one participants (mean age = 58.2; 86% women; 93.8% white) were randomly assigned to receive BWL (n=42) or DRL (n=39). Light devices were used for an average of 30 mins per day (SD=0.6), within 30 mins of waking (SD=23.2), and for a total of 26.7 days (SD=2.2). Linear mixed models analyses revealed a significant group-by-time interaction for fatigue symptoms (p=.034), amounting to a 17% greater reduction in fatigue among those in the BWL group after 4 weeks relative to those in the DRL condition (between group effect size d=.30). There were also significant improvements over time for both groups on measures of mood disturbance, depressive symptoms, and quality of life over the one-month intervention period.

**CONCLUSION:** Greater improvements in fatigue were observed among participants exposed to BWL compared to DRL. These results, in combination with previous reports of light therapy during and after cancer treatment, support the use of this therapy for the improvement of fatigue symptoms in those affected by cancer.

## Abstract 1116

### PRELIMINARY EFFECTS OF A TECHNOLOGY-ADMINISTERED CBT-BASED STRESS- AND SELF-MANAGEMENT INTERVENTION ON DEPRESSION SYMPTOMS IN MEN UNDERGOING HORMONE THERAPY FOR ADVANCED PROSTATE CANCER

Rina S. Fox, PhD, MPH, Patricia I. Moreno, PhD, Betina Yanez, PhD, Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, Heather L. McGinty, PhD, Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, Sarah C. Flury, MD, Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, David C. Mohr, PhD, Preventive Medicine, Katy Wortman, MSW, Jessica Thomas, LCSW, Cody Boland, BS, Luke T. Smith, BS, Frank J. Penedo, PhD, Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
Hormone therapy (HT) is a primary treatment for advanced prostate cancer (APC), which is commonly seen among men age 65 and older. While HT can effectively suppress tumor growth, it is associated with numerous adverse side effects, including depression. This risk for depressive symptoms in APC can be exacerbated by common aging-related stressors, such as retirement and loss of independence. Research has supported the efficacy of cognitive behavioral therapy (CBT)-based stress- and self-management interventions (i.e., CBSM) to mitigate the physical and psychological symptoms experienced by localized prostate cancer patients. However, no evidence-based psychosocial treatments have been developed specifically for men with APC. Additionally, traditional psychosocial interventions require patients to attend in person sessions with health providers, which can present challenges for
APC patients due to greater comorbidities, functional limitations, and heightened symptom burden. This study evaluated the impact of a technology-based adaptation of CBSM on depressive symptoms among men with APC receiving HT. As part of a larger, ongoing study, patients were randomized to participate in either a CBSM group intervention (n = 51), or a health promotion attention-matched control condition (n = 51) for 10 weeks. Participants attended all weekly sessions with trained facilitators via video conferencing technology using tablet computers, and completed computer-administered psychosocial assessments at baseline (i.e., prior to participating in the intervention), and again six months later. Depression was evaluated with the Patient-Reported Outcomes Information System (PROMIS) Depression, which yields normed t-scores. Mixed model ANOVA demonstrated a significant effect of study condition over time, such that reported depressive symptoms significantly improved (F(1, 100) = 5.35, p = 0.02) for participants in the CBSM condition from baseline (M = 46.09, SD = 7.68) to six month follow-up (M = 44.36, SD = 7.36) as compared to the health promotion control condition (baseline: M = 45.30, SD = 7.86; six months: M = 46.83, SD = 7.36). Neither a significant main effect of condition nor of time was found. Results indicated that technology-administered CBSM may be an effective strategy to decrease depressive symptoms among men with APC undergoing HT.

## Abstract 1137

### EXPRESSIVE WRITING INTERVENTION AND SELF-REPORTED PHYSICAL HEALTH OUTCOMES: RESULTS FROM A NATIONWIDE RANDOMIZED CONTROLLED TRIAL WITH BREAST CANCER PATIENTS

Robert Zachariae, DMSc, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Central Region Denmark, Denmark, Mia S. O'Toole, PhD, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Central Region Denmark, Danmark, Søren Christensen, MSc, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Central Region Denmark, Denmark, Heiddis Valdimarsdottir, PhD, Psychology, Reykjavik University, Reykjavik, Iceland, Sandra Zakowski, PhD, Psychology, Argosy University, Chicago, IL, Dana Bovbjerg, PhD, Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, Mikael B. Jensen-Johansen, PhD, Social work, VIA University College, Aarhus, Central Region Denmark, Denmark, Anders B. Jensen, MD, Oncology, Aarhus University Hospital, Aarhus, Central Region Denmark, Denmark

**Aims:** To examine the effect of Expressive Writing Intervention (EWI) on self-reported physical symptoms and healthcare utilization in a nationwide randomized controlled trial with Danish women treated for primary breast cancer, and to explore participant characteristics related to emotion regulation as possible moderators of the effect.

**Methods:** Women who had recently completed treatment for primary breast cancer (n=507) were randomly assigned to three 20 min. home-based writing exercises, one week apart, focusing on emotional disclosure (EWI) of a distressing experience (their cancer or a non-cancer topic) or a non-disclosing topic (control). Outcomes were self-reported physical symptoms (Patient Health Questionnaire; PHQ-15) and healthcare utilization (visits and telephone contacts with GP) 3 and 9 months post-intervention. Potential moderators were repressive coping, alexithymia, rumination, social constraints, and writing topic.

**Results:** No group by time interaction effects were found for any outcomes (Cohen's d=0.02-0.09; p=0.36-0.85). Moderation analyses showed that 1) low alexithymic women showed larger decreases in telephone contacts with their GP than high alexithymic women and controls (d=0.17; p=0.029), and 2) women who wrote about their cancer, but not women writing about other topics, showed larger decreases in visits (d=0.30; p=0.012) and telephone contacts with their GP (d=0.37; p=0.001) compared to controls.

**Conclusions:** The results from this large randomized trial are concordant with previous findings showing that EWI is unlikely to be a generally applicable intervention to improve health-related outcomes in cancer patients and cancer survivors. However, written disclosure may have a beneficial impact for individuals who write about their own cancer, as well as for those low in alexithymia.

## Abstract 1138

### BRIEF STRESS MANAGEMENT DECREASES LEUKOCYTE NUCLEAR NFKB DNA BINDING IN DISTRESSED BREAST CANCER PATIENTS UNDERGOING PRIMARY TREATMENT

Michael H. Antoni, Ph.D., Psychology, University of Miami, Coral Gables, Florida, Alain Diaz, Ph.D., Microbiology/Immunology, University of Miami School of Medicine, Miami, Florida, Chelsea Amiel, B.S., Bouchard Laura, M.S., Psychology, University of Miami, Coral Gables, Florida, Jamie Jacobs, Ph.D., Psychiatry, Harvard/MGH, Boston, MA, Lisa Gudenkauf, Ph.D., Psychiatry, Mayo Clinic, Rochester, MN, Devika Jutagir, M.S., Psychology, University of Miami, Coral Gables, Florida, Suzanne Lechner, Ph.D., Psychiatry, University of Miami School of Medicine, Miami, Florida, Charles S. Carver, Ph.D., Psychology, University of Miami, Coral Gables, Florida, Bonnie Blomberg, Ph.D., Microbiology/Immunology, University of Miami School of Medicine, Miami, Florida

**INTRODUCTION.** Breast cancer patients experience heightened distress during primary treatment. A 10-wk group-based cognitive behavioral stress management (CBSM) intervention showed concomitant decreases in negative affect and leukocyte pro-inflammatory gene expression. CBSM effects were strongest in women presenting with elevated cancer-specific distress. In a dismantling trial we found that even 5-wk interventions featuring CBSM components—cognitive behavioral therapy (CBT) or relaxation training (RT)—improve negative affect during treatment. It is unclear whether these brief approaches are sufficient to bring about changes in inflammatory signaling among those with elevated cancer-specific distress. **METHODS.** We conducted intensive molecular analyses of women who participated in the trial of these 5-week interventions and who reported elevated cancer-specific intrusive thoughts at entry (Impact of Events Scale-Intrusive Thoughts > 14). Peripheral blood mononuclear cells from 51 women (5wk CBT=23, 5wk RT=14, 5wk Health Education [HE]=14) were obtained at baseline (4 – 8 wks post-surgery and before adjuvant therapy) and 12 month follow-up for nuclear protein extraction and determination of nuclear factor Kappa-B (NFkB) DNA binding by electromobility shift assay. Samples were electrophoresed and dried gels were exposed to Kodak x-ray films. Films were scanned and analyzed for integrated areas under the densitometric curves. Optical density [OD] for each band was used to estimate protein binding. Mean OD values for NFkB were compared over time in a Repeated measures analysis of variance testing for condition by time effects. **RESULTS.** Women assigned to the 3 study conditions showed no differences in sociodemographics, disease characteristics or treatments received. Women in either stress management condition (RT or CBT) showed decreases in NFkB expression over 12-month follow-up while those in HE showed increases (*p* < .05). Greater levels of cancer-specific distress at 12-months were associated with greater NFkB expression. **CONCLUSION.** Over a 12-month period brief stress management appeared to down-regulate expression of NFkB nuclear protein—a complex that controls DNA transcription, cytokine production and cell survival, and is one of the chief mediators of inflammatory signaling in immune cell nuclei—a key upstream pathway relevant for breast cancer.
## Abstract 1497

# A MATTER OF LIFE AND DEATH: PSYCHOSOCIAL STRESS PREDICTS ALL-CAUSE MORTALITY OVER 20 YEARS

Joshua F. Wiley, PhD, School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia

**Objective:** Extensive evidence links higher stress with poor psychological, behavioral, and physical outcomes. Stress is not unidimensional but varies in domain, duration, and severity; however, most stress research tests individual stress measures leaving open the question are all stressors equally important for health? The current study compares the prospective relationship between different stress measures and all-cause mortality.

**Methods:** Participants were 7,074 adults from the Midlife in the United States Study with data on at least one stress measure and mortality. Eight stress measures were assessed in the mid-1990s from three domains: (1) discrimination—daily and lifetime; (2) inequality—family, home, and work; (3) interpersonal strain—family, friend, and partner. Mortality data were assessed from informants connected to participants and national death index searches up to 2015, approximately 20 years after the initial stress surveys were completed. Missing data were addressed using random forest multiple imputation. Analyses were conducted using Cox proportional hazard models with age at death or censorship. The following covariates were adjusted in models: sex, race, parental education, welfare in childhood, participant education, work status, smoking, worst alcohol use, physical activity, and body mass index.

**Results:** Each domain of stress predicted significantly earlier mortality independent of all covariates (all *p* < .05). Within domains, daily discrimination, home inequality, and interpersonal strain from friends predicted earlier mortality (all *p* < .01) and these unique associations were sustained in a multivariate model simultaneously including all stress measures (all *p* < .05 for those three stress measures).

**Conclusions:** Psychosocial stress measures emerged as robust predictors of all-cause mortality up to 20 years later after adjusting for several potential confounding factors. Each of the three conceptual domains of stress were predictive, but daily discrimination, perceived home inequality, and interpersonal strain from friends emerged as unique predictors independent of the other stress measures.

## Abstract 1471

# CHRONIC INFLAMMATION IN ANXIETY DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Megan E. Renna, M.A., Psychology, The Graduate Center, City University of New York, New York, NY, Mia S. O'Toole, Ph.D., Psychology & Behavioral Sciences, Aarhus University, Aarhus, Denmark, Denmark, Phillip Spaeth, B.A., Douglas S. Mennin, Ph.D., Psychology, Hunter College, New York, NY

The prolonged psychological activation common to many anxiety disorders may contribute to increased physiological activation over time, ultimately leading to a higher likelihood for people with anxiety disorders to be at risk for the development of chronic illness. Inflammation may play an integral role in the relationship between anxiety and poor health, and research has begun to examine the relationship between anxiety disorders and inflammation. The aim of the current meta-analysis was to examine differences between healthy controls and people with anxiety disorders in terms of inflammation. It was hypothesized that people with anxiety disorders would have significantly higher levels of pro-inflammatory markers and significantly lower levels of anti-inflammatory markers than controls. After screening the abstracts of 1173 search results and 73 full-text articles for eligibility, 41 studies (N = 2083) were included in the meta-analytic investigation. Results demonstrated a significant overall difference between healthy controls and people with anxiety disorders

in terms of inflammation (*p* = .009, hedge's *g* = -.36), with this result being largely driven by IL-6 (k = 24, *p* < .001, hedge's *g* = -.93), IL-1β (k = 18, *p* = .009, hedge's *g* = -.50), and TNF-α (k = 20, *p* = .030, hedge's *g* = -.56). Moderation analyses revealed a moderating effect of type of anxiety disorder, as only individuals with PTSD (k = 22, *p* < .001, hedge's *g* = -.65), in comparison to OCD (k = 6, *p* = .594, hedge's *g* = .12) or other anxiety disorders (k = 12, *p* = .851, hedge's *g* = -.04), demonstrated significant differences in inflammation between controls. However, there was not sufficient power to examine the effects of specific diagnoses in the other anxiety disorders category (i.e., generalized anxiety disorder, panic disorder, social anxiety disorder). These results were not moderated by comorbid depression (k = 30, *p* = .876), highlighting a unique contribution of an anxiety diagnosis on the exacerbation of dysregulated inflammation. Taken together, these findings have the potential to advance the understanding of the immunological impact of an anxiety disorder diagnosis, and provide an opportunity for researchers to consider the impact of anxiety on basic health markers such as inflammation in an effort to better inform the link between anxiety and risk factors for physical illness.

## Abstract 1565

# THE MITOCHONDRIAL HEALTH INDEX LINKS CHRONIC STRESS AND PSYCHOSOCIAL FACTORS TO CELLULAR BIOENERGETICS

Martin Picard, Ph.D., Psychiatry and Neurology, Columbia University, New York, NY, Eli Puterman, Ph.D., School of Kinesiology, University of British Columbia, Vancouver, BC, Canada, Aric Prather, Ph.D., Psychiatry, University of California San Francisco, San Francisco, CA, Alexanne Cuillierier, B.Sc., Health Sciences, University of Ottawa, Ottawa, ON, Canada, Michael Coccia, M.Sc., Kirstin Aschbacher, Ph.D., Psychiatry, University of California San Francisco, San Francisco, CA, Yan Burelle, Ph.D., Health Sciences, University of Ottawa, Ottawa, ON, Canada, Elissa S. Epel, Ph.D., Psychiatry, University of California San Francisco, San Francisco, CA

**Background:** Chronic psychosocial stress is associated with inflammation, gene dysregulation, and telomere shortening. The biological mechanisms underlying these pathophysiological markers are still incompletely understood, but emerging evidence suggests that a common cause may involve mitochondria. The mitochondrion is a cellular organelle with its own DNA – the mitochondrial DNA (mtDNA) – that sustains life by energy production and adaptive intracellular signaling. Chronic psychosocial stressors may impact cellular mitochondrial DNA content, but the association with dynamic mitochondrial function remains to be determined.

**Methods:** To address the hypothesis that chronic stress alters mitochondrial health, we studied healthy women who were either high stress maternal caregivers with a child with autism spectrum disorder (n=46) or low stress control mothers with a normally developing child (n=45). Peripheral blood mononuclear cells (PBMCs) were collected, frozen, and used to develop the mitochondrial health index (MHI), composed of three enzymatic measurements of mitochondrial energy production capacity and mtDNA content (mtDNA copy number). Other protein markers of mitochondrial energy production were also assessed.

**Results:** Women under high stress had a significantly lower MHI than controls (t(84)=2.42, P=0.02). Analyses of individual MHI components showed a signature consistent with molecular mtDNA alterations, although there was no difference in mtDNA copy number (t(87)=0.92, P=0.36). Multivariate analyses demonstrated that mtDNA copy number was a good indicator of cellular mitochondria content, but not of function. Furthermore, a time-lag analysis of daily affective states assessed 3 days before and 3 days after blood collection showed that affect predicted MHI, but not the reverse, suggesting an influence of psychological states on mitochondria.

**Conclusions:** The approach described allows reliable measurements of mitochondrial health in frozen blood cells from healthy women. These results support the hypothesis that chronic stress alters mitochondrial health. In addition, this study suggests that these effects are not unique
to chronic stress but that affective states dynamically influence
mitochondrial health. Further work is needed to establish whether
impaired mitochondrial health contributes to known markers of stress
pathophysiology.

<figure><img src="image_44.png" /></figure>

**Abstract 1414**

AN UNHEALTHY LIFESTYLE INDEX PREDICTING LONGITUDINAL COURSE OF DEPRESSION AND ANXIETY

Sarah Hiles, PhD, Femke Lamers, PhD, Brenda Penninx, PhD, Psychiatry, VU University Medical Center, Amsterdam, North Holland, Netherlands

**Objective:** People with depression and anxiety often exhibit unhealthy lifestyle behaviours, including physical inactivity, high alcohol use, smoking, drug use, and shortened sleep. These behaviours tend to cluster together. Previous longitudinal studies have seldom examined whether an aggregated "unhealthy lifestyle index" of these risk behaviours predicts course of psychopathology.

**Method:** Participants were from the Netherlands Study of Depression and Anxiety (NESDA; 18-65 years; N = 2981). At baseline, 2, 4, and 6 year follow-up assessments, participants completed a diagnostic interview and self-report questionnaires. The unhealthy lifestyle index was calculated from responses to self-report questionnaires completed at baseline regarding physical activity levels, alcohol use, smoking, drug use and sleep duration. Participants scored one point for any lifestyle behaviour not meeting health guideline recommendations. Psychopathology course over time among those with a disorder at baseline was defined as chronic (disorder at all follow-up assessments), remitted (no disorder at follow-up assessments) or intermediate (neither remitted nor chronic).

**Results:** At baseline, smoking and low sleep duration were associated with greater odds of current or lifetime disorder relative to having no history of anxiety or depression. Examining the behaviours as a summed lifestyle index, for each additional poor lifestyle behaviour, odds of current disorder increased by 50% (95% CI 1.35 to 1.96) and odds of remitted disorder by 21% (95% CI 1.06 to 1.38), relative to controls. In examining course of psychopathology over time among people with a current disorder at baseline, for each additional poor

lifestyle behaviour present at the baseline assessment, odds of chronic course increased by 19% (95% CI 1.02 to 1.39) and odds of intermediate course by 15% (95% CI 1.00 to 1.33), relative to remitted course. Greater lifestyle index scores at baseline were also significantly associated with an increased proportion of time with depression, but not anxiety, across the follow-up period.

**Conclusion:** The presence of more lifestyle behaviours that do not meet health guidelines is associated with psychopathology cross-sectionally and poorer psychopathology course over time. A lifestyle index may therefore be a simple indicator of unfavourable course in depression and anxiety.

**Technology-based Interventions**

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

**Abstract 1528**

A REMOTE SENSING PLATFORM FOR SUPPORTING EXERCISE IS AS EFFECTIVE AS TRADITIONAL SUPERVISED EXERCISE FOR IMPROVING CARDIORESPIRATORY FITNESS IN PEOPLE WITH CARDIOVASCULAR DISEASE: THE REMOTE-CR RANDOMISED CONTROLLED NON-INFERIORITY TRIAL

Ralph Maddison, Ph.D, Institute of Physical Activity and Nutrition, Jonathan Rawstorn, Ph.D, Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Vic, Australia, Nick Gant, Ph.D, Sport and Exercise Science, Yannan Jiang, Ph.D, Statistics, Robyn Whittaker, MBCHB, Ph.D, National Institute for Health Innovation, Ralph Stewart, Ph.D, MBCHB, Medicine, University of Auckland, Auckland, AKL, New Zealand, Jocelyn Benatar, MBCHB, Medicine, Auckland City Hospital, Auckland, AKL, New Zealand, Ian Warren, Ph.D, Computer Science, Unversity of Auckland, Auckland, AKL, New Zealand, Anna Rolleston, Ph.D, Cardiac Clinic, Cardiac Clinic, Tauranga, BOP, New Zealand

**Background:** Exercise is an essential but underutilized component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease. Increasingly powerful mobile technologies, such as smartphones and wireless physiological sensors, may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for those with coronary heart disease.

**Aim:** This study aimed to compare the effectiveness of mobile and wireless technology-assisted, home-based, remotely monitored exercise cardiac rehabilitation (exCR) to standard supervised centre-based cardiac rehabilitation in adults with ischaemic heart disease.

**Methods:** A randomized controlled non-inferiority trial of a smartphone-based remote intervention (REMOTE) was conducted in New Zealand to compare the effectiveness on exercise capacity and physical activity levels to current supervised cardiac rehabilitation for people (n=162) with ischemic heart disease. The REMOTE platform comprised commercially available smartphones and wearable sensors, bespoke smartphone and web apps, and custom middleware. Participants randomised to REMOTE received a 12 week programme of exercise prescription and support, as well as evidence and theory based behaviour change strategies encouraging participants to exercise regularly. The control condition comprised 12 weeks of supervised exercise delivered by trained exercise scientists in established cardiac rehabilitation clinics.

**Results:** The REMOTE platform was as effective at improving maximal oxygen (VO2max) (INT=2.75 ml·kg⁻¹·min⁻¹) compared to supervised exercise (CON=1.69 ml·kg⁻¹·min⁻¹), (adjusted mean difference = 0.46 [-0.92 – 1.84]). There were also changes in physical activity, sedentary behaviour, and self-efficacy and motivation variables.
Conclusions: Treatment effects of remotely delivered exCR were comparable with established centre-based exCR. Real-time remote exercise monitoring could help to close the gap between existing home- and centre-based programmes by making responsive, individualised exercise monitoring and coaching, behaviour change education, and social support available to patients in almost any location.

### Abstract 1553

## IS COMPUTERIZED COGNITIVE BEHAVIORAL THERAPY AN EFFECTIVE MENTAL HEALTH TREATMENT FOR BOTH AFRICAN AMERICANS AND WHITES?

Charles Jonassaint, PhD, Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, Bea Belnap, Dr Biol Hum, Medicine, University of Pittsburgh, Pittsburgh, PA, Jordan Karp, MD, Psychiatry, University of Pittsburgh, Pittsburgh, PA - Pennsylvania, Kaleab Abebe, PhD, Medicine, University of Pittsburgh, Pittsburgh, PA, Bruce Rollman, MD, MPH, Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

**Background:** Access to effective treatment for depression and anxiety in primary care is often limited, particularly for minority patients who also experience racial disparities in treatment outcomes. Recent trials demonstrate that computerized cognitive behavioral therapy (CCBT) programs may help improve access to treatment. However, it is unclear if these programs are equally acceptable to African Americans (AAs) as Whites, and whether these groups experience comparable benefits. We examined these questions among patients enrolled in our NIMH-funded trial of online collaborative care for mood and anxiety disorders.

**Methods:** Patients aged 18-75 with current depression, panic and/or generalized anxiety disorder were referred to our trial from 26 Pittsburgh-area primary care practices. We randomized protocol-eligible and consenting patients who reported elevated levels of mood and/or anxiety symptoms (PHQ-9 or GAD-7 ≥10) with Internet access to receive their doctors' usual care or one of two other groups (1-3-3 ratio) that included 6-months of care manager-guided access to the U.S. version of the 8-session "Beating the Blues" CCBT program. Blinded assessor determined PROMIS depression and anxiety outcomes by phone at 6-months follow-up.

**Results:** Between 8/1/12 and 9/30/14, we randomized 91 AA and 499 White participants to our two CCBT study arms (mean age: 43 years; SD=14; range 18-75). AA patients, compared to Whites, had higher baseline PHQ-9 scores (14.4 vs. 13.1; *p*<0.01) and completed fewer CCBT sessions at both 3- and 6-months follow-up (mean sessions: 4.2 vs. 4.8; *p*=0.08 and 4.7 vs. 5.5; *p*=0.03, respectively). However, AAs showed a greater 6-month decrease in depression (-4.76 vs. -1.73; *p*=.024) and anxiety symptoms (-5.43 vs. -1.44; *p*=.083) compared to whites.

**Conclusion:** Internet-delivered and care manager-guided CCBT is an acceptable and effective means to provide depressed and/or anxious AA patients with access to mental health care at scale and potentially reduce racial disparities in treatment outcomes.

### Abstract 1437

## BIOBEHAVIOURAL THERAPY FOR EPILEPSY: TECHNOLOGICAL APPLICATION OF GALVANIC SKIN RESPONSE (GSR) BIOFEEDBACK TO REDUCE EPILEPTIC SEIZURES

Yoko Nagai, PhD, Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK, Julia Aram, MD, PhD, Neurology, Brighton and Sussex University Hospital, Brighton, East Sussex, UK, Sanjay Sisodiya, MD, PhD, Matthias Kopek, MD, PhD, Neurology, Institute of Neurology, London, Greater London, UK, Marco Mula, MD, PhD, Neurology, St Georges Hospital, London, Greater London, UK, Louis Lemieux, PhD, Medical Physics, Institute of Neurology, London, Greater London, UK, Mara Cercignani, PhD,

Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK

Epilepsy is a neurological condition in which patients suffer from acute episodes of abnormal sensory and motor activity: seizures. One in a hundred people suffer from epilepsy. The unpredictability of seizures, and side-effects associated with drug treatment, often severely impact patients' lives. Over a decade ago, Nagai and her colleagues (2004a) introduced Galvanic Skin Response (GSR) biofeedback in patients with drug resistant epilepsy, demonstrating a robust positive effects. In the first randomized controlled trial, 60% of patients in the active biofeedback therapy group experienced seizure reduction of more than 50%. The therapy is grounded on neuroscientific observations characterizing an inverse relationship between electroencephalographic (EEG) indices of cortical neural excitability (slow cortical potentials) and peripheral sympathetic arousal (indexed by GSR activity) [Nagai et al., 2004b; Nagai et al., 2009]. Accompanying neuroimaging investigations also implicated thalamo-cortical circuitry in the generation of slow cortical potentials [Nagai et al., 2004c], and showed that ventromedial prefrontal cortex/orbitofrontal neural activity is inversely correlated to biofeedback-driven changes in the tonic level of GSR (Nagai et al., 2004d). In the current study, we conducted a wider clinical trial with 40 patients with drug resistant temporal lobe epilepsy (N= 20 Therapy group, N = 20 Control). Neuroimaging (fMRI) was conducted to explore neural network changes before and after GSR biofeedback intervention. A month of biofeedback training, elicited a significant reduction in the patients' seizure frequency (*p*<0.001). In the active therapy group, 9/20 of patients showed a reduction in seizure frequency of over 50%. The average seizure reduction in the active therapy group was 45.8%, compared to an increase of 14.3% seizure increase in the control (treatment as usual) group (*p* = 0.001). Resting state functional neuroimaging indicated that GSR biofeedback strengthened neural connectivity within the default mode network, consistent with a normalization of abnormal default mode connectivity with this patient group.

Our combined clinical trial and neuroimaging study demonstrates the potential of GSR biofeedback as an effective technology-driven therapy that can be widely offered for patients with drug resistant epilepsy in the near future.

### Abstract 1033

## COMBINED GROUP AND TECHNOLOGY-SUPPORTED SINGING INTERVENTIONS FOR POSTNATAL DEPRESSION: PSYCHOLOGICAL AND BIOLOGICAL RESULTS FROM A THREE-ARM RANDOMISED CONTROL TRIAL

Daisy Fancourt, PhD, Rosie Perkins, PhD, Centre for Performance Science, Imperial College / RCM, London, England, UK

**Background:** Postnatal depression (PND) affects at least 13% of new mothers with over 75,000 cases per year in the UK alone. Current treatments models include antidepressants and psychotherapy, yet significant challenges are associated with each. However, given that studies examining predictors of PND have identified psychosocial factors such as stress and social support, group psychosocial interventions that simultaneously relax mothers and enhance their support networks could be of value. Technology could also play an important role in consolidating the effects from workshops. To explore this combined group and technology-supported approach, we focused on group singing interventions, since studies in other populations have suggested mental health benefits from music engagement.

**Methods:** 155 women with PND up to nine months post birth were randomised to one of three groups: usual care, 10 weeks of group play workshops or 10 weeks of group singing workshops, supported by singing recordings streamed over the internet and/or via smartphones in participants' own homes. Psychological scales including the Edinburgh Postnatal Depression Scale (EPDS) were taken at baseline, week 6 and week 10 along with saliva samples measuring neuroendocrine markers (including cortisol) and cytokine levels.
**Results:** Two different cut-offs for PND apply using EPDS: 9/10 (minor) and 12/13 (moderate-severe). Across time, there were improvements in PND across all groups. However, when applying 9/10, there was a near-significant difference between groups, with the singing group showing a trend towards a faster reduction in symptoms of PND. When applying 12/13, this result became significant (p<.05) with post-hoc tests showing faster improvements in the singing group, including a drop to below the clinical cut-off a month earlier than either the play or usual care groups. Biological data exploring changes in stress response and inflammatory immune function over the length of the intervention and over single sessions are currently under analysis, with full results expected in November 2016.

**Conclusions:** This study suggests that 10-week programmes of group singing workshops supported by technology-streamed recordings could help reduce symptoms of PND amongst new mothers, especially amongst mothers experiencing more severe PND. Further research and app-development is underway.

## The Harms and Modification of Prenatal Stress

Friday, March 17 from 1:15 - 2:30 pm

### Abstract 1580

#### PRENATAL STRESS IN LOW-INCOME, OVERWEIGHT MOTHERS PREDICTS INFANT PHYSICAL ILLNESS ASSESSED VIA MEDICAL RECORDS

Nicole Bush, PhD, Psychiatry and Pediatrics, Jennifer Savitz, BA, School of Medicine, Michael Coccia, MS, Psychiatry, W. Thomas Boyce, MD, Psychiatry and Pediatrics, UCSF, San Francisco, CA, Kimberly Coleman-phox, MPH, School of Public Health, UC Berkeley, Berkeley, CA, Melanie Thomas, MD, MPH, Psychiatry, UCSF, San Francisco, CA, Barbara Laraia, PhD, MPH, RD, School of Public Health, UC Berkeley, Berkeley, CA, Nancy Adler, PhD, Elissa Epel, PhD, Psychiatry, UCSF, San Francisco, CA

**Background:** Developmental Origins of Health and Disease (DOHaD) research has revealed that maternal prenatal stress, through activation of the maternal HPA axis, can adversely affect the developing fetus in ways that can influence its health in infancy and beyond. A small body of evidence has found prenatal stress is associated with alterations in offspring immunity and increased risk of hospitalization for infectious diseases. Yet, the few studies specifically examining offspring illness in infancy have been predominantly conducted in European, high-SES populations and/or have used maternal-report of illness. We sought to examine these associations in a diverse U.S. population, using objectively-rated health data abstracted from medical records.

**Methods:** In a sample of 161 low-income, ethnically-diverse, overweight pregnant women, mothers reported on their experience of significant negative life events during pregnancy (SLE) and their perceived stress (PS) and depression at 2nd and 3rd trimester and 6 months postpartum. Infant illness was assessed by medical record abstraction of all PCP and ER visits in the first 13 months of life (N=83 dyads with complete maternal and abstracted offspring data at the time of analyses). Negative Binomial regression was used to model PS and SLE as predictors of 1) total number of infections and 2) total number of unique diagnoses, with each model adjusting for gestational age, maternal age, household income, and postnatal PS.

**Results:** The sample experienced high levels of trauma and stress during their pregnancy. Results revealed that higher mean PS across pregnancy was significantly associated with a higher number of infant infections and number of unique diagnoses. Follow-up analyses revealed that effects were driven largely by PS during later pregnancy. See Table 1 for final model.

**Conclusions:** Even within a highly-stressed sample, variation in maternal psychosocial stress during pregnancy was positively associated with incidence of and diversity of their infants' physical

illness, after adjusting for postpartum maternal stress and covariates. Prenatal programming of infant immune system functioning may be evident within the first year of life, and the timing of stress exposure appears important for the developing fetus. Improved attention to maternal psychosocial wellbeing during pregnancy may prevent infant illness.

<table><caption>Table 1. Negative Binomial Regression Results</caption><thead><tr><th>Exp (estimates)</th><th>Total<br>Infections<br>Count</th><th>Total Unique<br>Dx Count</th></tr></thead><tbody><tr><th scope="row">Predictors</th><td></td><td></td></tr><tr><th scope="row">SLE Count</th><td>1.040</td><td>1.001</td></tr><tr><th scope="row">3<sup>rd</sup> trimester PS</th><td>1.750**</td><td>1.722***</td></tr><tr><th scope="row">Postnatal PS</th><td>0.805</td><td>0.923</td></tr><tr><th scope="row">Maternal Age</th><td>1.010</td><td>1.007</td></tr><tr><th scope="row">% Poverty</th><td>0.999</td><td>0.998**</td></tr><tr><th scope="row">Gestational Age</th><td>1.016</td><td>1.007</td></tr><tr><th scope="row">Birth weight</th><td>1.109</td><td>0.960</td></tr></tbody></table>

Note: * = <.05, ** = <.01, *** = <.001

### Abstract 1276

#### PRELIMINARY FINDINGS ON GENERAL AND PREGNANCY-SPECIFIC ANXIETY ASSOCIATED WITH INTERLEUKIN-6 IN SECOND TRIMESTER OF PREGNANCY

Kharah Ross, PhD, Christine Dunkel Schetter, PhD, Psychology, University of California, Los Angeles, Los Angeles, CA, Calvin J. Hobel, MD, Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, Camille Hoffman, MD, Obstetrics and Gynecology, University of Colorado, Denver, Denver, CO, Michele L. Okun, PhD, Trauma, Health & Hazard Center, University of Colorado, Colorado Springs, Colorado Springs, CO, Roberta Mancuso, PhD, College of Contemporary Liberal Studies, Regis University, Denver, CO, Mary E. Coussons-Read, PhD, Psychology, University of Colorado, Colorado Springs, Colorado Springs, CO

**Background.** Antenatal mood disorders have been associated with poor pregnancy outcomes. Increased inflammation may be one pathway to poor pregnancy outcomes. In non-pregnant adults, mood disorders have been associated with increased inflammation. Few studies have assessed whether depression symptoms, general anxiety or pregnancy-specific anxiety are associated with inflammation during pregnancy. The purpose of these analyses is to determine whether maternal mood (general anxiety, pregnancy-specific anxiety, depressive symptoms) are associated with inflammatory markers (IL10, IL4, IL6) during the second trimester of pregnancy. **Methods.** The sample consisted of the first 36 participants of an on-going study of mood and inflammation during pregnancy. Women were recruited at 20-26 weeks gestational age (GA) from Denver and Los Angeles and interviewed with standardized scale measures of general anxiety (OASIS), pregnancy-specific anxiety and depressed mood (PHQ-9). At the same time points, they provided a blood sample. Blood serum was assessed using multiplex bead assay on Luminex for IL6, IL4 and IL10. Covariates included age, race/ethnicity, socioeconomic status, GA at assessment, partner cohabitation and pre-pregnancy BMI. **Results.** Women were predominately White (43%) and Latina (41%). None of the mood variables were associated with second trimester IL4 or IL10. Higher levels of IL6 was associated with higher general anxiety ($r$ = .304), and pregnancy-specific anxiety ($r$ = .353) during the second trimester of pregnancy, but depression symptoms were not ($r$ = .003). When general
anxiety and pregnancy-specific anxiety were entered simultaneously into regression analyses, only pregnancy-specific anxiety was marginally associated with second trimester IL6, $β = .271, p = .099$. **Conclusions.** These preliminary findings from an on-going study suggest that prenatal mood, specifically general anxiety and pregnancy-specific anxiety, may be associated with increased inflammatory IL6 during the second trimester of pregnancy, and that of the two, pregnancy anxiety is potentially a stronger marker. On-going data collection will allow extension of these analyses to test whether prenatal mood is associated with pregnancy outcomes, as mediated by inflammatory pathways.

### Abstract 1563

## THE EFFECTS OF MATERNAL CORTISOL AND POSTPARTUM DEPRESSION ON INFANT SALIVARY CORTISOL

Lauren A. Dunne, B.A., Grace M. Thornburgh, B.A., Guido Urizar, PhD, Psychology, California State University, Long Beach, CA

Recent studies have shown flatter diurnal cortisol patterns to be associated with several adverse health outcomes in at-risk populations. Yet, few studies have examined the effects of maternal cortisol on their infant's cortisol patterns. Even fewer studies have examined this relationship as it relates to postpartum depression. The purpose of this study was to investigate whether maternal cortisol and postpartum depression were associated with infant cortisol patterns. We hypothesized that mothers with flatter diurnal cortisol patterns and high levels of postpartum depression would have infants with flatter diurnal cortisol patterns at 3 months postpartum. Our sample included 72 low-income mothers and their infants (71% Latina, 71% with a high school education or less, 75% earned less than $20,000 in total family income per year). At three months postpartum, seven saliva samples were collected from mothers throughout one collection day (upon waking, 30 minutes, 45 minutes, and one hour after waking, 12pm, 4pm, and 8pm) to calculate diurnal cortisol. On the same collection day, mothers also collected two saliva samples from their infants (8am and 8pm) to calculate their diurnal cortisol. Levels of postpartum depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Results from a hierarchical multiple regression analysis revealed that mothers with flatter diurnal cortisol patterns had infants with flatter diurnal cortisol patterns ($b = .243, p = .05$). Additionally, mothers with high levels of postpartum depression had infants with flatter cortisol patterns ($b = .02, p < .05$). These results support the need for interventions focused on reducing maternal stress and the onset of postpartum depression to promote positive health outcomes in infants of at-risk mothers.

### Abstract 1204

## BEING MINDFUL DURING PREGNANCY PREDICTS NOT ONLY MOOD OF THE MOTHER BUT ALSO BIRTH WEIGHT OF THE CHILD

Ivan Nyklicek, PhD, CoRPS Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, NB, Netherlands, Sophie E. Truijens, PhD, Obstetrics and Gynecology, Máxima Medical Center, Eindhoven, NB, Netherlands, Viola Spek, PhD, Victor J. Pop, MD, PhD, CoRPS Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, NB, Netherlands

**Background:** Mindfulness skills have been associated with better mood and several health related outcomes. Because distressed mood during pregnancy has been related to worse child outcome, the aim was to examine the association of mindfulness skills during pregnancy with the mother's psychological distress and the child's birth medical records.

**Methods:** Participants were 905 pregnant women who participated in the longitudinal HAPPY study (Holistic Approach to Pregnancy and the first Postpartum Year). The 12-item Three Facet Mindfulness-Questionnaire-Short Form (Truijens et al., 2016) was completed at 22 weeks of gestation.

Psychological distress was assessed using the Edinburgh Depression Scale at 22 and 32 weeks, and post-delivery. The child's medical records were examined for gestation length, kind of delivery, birth weight, and Apgar score.

**Results:** Mindfulness skills Acting with Awareness and Nonjudging at 22 weeks were associated with lower depressive mood at 22 weeks, at 32 weeks and post-delivery. When controlled for depressive mood at 22 weeks, the association was still significant for Nonjudging predicting depressive mood at 32 weeks ($β = -.14, p < .001$) and post-delivery ($β = -.17, p < .001$). Regarding the child's medical records, only the mindfulness skill of Nonreacting predicted higher birth weight. Specifically, controlling for length of gestation and depressive symptoms, Nonreacting predicted having normal (non-underweight) birth weight (OR = 1.10, 95% CI = 1.03 – 1.18).

**Discussion:** It seems that different mindfulness skills during pregnancy are important in predicting mother's depressive symptoms versus child's birth weight. Potential mechanisms responsible for the associations found will be discussed. Successful replication of the findings may result in the consideration of application of mindfulness based interventions in prenatal care.

### Abstract 1547

## IMPACT OF A PRENATAL COGNITIVE BEHAVIORAL STRESS MANAGEMENT INTERVENTION ON REGULATING CORTISOL LEVELS AMONG LOW-INCOME MOTHERS AND THEIR INFANTS

Guido Urizar, PhD, Psychology, California State University, Long Beach, CA

Altered cortisol patterns during the postpartum period may lead to significant long-term health problems for low-income mothers and their infants. Yet, few studies have examined how to regulate cortisol in this population. The current randomized trial examined the impact of a prenatal cognitive behavioral stress management (CBSM) intervention on regulating postpartum salivary cortisol levels [i.e., total daily cortisol output (Area Under the Curve; AUC), diurnal cortisol] among 100 low-income mothers (mean age=27±6 years; 75% annual income<$19K; 71% Latina) and their infants. During their first trimester of pregnancy, mothers were randomized to either an eight-week CBSM intervention or an attention-control (AC) group. Women in the CBSM intervention (n=55) attended weekly group-based sessions in which a clinically trained researcher taught relaxation and coping skills, whereas women in the AC group (n=45) received weekly print-based prenatal health information by mail. At three months postpartum, mothers' cortisol levels (AUC, diurnal cortisol) were estimated from seven saliva samples provided on one collection day (four morning samples, 12pm, 4pm, and 8pm). Additionally, infants' cortisol levels (average and diurnal cortisol) were estimated from two saliva samples (8am and 8pm) provided on the same collection day as their mothers. Results demonstrated that infants of mothers randomized to the AC group had higher cortisol (AUC) than infants of mothers receiving the CBSM intervention [$F(1, 68) = 7.8, p = .007$]. Furthermore, infants of mothers randomized to the AC group showed flatter diurnal cortisol patterns (associated with poorer health outcomes) than infants of mothers receiving the CBSM intervention [$F(1, 68) = 3.5, p = .07$]. These findings demonstrate the long-term impact that prenatal CBSM group interventions can have in regulating postpartum cortisol levels among low-income mothers and their infants.
Abstract 1329

INVESTIGATING THE CROSS-STRESSOR HYPOTHESIS
UNDER REAL-WORLD CONDITIONS: HABITUAL
PHYSICAL ACTIVITY AS A MODERATOR OF THE
ASSOCIATION BETWEEN MOMENTARY ANXIETY, AND
HEART RATE AND BLOOD PRESSURE

Ipek Ensari, PhD, Joseph E. Schwartz, PhD, Donald E. Edmondson, PhD, Andrea T. Duran, MS, Daichi Shimbo, MD, Keith M. Diaz, PhD, Medicine, Columbia University Medical Center, New York, NY

The cross-stressor hypothesis of physical activity(PA) postulates that engaging in regular PA results in cardiorespiratory, muscular and neural adaptations, which then favorably buffer the physiological response (e.g., heart rate [HR]; systolic blood pressure [SBP]) to psychological stressors that might be experienced in daily life. Few data exist testing this hypothesis outside of laboratory conditions.

Using ecological momentary assessment(EMA), we examined whether
self-reported PA levels moderate the association between momentary
fluctuations in self-reported anxiety and corresponding fluctuations in
ambulatory HR and SBP measured over a 24-hour period.Adult
participants without a history of cardiovascular disease(N=834)
completed a 24-hour ambulatory monitoring of HR and SBP. The
monitoring was done using an arm pressure cuff that was programmed
to take readings at 28-minute intervals and self-reported anxiety levels
were concurrently measured based on a visual analog scale(VAS) of 0
to 100 using a Palm Pilot. Habitual PA levels (i.e., minutes/week) were
assessed using a self-reported questionnaire. Slope of the within-
subjects regression on ambulatory HR and SBP readings on time-
matched VAS anxiety ratings were estimated using a random-
coefficients linear regression model. Habitual PA levels were
categorized as no weekly PA, less than 150 minutes/week and at least
150 minutes/week; and added to the model as a between-subjects factor
to estimate the average B-coefficient of the anxiety-HR and anxiety-
SBP regression slopes for each PA category.

Higher anxiety scores were associated with greater momentary
ambulatory HR and SBP(B=0.76, SE=0.09, and B=0.76, SE=0.15,
respectively; p<0.001). Models testing the moderating effect of PA on
the anxiety-HR and anxiety-SBP associations showed a trend wherein
higher PA levels were associated with blunted HR and SBP responses
to anxiety; however, the interaction did not reach statistical significance
(p>0.05). No PA category was associated with significantly higher
ambulatory HR and SBP when compared to the highest PA
category(B=1.03, SE=0.84, p=150 minutes/week.

Using ambulatory data (i.e., repeated EMA), we observed a trend in
this cohort of 834 adults wherein those who engage in greater doses of
habitual PA experience blunted HR and SBP responses associated with
momentary experiences of anxiety throughout the day.

Abstract 1402

EFFECT OF WELL-BEING ON LATER ACTIGRAPHIC PHYSICAL ACTIVITY

Jerrald L. Rector, PhD, Elliot M. Friedman, PhD, Human Development and Family Studies, Purdue University, West Lafayette, IN

**Background** Physical activity (PA) is associated with numerous health benefits. Recent evidence suggests that PA may be bolstered by positive psychosocial factors, including hedonic well-being (positive affect) and eudaimonic well-being (a sense of purpose and engagement in life). While physical exercise improves later mood, precedence for a temporal effect of well-being on PA has not been established. Further, it is unclear if any effects of well-being exist beyond other predictors of PA. The aim of this study was to investigate the prospective relationship between well-being and objective PA at varying time

intervals. We hypothesized that higher well-being would be related to
greater PA after controlling for other predictors. Based on the Broaden-
and-Build Theory, we also anticipated that the benefits of well-being on
PA would be greater as lag time increased.

**Methods** Participants (N=371) were from a sub-sample of the 2nd wave of the Survey of Midlife Development in the United States (MIDUS). Hedonic (PANAS) and eudaimonic (Ryff scales) well-being were measured by questionnaire, and 7 days of actigraphy data was obtained 1 to 62 months later. Linear regressions examined the relationship of (a) well-being, (b) time between measurements, and (c) the interaction between well-being and time with PA (total activity, maximum activity, and percent time active). Models were adjusted for demographics (age, sex, education, race), lifestyle (smoking, BMI), health status (chronic conditions), and fitness (resting heart rate).

**Results** Consistent with our hypothesis, positive affect (β=.14, p<.05) and composite eudaimonic well-being (β=.11, p<.05), as well as personal growth (β=.17, p<.01), positive relationships (β=.13, p<.05), and purpose in life (β=.16, p<.01) predicted total activity after full adjustment. Nearly identical associations were observed for percent time active, but not maximum activity. Interaction analyses revealed that the slope of PA with increasing lag time was steeper at higher levels of well-being. That is, the difference in later PA due to higher well-being is larger with increased lag time.

**Conclusion** This study provides evidence that well-being may increase objective PA up to 5 years later, and that well-being makes a unique contribution to long-term PA beyond other predictors.

Abstract 1031

A RANDOMIZED CONTROLLED TRIAL OF THE
COGNITIVE EFFECTS OF AN AEROBIC EXERCISE
TRAINING INTERVENTION IN HEALTHY YOUNG ADULTS

Lars B. Margolis, B.A., Medicine, Columbia University College of Physicians and Surgeons, New York, NY, Paula S. McKinley, PhD, Medicine, Montefiore Medical Center, Bronx, NY, Adam M. Brickman, PhD, Neurology, Columbia University Medical Center, New York, NY, Kathleen M. McIntyre, MSW, Grace Liu, MA, Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, Jimmy K. Duong, MPH, Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY

Background:

Exercise-training and cardiorespiratory fitness have been associated with improved performance on cognitive assessments. However, the majority of studies have been performed in older adults. This study assessed the cognitive effects of an aerobic exercise training program for healthy young adults.

Methods:

242 young adults were recruited for a study of the effects of aerobic exercise training on inflammatory markers. Of these, 79 were enrolled in a substudy to assess for cognitive changes associated with exercise-training. The participants underwent baseline neuropsychological and VO2 max assessments prior to either a 12-week aerobic exercise training intervention or placement in a waitlist control group. Afterwards, 62 participants underwent repeat assessment. The outcomes of the following neuropsychological assessments were analyzed: Modified Rey Auditory Verbal Learning, CogState Identification Task, CogState Continuous Paired Associate Learning, CogState Groton Maze Chase, CogState One Card Learning, CogState One Back, ModBent average response time for correct rejections, Stark Separation Bias, Verbal Fluency Task, Category Fluency Test, Stroop Color-Word Interference, Digit Symbol Substitution Test. Statistical analysis was performed using a linear regression model where the outcome was change in score from baseline to follow-up, and the predictors were treatment group and baseline evaluation score.

Results:
The average age was 31.0 years-old (SD: 6.1), 50.0% were female. Mean VO₂ max change in the exercise group was 3.88 mL/kg/min (SD: 2.89), as compared with (-) 1.02 mL/kg/min (SD: 4.00) in the control group (F(2,59)=15.28, p<.001). However, there was no significant effect on any of the neuropsychological domains assessed as defined by a significance level of p<0.05.

Conclusions: In a study of healthy young adults, an aerobic exercise-training intervention resulted in a statistically significant increase in aerobic capacity but did not result in improvements in cognitive functioning. These negative findings are consistent with the hypothesis that aerobic exercise training has the greatest neurocognitive effect in people with cognitive compromise, or at high risk for cognitive decline, but not in healthy young adults without apparent risk factors for cognitive decline.

Abstract 1131

AEROBIC EXERCISE TRAINING AND INFLAMMATION
ACROSS THE AGE SPAN - A CAUTIONARY TALE

Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, New York, NY, Paula S. McKinley, PhD, General Medicine, Montefiore Medical Center 3300 Kossuth Ave. 2nd Floor, Bronx, NY, Kathleen McIntyre, LCSW, Vincenzo Lauriola, MS, Psychiatry, Martina Pavlicova, PhD, Biostatistics, Columbia University Medical Center, New York, NY, Tse-Hwei Choo, MS, Biostatistics, New York State Psychiatric Institute, New York, NY, Yaakov Stern, PhD, Neurology, Columbia University Medical Center, New York, NY

Objective

The cardioprotective effects of aerobic exercise and the role of
inflammation in atherogenesis suggest that one mechanism by which
exercise contributes to cardioprotection through its anti-inflammatory
effects. However, both observational and intervention studies have
yielded equivocal results, with some studies showing that exercise was
associated with lower levels of inflammatory markers and others
showing no such effect. Here we report the results of a 24 week
randomized controlled trial of aerobic exercise training vs. a
stretching/toning control condition on serum TNFa and IL6 levels.

Method

129 healthy, sedentary adults (age 20-67 years) were randomly
assigned to 24 weeks of either aerobic exercise training or a
stretching/toning control condition. In either condition, participants
attended 4 gym session/week. In the exercise condition, they performed
40 min of aerobic exercise beginning at 60% of their maximum heart
rate and progressed to 75% after 4 weeks, where they remained for the
rest of the intervention period. Stretching/toning participants practiced
a series of stretches for 40 min in each session. Compliance with the
protocol was established by Polar heart rate monitoring. Sedentary
status and the effect of the exercise intervention were established by
cardiopulmonary exercise testing. Blood samples for analysis of
inflammatory markers were collected prior to randomization and after
24 weeks.

Results

VO₂max increased by 11.58% in the exercise group compared to 0.96% in the stretching/toning group. However, there was no significant effect of group assignment on changes in TNFa levels (p=.91), and neither treatment group's change in TNFa was significantly different from zero. While there also was no significant effect of group assignment on changes in IL6 (p=.89), IL6 levels decreased from time 1 to time 2 in both the exercise and the stretching group, and the overall change in IL6, combining all subjects was significant (p=.03).

Discussion

These findings raise questions about the often reported effect of aerobic exercise training on inflammatory markers. Despite significant improvements in aerobic capacity in the exercise group, there was no effect of training on TNFa and no difference between the two intervention groups in the effect on IL6, despite significant differences in changes in aerobic capacity.
## The Enduring Influence of Responsive Others: Implications for Health and Longevity across the Lifespan

Ledina Imami, M.A., Department of Psychology, Wayne State University, Detroit, Michigan, Sarah Stanton, Ph.D., Department of Psychology, University of Edinburgh, Edinburgh, Edinburgh, United Kingdom, Julianne Holt-Lunstad, Ph.D., Department of Psychology, Brigham Young University, Provo, Utah, Sarah Stanton, Ph.D., Department of Psychology, University of Edinburgh, Edinburgh, Edinburgh, Ledina Imami, M.A., Department of Psychology, Wayne State University, Detroit, Michigan, LillyBelle K. Deer, B.A., Department of Psychology, University of California-Davis, Davis, California, Beate Ditzen, Ph.D., Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Heidelberg, Germany

Perceived responsiveness and support from others are interpersonal processes that help us forge nurturing social bonds. Extensive research suggests that these processes allow us not only to build satisfying relationships, but also to sustain better health and well-being throughout the lifespan. The current symposium presents evidence from different developmental stages that addresses some of the most pressing questions arising from these insights: Which psychological mechanisms enable the health-promoting effects of responsiveness and social support? Which biological pathways underlie these links? And finally, are we able to successfully engineer social support interventions in clinical settings in order to reduce the mortality risk associated with social disconnection? The first talk reviews the association between social connection and survival odds and the robustness of this effect as revealed by two large meta-analyses. This talk also presents data from a third meta-analysis which critically examines current evidence from social support interventions and their effectiveness in reducing mortality risk. The following talks investigate the conditions under which responsive social ties are associated with beneficial health outcomes, as well as the biological processes that enable these associations. More specifically, the second talk investigates responsiveness processes among middle-aged adults and shows that increased perceptions of partner responsiveness over 10 years predict lower negative affectivity to daily stressors and lower all-cause mortality at the end of 20 years. The third talk examines how gender differences influence the association between perceived responsiveness, anti-inflammatory gene expression, and psychological well-being among youth with asthma. Finally, the fourth talk investigates the association between perceived support from close friends and cortisol reactivity to a laboratory-staged social evaluative stressor. The discussion will emphasize how these talks highlight the idea that being intimately connected to others in ways that make us feel valued and secure can have important implications for physical health and longevity. The symposium will conclude with a focus on the underlying psychobiological mechanisms and implications on how to use these insights in order to promote health and well-being across the lifespan.

### The Social Buffering of the HPA Axis in Children and Adolescents: The Role of Perceived Support from Close Friends

LillyBelle K. Deer, B.A., Department of Psychology, University of California-Davis, Davis, California, Megan R. Gunnar, Ph.D., Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, Camelia E. Hostinar, Ph.D., Department of Psychology, University of California-Davis, Davis, California

Positive relationships with close friends are associated with a plethora of beneficial mental and physical health outcomes across the lifespan. The stress-buffering role of social relationships has been proposed as

one underlying mechanism, but more research is needed to understand who can serve as a stress buffer at each developmental stage. The goal of the present study was to examine whether perceived social support from close friends is associated with lower cortisol reactivity to a laboratory-based stress paradigm in children and adolescents.

**Methods:** A sample of 81 children (ages 9-10, N = 40, 50% female) and adolescents (ages 15-16, N = 41, 48.8% female) completed the Trier Social Stress Test for Children (TSST-C) in the laboratory. Participants were randomly assigned to prepare for the TSST-C with their parent (low-stress condition) or a stranger (high-stress condition), followed by participating in the TSST-C alone. Salivary cortisol was collected 0, 20, 40, and 60 min post-stressor. Participants' perceived support from their closest same-sex friend was assessed using the Network of Relationships Inventory (Furman & Buhrmester, 2009) by averaging the Companionship, Instrumental Aid, Disclosure, Nurturance, Affection, Worth and Alliance scales (21 items, alpha = .91). Hierarchical linear modeling was used to model the cortisol response as a function of time and time-squared, including the effects of perceived friend support, age group, condition and their interactions in the model.

**Results:** Analyses revealed a significant interaction between perceived support from closest friends and condition on the linear time term, $F(1,151) = 13.4, p < .001$, and on the quadratic time term, $F(1,151) = 9.2, p = .003$, such that higher levels of perceived support from closest friends was associated with lower cortisol production in the high-stress condition. This effect was not noted in the low-stress condition. These findings remained significant after adjusting for sex, family income, life events, and prior-night sleep.

**Discussion:** The results suggest that, as early as age 9-10, perceived support from close friends may serve as an ongoing resource for children confronting stressful situations, and be associated with lower cortisol stress responses. The same effects were found in adolescents, consistent with the importance of peers during this developmental stage.

### Self-disclosure and Perceived Responsiveness in Youth with Asthma: Links to Gene Expression and Psychological Well-being

Ledina Imami, M.A., Department of Psychology, Wayne State University, Detroit, Michigan, Sarah Stanton, Ph.D., Department of Psychology, University of Edinburgh, Edinburgh, Edinburgh, United Kingdom, Samuele Zilioli, Ph.D., Department of Psychology and Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, Erin T. Tobin, Ph.D., Henry Ford Health System, Henry Ford Health System, Dearborn, Michigan, Francesca Luca, Ph.D., Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan

Self-disclosure and responsiveness are two key intimacy-building processes that allow us to affiliate with others in ways that make us feel valued, understood, and secure. Emerging evidence suggests that self-disclosure and responsiveness may also have long-lasting consequences for physical health that extend beyond the romantic dyad. Despite the important implications of this line of work, researchers do not have a clear understanding of the conditions under which self-disclosure and responsiveness are more likely to lead to positive health outcomes. The current study examined how the interplay between these two processes affects biological pathways that sustain desirable health-outcomes among youth with asthma.

**Methods:** One hundred and forty two youth (12 -17 year old, 42% female) completed daily diaries throughout four days. Youth reported the extent to which they disclosed to others and rated their interaction partners' responsiveness to their disclosures. In addition, youth also reported the degree of negative and positive affect experienced throughout each day. NR3C1 gene expression was assessed by collecting 8 mL of peripheral blood from each youth after the daily diary period.
**Results:** Results revealed that among youth who disclosed more frequently, higher levels of perceived responsiveness were associated with higher levels of anti-inflammatory glucocorticoid receptor gene NR3C1 expression. Gender showed a moderating effect on responsiveness, such that higher levels of perceived responsiveness were linked with higher levels of NR3C1 expression in females but not in males. In terms of psychological well-being, findings revealed a significant interaction between self-disclosure and responsiveness for positive affect only. Higher levels of responsiveness were linked to higher levels of positive affect and this relationship was stronger among youth who engaged in self-disclosure more frequently.

**Discussion:** These findings are among the first to identify a molecular pathway through which intimacy-building processes can potentially impact immune responses and health outcomes in youth with asthma. In addition, our findings also suggest that the benefits of self-disclosure and responsiveness are not confined to adult romantic couples, but can have an important influence for both physical and psychological health throughout late childhood and adolescence.

Individual Abstract Number: 1256

Partner Responsiveness Predicts All-Cause Mortality via Daily Negative Affect Reactivity: A 20-Year Longitudinal Study

Sarah Stanton, Ph.D., Department of Psychology, University of Edinburgh, Edinburgh, Edinburgh, Emre Selcuk, Ph.D., Department of Psychology, Middle East Technical University, Ankara, Ankara, Turkey, Allison K. Farrell, Ph.D., Richard B. Slatcher, Ph.D., Department of Psychology, Wayne State University, Detroit, Michigan, Anthony D. Ong, Ph.D., Department of Human Development, Cornell University, Ithaca, New York

**Background:** Research has demonstrated that individuals with positive close relationships have a lower risk of death. Over and above simply being socially integrated, the quality of individuals' close relationships is an especially meaningful predictor of long-term health. The specific elements of relationship quality linked to health and longevity are not yet fully understood; however, growing evidence indicates that partner responsiveness—the extent to which people feel understood, cared for, and appreciated by their romantic partners—is positively linked to health and longevity. The effects of partner responsiveness may partly stem from its capacity to down-regulate reactivity to stressful events.

**Purpose:** This study tested longitudinal associations between partner responsiveness, negative affect (NA) and positive affect (PA) reactivity, and all-cause mortality in a sample of 1,208 U.S. adults over three waves of data collection spanning over 20 years.

**Method:** Participants completed measures of partner responsiveness at Wave 1 and Wave 2. At Wave 2, participants also completed an 8-day daily diary study wherein each day they reported whether they had experienced a number of common daily stressors, as well as their NA and PA. Names of participants who could not be contacted for a follow-up survey at Wave 3 were submitted to the National Death Index to ascertain if participants were deceased.

**Results:** Increases in partner responsiveness from Wave 1 to Wave 2 (10-year follow-up) predicted lower NA (but not PA) reactivity to daily stressors at Wave 2, which, in turn, predicted lower mortality risk a decade later (Wave 3). Results held when controlling for a number of demographic, health, and psychosocial factors.

**Discussion:** These findings provide some of the first direct evidence of psychological mechanisms underlying the links between marital relationships and mortality as well as the capacity for changes in partner responsiveness over time to be linked with long-term health. Partner responsiveness is a tractable and potentially modifiable target for marital therapy that could lead to beneficial reductions in negative reactions to daily stressors as well as improvements in health. Thus, a logical next step for future studies is to test interventions that promote an increase in partner responsiveness immediately and over time.

Individual Abstract Number: 1029

Social (dis)Connection and Mortality Risk: A more Nuanced Approach Needed for Effective Interventions?

Julianne Holt-Lunstad, Ph.D., Department of Psychology, Timothy B. Smith, Ph.D., Department of Counseling Psychology, Devin Peterson, B.S., Department of Psychology, Brigham Young University, Provo, Utah

Accumulating epidemiological data documents the association between social connection and longevity, but important questions remain regarding how to translate this to interventions aimed at risk reduction. Therefore, we examine meta-analytic data to address this issue.

**Methods:** We will first briefly present data from two previous meta-analyses establishing the overall association between social connection and survival odds (N=308,849) and the overall effect of social deficits on mortality risk (N=3,407,134). Then we will present data from a current meta-analysis examining the overall magnitude of mortality risk reduction among social support interventions in clinical populations-- including 39 clinical trials and 14 non-experimental studies (N=19,648).

**Results:** The previous meta-analyses reveal the magnitude of the effect of social connection and isolation is robust and rivals that of other leading health indicators; however, data from the intervention meta-analysis reveals a relatively modest effect for reducing mortality risk. Among studies examining discrete endpoint the OR = 1.21 (CI=.94-1.55; ns) and those examining time to death the HR = 1.32 (CI = 1.11-1.57; p < .002).

**Discussion:** These findings suggest potential problems in translating observational data into effective interventions. Specifically, we will highlight gaps in the currently literature and point to potential limitations of current intervention approaches. We will conclude by discussing the potential implications of considering responsiveness to individual needs and desires (and when needs may not match desires) to increase effectiveness.

Symposium 1051

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

Neuromodulation of emotion, cognition and behavior

Andreana P. Haley, Ph.D., Psychology, The University of Texas at Austin, Austin, TX, Sarah Prinsloo, Ph.D., General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, Andreana P. Haley, Ph.D., Psychology, The University of Texas at Austin, Austin, TX, Asli Demirtas-Tatlidede, M.D., Neurology, Istanbul University, Istanbul, N/A, Turkey

Millions of patients all over the world suffer the emotional, cognitive, and behavioral consequences of chronic illnesses such as cancer, cardiovascular diseases, stroke, psychiatric disorders, and dementia among others. While an ideal intervention for any of these conditions will restore each disordered physiological system to its original state, that is often not possible. Pharmacotherapies provide some symptom relief, but not infrequently add their own emotional, cognitive, and behavioral side effects. Neuromodulation through non-invasive means can be used to mobilize technology to advance health, to treat and enhance quality of life in individuals who suffer with persistent pain, spasticity, mood disorders, and cognitive impairment. This symposium is intended to provide an overview of several available tools for neuromodulation and some of their applications in treating disordered emotion, cognition, and behavior. Discussed neuromodulation tools will include electroencephalogram (EEG) neurofeedback (NF), transcranial low level light/laser therapy (LLLT), and repetitive transcranial magnetic stimulation (rTMS).
**Individual Abstract Number:** 1564

**Electroencephalographic (EEG) Neurofeedback to Treat Physical and Emotional Conditions: A Brain-Computer Interface to Regulate Brain Activity**

Sarah Prinsloo, Ph.D., General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Brain changes due to physical and emotional challenges have been well documented and are commonly measured via functional brain imaging techniques such as positron emission tomography and functional magnetic resonance imaging. However, the potential to measure temporal dynamics are often lost with these modalities. Because EEG imaging via quantitative EEG (qEEG) and Low Resolution Electromagnetic Tomography (LORETA) better measure temporal dynamics, we gain information about location and timing of brain function associated with symptoms. With advancement of technologies listed under the umbrella of 'brain-computer-interface', neuromodulatory techniques are becoming increasingly common as a symptom management tool for a variety of medical conditions. Although modifying the source of perception of the symptom, the brain, has been shown to relieve symptoms, these techniques are not yet the standard of care. For example, EEG neurofeedback (NFB) has been used successfully to treat a variety of health issues including pain, anxiety, and learning disabilities. NFB takes advantage of the learning process by providing 'feedback' to the participant about the workings of their own brain in real time while the participant plays a video game designed to reward brain change.

This presentation will focus on neuromodulation through NFB and will review imaging and treatment findings from the most recent studies regarding pain, mental health, and learning disabilities. A brief demonstration of EEG neurofeedback will be given.

**Individual Abstract Number:** 1561

**Neuromodulation of Cognition through Transcranial Laser Stimulation**

Andreana P. Haley, Ph.D., Douglas Barrett, Ph.D., Enrique Vargas, H.S., Psychology, Evan Pasha, M.A., Hirofumi Tanaka, Ph.D., Kinesiology and Health Education, Francisco Gonzalez-Lima, Ph.D., Psychology, The University of Texas at Austin, Austin, TX

**Background:** Cognitive impairment is the number one predictor of poor quality of life and loss of independence in the elderly. Decline in neurocognitive functions is often associated with highly prevalent chronic conditions such as cardiovascular disease and diabetes, thus impacting a great number of older adults, even those not suffering from dementia. While restoring cardiovascular health would be an ideal intervention in these cases, that is often not feasible and seeking alternative treatments to maintain and enhance cognitive function is of utmost importance. In this presentation, we will present data regarding the feasibility and efficacy of enhancing neurocognitive performance in the elderly through photoneuromodulation using non-invasive transcranial infrared laser to deliver low-power and high-fluence photonic energy to stimulate neuronal oxidative energy metabolism.

**Methods:** Twelve older adults (ages 49-90, median 54) underwent four weeks of transcranial laser stimulation. The psychomotor vigilance test (PVT, sustained attention) and the delayed match-to-sample test (DMS, working memory) were the primary outcome measures. Treatment consisted of applying light of a specific wavelength (1064 nm) using a laser diode supplied by Cell Gen Therapeutics, LLC (CG-5000 laser, HD Laser Center, Dallas, TX, USA). Each session included eight 1 min/cycle treatments alternating between two locations on the right forehead (right frontal polar and right midfrontal), each 4 cm in diameter. Each location was exposed to an irradiance (or power density) of 250 mW/cm² (3400 mW/13.6 cm² = 250 mW/cm²) for 4 min (3.4 W × 240 s = 816 J/location), which corresponds to a cumulative fluence (or energy density) of 60 J/cm²(0.25 W/cm² × 240 s = 60 J/cm²).

**Results:** Paired t-tests indicated a significant improvement after a Single Session vs. Baseline for PVT reaction time (p<0.05), PVT failures (p<0.001), and DMS correct responses (p<0.05). Paired t-tests conducted on Baseline vs. 4 Weeks of Treatment were significant for PVT reaction time (p<0.001), PVT failures (p<0.01), and DMS correct responses (p<0.05).

**Conclusion:** The present study demonstrates both within session and across session benefits of transcranial laser stimulation in older adults.

**Individual Abstract Number:** 1289

**Repetitive Transcranial Magnetic Stimulation for Regulation of Affect, Mood and Emotio**

Asli Demirtas-Tatlildede, M.D., Neurology, Istanbul University, Istanbul, N/A, Turkey

Repetitive transcranial magnetic stimulation (rTMS) is a novel noninvasive technique that employs rapidly fluctuating magnetic fields in order to regulate activity and enhance neuroplasticity within specific brain networks. Depending on the stimulation settings and number of applied sessions, rTMS-induced effects last beyond the time of application. In the last decade, this important feature led to its investigation as a treatment modality for neuropsychiatric diseases and numerous studies have been completed with promising results. In the clinical context, rTMS has been demonstrated to enhance induction of alterations in neural networks subserving affect, mood and emotion in several affective and cognitive disorders. Most prominently, large-scale studies have been carried out on the use of rTMS for treatment of major depressive disorder and recent meta-analyses of randomized-controlled studies confirmed the efficacy of repetitive transcranial magnetic stimulation in acute treatment of depression.

This presentation will focus on the neuromodulatory potential of repetitive transcranial magnetic stimulation with reference to findings from recent studies regarding affect, mood and emotion. A critical assessment of the available research on the symptomatology of depression, schizophrenia, autism, attention deficit and hyperactivity disorder will be provided. The perspectives of individually-tailored and neuronavigation-guided TMS, functionally relevant new target regions and innovative stimulation protocols for therapeutic effectiveness will be discussed.

**Symposium 1066**

Thursday, March 16 from 2:00 - 3:15 pm

**Harnessing mHealth Technology to Advance Intervention Research on Stress, Addiction, and Mental Health Disorders**

Mustafa al'Absi, Ph.D., Biobehavioral Health, University of Minnesota Medical School, Minneapolis, MN, Inbal (Billie) Nahum-Shani, Ph.D., Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA, Andrine Lemieux, Ph.D., Biobehavioral Health, University of Minnesota, Duluth, Minnesota, David W. Wetter, Ph.D., Population Health Sciences, University of Utah, Salt Lake City, Utah, Joel Swendsen, Ph.D., National Center for Scientific Research, University of Bordeaux, Bordeaux, Bordeaux, France, Emre Ertin, Ph.D., Electrical Engineering, Ohio State University, Columbus, Ohio Advancements in the field of mobile and wireless technologies provide a strong potential to transform health care. Leveraging advances in mobile technologies and applications to improve assessment and intervention strategies provides exciting opportunities to scientists and clinicians in behavioral health. This symposium will focus on novel evidence related to the use of recent technological innovations in the context of stress, addiction, and mental health assessment and intervention. The symposium will include the use of multiple technologies, including mobile phones, wearable sensors, and software applications in laboratory and field studies.
Presenters will focus on the following **themes**: 1) using real-time, real-world assessments of stressors and smoking lapse likelihood with a focus on assessment of minority specific stressors, such as discrimination; 2) developing novel applications for wearable sensors capable of unobtrusive measurement of stress physiology and smoking behavior; 3) using such technology for implementing "just-in-time" adaptive interventions (JITAI) for stress-management; and 4) reviewing the vast opportunities, challenges, and risks associated with the use of mobile technologies for research and treatment in the area of stress, addiction, and mental health.

The symposium will **conclude** with a discussion that will cover challenges in using mHealth in the context of stress and addictive behaviors, and opportunities for developing existing technologies to be used in delivering real-time interventions to mitigate the impact of stress on addictive behaviors and mental health problems. Future opportunities for intervention research, integration of these technologies with online social networks, using a team science approach will also be discussed.

**Individual Abstract Number: 1070**

**Unobtrusive Measurement of Stress and Smoking Psychophysiological Markers in the Natural Environment**

Andrine Lemieux, Ph.D., Biobehavioral Health, University of Minnesota, Duluth, Minnesota, Motohiro Nakajima, PhD, Biobehavioral Medicine and Population Science, University of Minnesota, Minneapolis, MN, Soujanya Chatterjee, BE, Hillol Sarker, MS, Nazir Saleheen, MS, Computer Science, University of Memphis, Memphis, TN, Emre Ertin, PhD, Electrical and Computer Engineering, Ohio State University, Columbus, OH, Santosh Kumar, PhD, Computer Science, University of Memphis, Memphis, TN, Mustafa al'Absi, PhD, Biobehavioral Medicine and Population Science, University of Minnesota, Duluth, MN

Applications of wearable sensors that are capable of unobtrusive measurement of stress and smoking could provide novel information on the various conditions in which smokers use tobacco in the natural environment. One such application is AutoSense, which consists of a respiration band, sensor probes (e.g., ECG), wrist bands with 6-axis inertial sensors, and a mobile phone. AutoSense continuously monitors physiological activity, subjective states, and environmental information. In our ongoing research examining physiological and psychosocial markers of stress and smoking (N = 72), we conducted two preliminary projects to validate machine learning algorithms called *cStress* and *puffMarker*. The *puffMarker* is a model to detect smoking puffs in the natural environment (Saleheen et al., 2015). It uses data from two wearable sensors: a respiration band and two wrist bands. A smoking event is detected when the participant demonstrates the combined hand movements and respiratory cycles consistent with smoking. The rate of match in classifying lapse and no-lapse was 87% in *puffMarker* vs. retrospective interview, and 76% in *puffMarker* vs. Ecological Momentary Assessment. *cStress* is a computational stress model which estimates levels of the wearer's stress using physiological and subjective data. In past field studies the recall of signals was 89% and the rate of false positives 5%, while the accuracy 72% when compared with self-reports. Using *puffMarker* to define relapse in a field study requiring 72-hour abstinence, abstinent participants showed a progressive rise in *cStress* over the 72 hour abstinence (p = .02) while lapsers showed no change at all. *cStress* during pre-quit period correlated positively with depressive affect (p = .008). High *cStress* was moderately associated with fewer cigarettes per day (p = .009), which was specific to abstainers (p = .01) but not relapsers (p > .10). These results provide initial evidence that AutoSense and the machine learning algorithms could contribute to the assessment of stress and smoking relapse in the field in clinically relevant populations.

**Individual Abstract Number: 1068**

**Acute Stressors, Discrimination, and Smoking Lapse Likelihood Among Underserved Groups**

David W. Wetter, Ph.D., Cho Lam, PhD, Population Health Sciences, University of Utah, Salt Lake City, Utah, Christine Vinci, PhD, Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, Aaron Haslam, BA, Psychology, Texas Tech University, Lubbock, Texas, Liang Li, PhD, Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas

Several conceptual models posit that greater exposure to stressors is a key mechanism linking underserved status to lower rates of smoking cessation. Surprisingly, there are only a handful of studies examining the impact of acute stress on real time, real world cessation outcomes, and to the best of our knowledge, none that examine the acute effects of minority specific stressors such as discrimination. Two longitudinal cohort studies examined the influence of acute stressors on the likelihood of smoking lapse. In both studies, smokers received smoking cessation treatment (behavioral, patch) and were tracked both pre- and postcessation using Ecological Momentary Assessments (EMA). The first study included 364 predominantly low socioeconomic status smokers evenly split among African Americans, Latinos, and Whites. Participants reported the presence of a new stressor in 3%, an ongoing stressor in 10%, and both new and ongoing stressors in 31% of EMAs. The presence of any stressor (new OR=2.1, p<.001; ongoing OR=1.4, p=.003; both OR=1.8, p<.001) increased the likelihood of a lapse in the next 4 hours, even after controlling for smoking in the previous 4 hours. There was no synergistic effect of experiencing both new and ongoing stressors. The second study examined the impact of acute discrimination on lapse likelihood among 159 Spanish speaking Latino smokers. Participants reported that they were certain they had experienced discrimination in <1% of EMAs. The presence of discrimination increased the likelihood of a lapse in the next 4 hours (OR=6.1, p<.03), even after controlling for smoking in the previous 4 hours. The results from these studies suggest that acute stressors place underserved populations at greater risk for poor cessation outcomes. Ongoing research is building on these data using state of the science methodologies such as AutoSense and geographic positioning system (GPS). AutoSense tracks behavioral and physiologic data in real-time and can objectively detect when an individual smokes or encounters a stressor. GPS permits real-time spatial mapping, which can be paired with EMA and Autosense, and with relevant environmental exposures (e.g., tobacco outlets; area-level poverty).

**Individual Abstract Number: 1067**

**Stress-management just-in-time adaptive interventions: opportunities and challenges**

Inbal (Billie) Nahum-Shani, Ph.D., Institute for Social Research, University of Michigan, Ann Arbour, Michigan, Bonnie J. Spring, PhD, Preventive Medicine (Behavioral Medicine), Psychiatry and Behavioral Sciences and Weinberg College of Arts and Sciences, Northwestern, Chicago, IL, Susan A. Murphy, PhD, Department of Statistics and Institute for Social Research, U of Michigan, Ann Arbor, Michigan

The use of smartphones to prevent and support the treatment of addictions and other chronic disorders is increasing rapidly. Mobile and wearable devices facilitate the delivery of Just-In-Time Adaptive Interventions (JITAIs)—an intervention design in which the timing and type of support are adapted over time to address rapid changes in an individual's state and context. More specifically, JITAIs operationalize the personalization of the real time selection, and real time delivery, of intervention options based on real time assessments (e.g. just-in-time personalized medicine). A JITAI approach can help individuals better regulate stress; where stress is defined here as a state in which an individual's homeostasis is threatened by adverse conditions. First, although empirical evidence suggests that brief emotion-regulation exercises, such as those based on mindfulness approaches, are effective; empirical evidence also suggests that individuals rarely use these exercises to regulate stress in real-life. Hence, providing just-in-
time recommendations to engage in these exercises might be beneficial. Moreover, providing emotion-regulation interventions when stress arises in the person's natural environment can help him/her better identify and address "hot" or emotionally laden situations and bounce back quickly form stressful situations. Capitalizing on such "teachable moments" can support the learning of emotion regulation skills. Despite the potential of the JITAI approach for supporting stress management, most current empirical evidence and health behavior models fail to provide the dynamic theory necessary for guiding when and how to provide support so as to help individuals better regulate stress experiences, as they occur in real-life. Here, we will review the key elements of JITAI, using an example of a stress-management JITAI – Sense2stop—to guide the discussion. Currently under development, Sense2stop is designed to help individuals attempting to quit smoking regulate real-time experiences of stress in order to prevent stress-induced lapses. Open scientific questions concerning the development of this JITAI will be reviewed, and directions for future research aiming to advance the science of JITAI for supporting stress management will be discussed.

**Individual Abstract Number: 1069**

**The Huge Benefits, and Enormous Risks, of Mobile Technologies for Research and Treatment**

Joel Swendsen, Ph.D., National Center for Scientific Research, University of Bordeaux, Bordeaux, Bordeaux, France

The use of mobile technologies in mental health research has expanded exponentially over the past two decades, and these applications are increasingly used for treatment purposes. Using substance addiction as an illustration, this talk will demonstrate how mobile technologies overcome two traditional methodological barriers in research that have been long-acknowledged but remain poorly mastered. The first barrier is that of time, whereby the mechanisms underlying the expression of symptoms often have a very brief 'life cycle' spanning periods of seconds to hours, but are paradoxically studied in most clinical research protocols over periods of weeks or months. The second barrier is that of context, in that while some laboratory or hospital research protocols may be able to overcome temporal constraints, they are limited to assessments in the same environment each time. Mobile technologies overcome both limitations in order to investigate the expression of clinical phenomena in real-time and in the daily lives of patients. This approach can also be personalized to each patient in order to understand their unique risk and protective factors. However, despite the enormous benefits of this methodology for research purposes, its application to clinical treatment poses complex questions. Indeed, mobile technologies have the capacity to provide reminders and interventions at the very moment that they are most needed by patients, but they also have substantial limitations that may be counterproductive and, at times, dangerous.

**Symposium 1088**

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

**Early Life Adversity Predicts Coronary Heart Disease: Evidence, Mechanisms and Implications**

Richard Lane, M.D., Ph.D., Psychiatry, University of Arizona, Tucson, AZ, Eric B. Loucks, PhD, Epidemiology, Brown University, Providence, Rhode Island, Shaoyong Su, PhD, Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia, Christine Power, PhD, Population, Policy and Practice Programme, University College London, Great Ormond Street Institute of Child Health, London, -, UK, Christoph Herrmann-Lingen, MD, Psychosomatic Medicine & Psychotherapy, Univ. of Göttingen Medical Center, Göttingen, Nds, Germany

Stress, depression, anxiety, hostility, social isolation and adult socioeconomic status are established predictors of morbidity and mortality in coronary heart disease (CHD). A less well known and less appreciated area for which compelling evidence is emerging is the effect of early life adversities (disadvantage, abuse and neglect) on risk for CHD in adulthood. The first speaker will present compelling evidence from several large epidemiological studies showing that early adversities increase risk for incident CHD and mortality in adulthood. The second speaker will review evidence from human and experimental animal studies showing that stress in early life compromises endothelial function and blood pressure regulation. The third speaker will present evidence from the 1958 British Cohort study showing that a variety of early adversity factors predict risk factors for cardiometabolic disease, including obesity, dyslipidemia, hyperglycemia and inflammation. Each speaker will discuss implications for preventive intervention efforts to counteract the effects of early adversity. The discussant will address the adaptations that occur in the context of early adversity that predispose to physiological dysregulation and later heart disease, the implications of the current findings for clinical intervention and treatment, and the most pressing needs for future research in this area.

**Individual Abstract Number: 1142**

**Associations of adverse childhood experiences with cardiovascular disease incidence and mortality: An overview with implications on providing stronger tests for causality.**

Eric B. Loucks, PhD, Epidemiology, Brown University, Providence, Rhode Island

There is increasing evidence that Adverse Childhood Experiences (ACEs) predict cardiovascular disease (CVD) incidence and mortality, although methods to date have limitations, and effect sizes are somewhat variable. For example the ACE Study of 17,337 participants demonstrated an odds ratio of 3.6 (95% CI: 2.4-5.3) of ischemic heart disease for those with ≥7 vs. 0 ACEs. A prospective population-based study in Finland (n=23,916) found significant positive linear trends between number of ACEs and risk of incident, confirmed CVD cases; evidence was stronger in females than males. The prospective Nurses' Health Study (n=66,798) found, for those with severe vs. no physical abuse, hazard ratios of 1.46 (95% CI: 1.11, 1.92) for CVD events. A United States nationally representative telephone survey collected exposure information on ACEs from 53,998 adults in 10 US states and District of Columbia, and found that exposure @7 vs. 0 ACEs was associated with 3.8 (95% CI: 1.9, 7.8) higher odds of self-reported coronary heart disease. Details on the quality and quantity of evidence for the relation of ACEs with CVD incidence and mortality will be provided, with implications of ways forward to provide stronger tests for causality. One direction forward that will be emphasized includes randomized controlled trials customized to participants with ACEs. Evidence will include that from randomized controlled trials evaluating impacts of mindfulness-based interventions, showing differential effects between participants with low vs. high ACEs. New data will be shown, demonstrating in a clinical trial of Mindfulness-Based Blood Pressure Reduction, evidence of faster reductions in blood pressure for those with ≥2 vs. <2 ACEs.

**Individual Abstract Number: 1182**

**Endothelial Dysfunction, a Potential Mechanism Linking Early Life Stress and Cardiovascular Disease**

Shaoyong Su, PhD, Pediatrics, Augusta University Medical College of Georgia, Augusta, Georgia

Adverse environments in early life have been consistently associated with increased risk of cardiovascular diseases in later life, including hypertension. Recently, we have shown that young adults who were exposed to multiple adverse childhood experiences (ACEs) displayed an earlier onset of elevated BP compared to their counterparts without a history of ACEs, measured by the casual BP. Furthermore, using 24 hour ambulatory BP data collected from a longitudinal youth cohort,
we found that individuals exposed to ACEs showed altered BP regulation in real life, with increased BP variability in daytime and persistently high BP levels during nighttime. However, the underlying mechanism remains unclear. Study in rats showed that maternal separation, a rodent model of early life stress, induced increased circulating endothelin-1 (ET-1) levels, as well as BP reactivity through the ET-1 pathway. ET-1 is well known as a potent vasoconstrictor with inotropic and proinflammatory properties. Furthermore, in a study of 221 healthy adolescents and young adults, we found graded associations of ACE exposure with plasma ET-1 levels, which were on average 18% and 24% higher in participants with 1 ACE and ≥2 ACEs, respectively, vs. those without ACEs (P=0.001). Dysregulation of the endothelin pathway is considered to occur early during development of atherosclerosis and vascular complications. Elevated plasma ET-1 levels have been found in patients with coronary heart disease, heart failure, and pulmonary arterial hypertension. These studies suggest that altered endothelial function may in part underlie the link between early life stress and development of cardiovascular disease. We will review the evidence from human and experimental animal studies to indicate how stress in early life compromises endothelial function. Some new data and preliminary results from our longitudinal youth cohort will be presented.

**Individual Abstract Number: 1155**

**Early life adversities and risk factors for cardiometabolic disease: a population cohort followed to mid-life.**

Christine Power, PhD, Population, Policy and Practice Programme, University College London, Great Ormond Street Institute of Child Health, London, -, UK

Early life adversities (ELAs) are suspected to lead to cardiometabolic outcomes, such as ischaemic heart disease mortality. Attention has now turned to establish the full extent of long-term outcomes and associated mechanisms. One problem in research to date is the inter-relatedness of ELAs, hence many studies examine cumulative types of adversity. Whilst emphasising the increased health burden of those with multiple ELAs, the cumulative adversities approach is limited for the purpose of understanding mechanisms as we cannot assume that mechanisms operating are the same for a range of ELA-adult outcome associations. To shed light on mechanisms, the aim of this work is assess (i) whether specific ELAs namely, neglect and different forms of abuse, are related similarly to cardiometabolic intermediate phenotypes and (ii) whether explanations for child-adult outcome relationships differ. Data are from a general population birth cohort (N=10,000) in the UK with information collected during child and adulthood to age 50y. Child neglect, physical, psychological and sexual abuse were associated with dyslipidemia and, except for psychological abuse, also with raised glycated haemoglobin. After adjustment for other early life factors (birthweight and early life socio-economic position) associations for neglect and abuse were modest. For example, physical abuse was associated with an increased risk of elevated LDL-cholesterol (odds ratio 1.24 (95% CI 1.00,1.55) and psychological abuse with increased risk of elevated triglycerides (OR=1.23(1.03,1.46)). ELA groups differed from their contemporaries in terms of their lifetime development of adiposity, mental health and adult lifestyles: e.g. 32 to 47% of maltreated (neglect and abuse) females were smokers at 50y vs 20% of non-maltreated (p<0.001). After adjusting for these factors associations of ELAs and mid-life lipid and glucose measures were no longer evident; lifestyle differences were particularly important in explaining associations. By examining child neglect and abuse independent of other ELAs, notably economic disadvantage and poor prenatal development, our study suggests some modest specificity of child neglect and abuse associations with mid-life lipid and glucose metabolism. Implications for future research directions and interventions will be outlined.

**Symposium 1187**

Thursday, March 16 from 2:00 - 3:15 pm

**Current Directions in SES Disparities Research: Socio-emotional and physiological mechanisms.**

Meanne Chan, PhD, Psychology, University of Toronto, Toronto, Ontario, Canada, Jenny Cundiff, PhD, Psychological Sciences, Texas Tech University, Lubbock, TX, United States of America, Frederick K. Ho, PGDE, Pediatrics and Adolescent Medicine, University of Hong Kong, Pokfulam, Hong Kong, Hong Kong, Meanne Chan, PhD, Psychology, University of Toronto, Toronto, Ontario, Canada, Kharah M. Ross, PhD, Psychology, University of California Los Angeles, Los Angeles, CA, United States of America, Jennifer Morozink Boylan, PhD, Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado

The robust socioeconomic gradient in wellbeing and health outcomes has garnered extensive mechanistic research in the past two decades. The objective of this symposium is to further contribute to this literature by examining novel pathways across distinct socio-emotional and physiological domains. This symposium will bring together data from different developmental periods across the life course (e.g., adolescence, motherhood) and cultural backgrounds, and includes both longitudinal and meta-analytic results. One study shows, using two waves of longitudinal data, that factors such as sleep, physical activity, and parenting style may link socioeconomic position to socio-emotional functioning. Another study will present data showing that aspects of socio-emotional functioning, such as emotion regulation as well as implicit theory of emotions, may foster social mobility and attenuate the association between lower socioeconomic position and higher inflammatory biomarkers in a sample of adolescents. A third study will examine cardiometabolic risk during pregnancy and its relation to postnatal outcomes in a racially and socioeconomically diverse sample of women. The fourth and final study will present a systematic review and meta-analysis examining whether cardiovascular reactivity is a viable mechanism for explaining how low socioeconomic position “gets under the skin” to influence cardiovascular health. Findings add to the current understanding of mechanisms connecting socioeconomic disadvantage to health across development, and provide new insights into viable targets for intervention.

**Individual Abstract Number: 1190**

**Widening socioeconomic gap in child development and multi-domain mechanisms: Chinese kindergarten cohort study**

Frederick K. Ho, PGDE, Pediatrics and Adolescent Medicine, Nirmala Rao, PhD, Faculty of Education, University of Hong Kong, Pokfulam, Hong Kong, Hong Kong, Meanne Chan, PhD, Psychology, University of Toronto, Toronto, Ontario, Canada, Ko Ling Chan, PhD, Social Work and Social Administration, Patrick Ip, MPH, Paediatrics and Adolescent Medicine, University of Hong Kong, Pokfulam, Hong Kong, Hong Kong

Socioeconomic disparity in cognitive and socioemotional functions already exists in preschool. However, a dearth of longitudinal data tracking the dynamic changes of disparity from preschool to schooling ages has limited the exploration of mechanisms. The current study utilized a cohort sample to address this gap as an extension of Ip et al. (2016), which recruited a population representative sample of 5-year-old Chinese preschoolers. Health behaviours, parenting style, and family functioning dimensions were examined as possible mediators. The cohort was revisited four years after initial recruitment (N=519, Mean age=9.33 years, 55.3% girls, 76.2% retention). The effect of SES on both cognitive and socioemotional functions were relatively small ($\eta^2$=.02, p<.01) in initial recruitment but the effect became stronger at follow-up (cognitive development: $\eta^2$=.09, p<.0001; socioemotional development: $\eta^2$=.05, p<.0001; symptoms of attention-deficit hyperactivity disorder: $\eta^2$=.02, p=.008). Controlling for baseline SES, an upward change in SES also predicted better socioemotional development ($\beta$=-.10, p=.02).
Using path analysis, early exposure to electronic devices and family learning environment were identified as the mediators between SES and cognitive development, which collectively explained 33.6% of the main effect. Similarly, the mediators for socioemotional development were early exposure to electronic devices, regular sleeping habit, sleep quality, authoritarian parenting style, and physical activity level, which explained 73.8% of the main effect. Findings suggest a widened socioeconomic gap among Chinese children, which may be partially explained by behavioural risk factors such as exposure to electronic devices, sleep patterns, and physical activity, as well as family functioning. Comprehensive models exploring risk and resilience processes will be discussed. These diverse mediators serve as potential entry points to tackle vulnerable trajectories with early interventions.

**Individual Abstract Number: 1191**

**Establishing adaptive social capital in the face of risk: Subjective social status, emotion processing, and CVD risk in young adults**

Meanne Chan, PhD, Psychology, University of Toronto, Toronto, Ontario, Canada, Iris Chat, MA, Psychology, Northwestern University, Evanston, Illinois, Meghan Vinograd, MA, Michelle G. Craske, PhD, Madeline Roth, BA, Psychology, University of California Los Angeles, Los Angeles, CA, Gregory E. Miller, PhD, Rick Zinbarg, PhD, Robin Nusslock, PhD, Psychology, Northwestern University, Evanston, IL

**Objectives:** Independent of objective socioeconomic conditions (SES), subjective social status (SSS) has predicted morbidity. However, it has also been suggested that changes in subjective social status can have detrimental effects. The social capital needed for adaptive upward social mobility and reduced health implications remain unclear. This study examined SSS with emotion regulation, implicit theory of emotion, and parental care in a sample of adolescents transitioning to adulthood. Indicators of obesity and systemic inflammation were indexed as early cardiovascular risk.

**Method:** The sample consisted of 113 healthy young adults aged 18 to 19. SSS was assessed with the two versions of MacArthur Scale (nation and community). Re-appraisal vs. suppression regulation approaches was measured with Emotion Regulation Questionnaire. Fixed vs. malleable theories of emotion was assessed by Implicit Theories of Emotion Scale. Parental care during the first 16 years of life was indexed with Parental Bonding Inventory. Obesity dimensions include waist circumference and body mass index. Systemic inflammation was indexed by C-reactive protein (CRP) levels measured from peripheral blood. Age, gender, and ethnicity were included as covariates.

**Results:** Above and beyond objective SES (years of education), higher community SSS was associated with lower waist circumference (b=-.58, t=-1.946, p=.05). Nation SSS interacted with reappraisal tendencies to predict CRP levels (b=.47, t=3.38, p < .05), while community SSS interacted with parental care to predict CRP levels (b=1.27, t=2.47, p < .05). Patterns indicate that CRP levels are the lowest for those individuals higher in SSS but who also use reappraisal approaches to regulate emotion and report greater care from parents during childhood. On other hand, marginal interactions emerged between nation SSS and the entity subscale of Implicit Theory of Emotion (b=-.14, t=-1.97, p < .10), such that those individuals higher in nation SSS but reported a more fixed theory of emotion had higher levels of CRP.

**Conclusions:** These findings point to domains of emotion processing that help explain how subjective social status can buffer against health implications associated with socioeconomic disadvantage, as well as implicit theories that may hinder adaptive social mobility.

**Individual Abstract Number: 1189**

**Race/ethnicity, Socioeconomic Status and Diagnosis with Pregnancy Cardio-metabolic Disorders and Postpartum Cardio-metabolic Risk**

Kharah M. Ross, PhD, Psychology, University of California Los Angeles, Los Angeles, CA, Christine Guardino, PhD, Christine Dunkel Schetter, PhD, Psychology, University of California, Los Angeles, Los

Angeles, CA, Calvin J. Hobel, MD, Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA

Health disparities affect individuals of non-White race and lower socioeconomic status (SES). Pregnancy metabolic complications, although sometimes resolved when pregnancy ends, may “program” a woman’s physiology to increase postpartum cardiovascular disease risk. How factors implicated in health disparities interact with pregnancy metabolic complications to predict postpartum cardio-metabolic risk is understudied, with implications for identifying at-risk women and managing postpartum health. The purpose of these analyses was to assess whether SES, race/ethnicity and pregnancy metabolic disorders interact to predict postpartum cardio-metabolic risk. **Methods.** Women (n=1717; 53% Black) were recruited after birth in 5 US communities. Household income and size defined poverty status: Poor (<Federal Poverty Level [FPL], 43% of sample), near poor (100-200% FPL), low income (>200% FPL). Medical records identified women with a pregnancy metabolic disorder (preeclampsia, gestational hypertension, gestational diabetes). Four biomarkers were collected at 6 and 12 mos postpartum and used to calculate an average postpartum cardio-metabolic risk index: Mean arterial pressure, glycosylated hemoglobin, total cholesterol:HDL ratio, and waist-hip ratio. Covariates were maternal age, pre-pregnancy BMI, parity, health behaviors, breastfeeding and employment status. **Results.** Binary logistic analyses revealed that Black women were 84% more likely to have had a pregnancy metabolic disorder compared to Latina and White. A 3x3x2 ANCOVA revealed a race x poverty status interaction. Low income Black women had greater cardio-metabolic risk compared to poor Black and all Latina and White women. A marginally significant interaction between race/ethnicity, poverty status and pregnancy metabolic disorder further suggested that low income black women who also had a pregnancy metabolic disorder had greater postpartum cardio-metabolic risk compared to all other groups. **Conclusion.** Black women were more likely to have had a pregnancy metabolic disorder compared to non-Black. Low income Black women had greater risk than poor Black and non-Black women, and diagnosis of a pregnancy metabolic disorder exacerbated this risk. These findings echo research reporting inverse SES gradients in Black samples, and how Black women may be disproportionately impacted by cardio-metabolic complications.

**Individual Abstract Number: 1192**

**Socioeconomic Status and Acute Cardiovascular Responses to Stress in the Laboratory: A Systematic Review**

Jennifer Morozink Boylan, PhD, Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, Jenny M. Cundiff, PhD, Psychological Sciences, Texas Tech University, Lubbock, TX, Karen A. Matthews, PhD, Psychiatry, University of Pittsburgh, Pittsburgh, PA

Disparities in health by socioeconomic status (SES) are a pressing public health concern. Individuals with less education, lower incomes, and less prestigious occupations have more adverse biological risk factors and higher rates of morbidity and mortality than more advantaged counterparts. One of the key physiological mechanisms hypothesized to underlie how SES “gets under the skin” to affect poor health is through physiological dysregulation in stress responses systems, including the cardiovascular system. However, empirical evidence examining cardiovascular reactivity and recovery to stress as a mediator of socioeconomic disparities in health has not been systematically reviewed. Building on prior meta-analytic research that greater cardiovascular reactivity and poorer cardiovascular recovery are predictive of adverse cardiovascular outcomes and mortality (Chida & Steptoe, 2010, *Hypertension*; Panaite et al., 2015, *Psychosomatic Medicine*), the current study presents results from a systematic review of the literature on SES and cardiovascular (i.e., blood pressure and heart rate) reactivity and recovery to stress. PubMed and PsycINFO databases were searched, and 28 studies with relevant data were identified after thorough examination. Included studies had at least one
measure of SES and at least one measure of blood pressure or heart rate reactivity or recovery to an acute stressor among adolescent or adult samples (>12 years). Extant data across studies support that lower SES individuals exhibit reliably greater cardiovascular reactivity to stress, although the cumulative difference appears small, and there is notable heterogeneity in effect size. While considerably fewer studies have examined associations between SES and cardiovascular parameters in recovery from stress (n= 9), all but one support that lower SES individuals exhibit delayed recovery or higher blood pressure or heart rate during the recovery window following a stressor. Race is an important moderating factor in understanding the association between SES and cardiovascular reactivity and recovery that will be explored in the forthcoming meta-analysis, in addition to moderation by gender, SES indicator, and stressor type (i.e., physical or psychological). Taken together, results support cardiovascular responses to stress as a pathway underlying socioeconomic health disparities.

Symposium 1219

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

Beat-to-Beat Blood Pressure Variability in a Large, National
Study: Results from the Midlife in the US Study

Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, New York, NY, Tara Gruenewald, PhD, Gerontology, California State University, Long Beach, Long Beach, California, Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, New York, NY, Joshua Sweigert, BS, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, Tara Gruenewald, PhD, Gerontology, California State University, Long Beach, Long Beach, CA, Joseph E. Schwartz, PhD, Medicine, Columbia University Medical Center, New York, NY

For decades, it has been widely recognized that lower heart rate (HR) is associated with reduced morbidity and mortality. But HR is not stable - it fluctuates around the mean, even at rest. Beginning in the 1970's, research began to reveal that these fluctuations were not random noise but rather were organized into distinct periodicities that reflect underlying physiology. Quantification of these oscillations as Heart Rate Variability (HRV) indicates individual variation predictive of cardiovascular disease outcomes in initially healthy community samples. Thus, measurement "noise" in HR is now recognized as a valuable index of cardiovascular health and community studies have begun to explore its relationship to sociodemographic and psychosocial factors to understand the contextual factors that drive risk of CAD.

Today, blood pressure (BP) is in the same position as HR was 40 years ago. While the clinical significance of BP level is widely appreciated, within-subject BP variability (BPV), once dismissed as noise, is now thought to contain valuable information. However, the time scale of BPV measurement (e.g., week-to-week, year-to-year) has typically been much greater than for HRV. But BP also varies on a beat-to-beat basis, in the same frequency range as HRV, and beat-to-beat BPV may hold similar prognostic significance as HRV.

We will present findings from the first large, national study, the Midlife in the U.S. (MIDUS) Study, to collect beat-to-beat BPV and baroreflex sensitivity (BRS) data under conditions of rest and psychological and physical challenge. Presentations will report on sociodemographic (age, race, sex, socioeconomic status) variations in BPV and BRS under resting, challenge and recovery conditions and associations of beat-to-beat BPV and BRS with other autonomic nervous system, cardiovascular and endocrine biomarkers, morbid conditions, cognitive function and mortality. Presentations will highlight how beat-to-beat BPV and BRS variations diminish with advancing age and how greater reactivity and recovery of each are linked to cognitive function and mortality over time.

Individual Abstract Number: 1228

Effects of Age, Sex, And Race on Beat To Beat Blood Pressure
Variability - The MIDUS Study

Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, New York, NY, Paula McKinley, PhD, Medicine, Montefiore Medical Center, Bronx, NY, Teresa Seeman, PhD., Gerontology, UCLA, Los Angeles, CA, Maxine Weinstein, PhD, Graduate School of Arts and Sciences, Georgetown University, Washington, DC, Gayle Love, PhD, Institute on Aging, University of Wisconsin, Madison, WI, Joseph E. Schwartz, PhD, Medicine, Columbia University Medical Center, New York, NY, Tara Gruenewald, PhD, Gerontology, University of Southern California, Los Angeles, CA

Like heart rate, blood pressure oscillates at low (0.04 – 0.15 Hz, LF-BPV) and high (0.15 – 0.40 Hz, HF-BPV) frequency ranges. HF-BPV is the mechanical product of respiration-induced changes in intrathoracic pressure. The physiology of LF-BPV are less clear, with evidence that it may be the product of a central sympathetic oscillator, a resonance phenomenon, or the feedforward product of heart rate variability. Whether BPV is clinically meaningful is unknown, largely because the technical difficulties in noninvasively measuring beat-to-beat BPV have been difficult to overcome. For similar reasons, the effects of age, sex, and race on BPV have not been established. Here, we report analyses of LF-BPV during 11 min of seated rest using data from the Midlife in the US (MIDUS) study. Data were collected as part of a longer psychophysiology testing session.

Spectrally-defined LF-SBPV and LF-DBPV were inversely related to age, with this effect most pronounced for LF-DBPV. In unadjusted and covariate-adjusted models, both SBPV and DBPV were greater in men compared to women. Whites and non-whites did not differ in either measure of BPV. Socioeconomic status, measured either as educational attainment or income, generally was unrelated to BPV.

LF-BPV was significantly but weakly and inversely related to several inflammatory markers and urinary norepinephrine. It was inversely related to HDL cholesterol but positively related to LDL cholesterol. LF-DBPV was also inversely related to HbA1c. Both LF-SBPV and DBPV were inversely related to health condition burden. BPV was higher in hypertensives than normotensives, lower in diabetics than nondiabetics, lower in those with low CRP, and marginally lower in the obese compared to non-obese participants.

Individual Abstract Number: 1230

Beat-to-Beat Blood Pressure Variability and Cognition in the
MIDUS Study

Joshua Sweigert, BS, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, Paula McKinley, PhD, Internal Medicine, Montefiore Medical Center, Bronx, NY, Margie Lachman, PhD, Psychology, Brandeis University, Waltham, MA, Tara Gruenewald, PhD, Gerontology, California State University, Long Beach, Long Beach, CA, Teresa Seeman, PhD, Internal Medicine, UCLA, Los Angeles, CA, Gayle Love, PhD, Gerontology, University of Wisconsin, Madison, WI, Maxine Weinstein, PhD, Epidemiology, Georgetown University, Washington, D.C., Kathleen McIntyre, LCSW, Psychiatry, Jimmy Duong, MPH, Biostatistics, Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, New York, NY

**Background:** Blood pressure variability (BPV), the standard deviation of visit-to-visit measures of systolic and diastolic blood pressure, has been shown to provide meaningful prognostic information on numerous health outcomes, including risk of stroke, coronary artery disease and poorer cognitive performance. Advances in monitoring technology now permit measurement of beat-to-beat blood pressure but few studies have examined relationships between beat to beat variability and clinical outcomes. Here, we report on the relationship between beat-to-
beat blood pressure variability and cognitive function in a large, representative population sample.

**Methods:** 842 subjects (mean age = 54 ± 11 years) from the Midlife in the United States (MIDUS) study underwent a brief cognitive evaluation assessing processing speed, verbal fluency, as well as episodic and working memory, via telephone. In addition, beat-to-beat blood pressure recordings were collected for an 11 minute resting period during a psychophysiological evaluation.

**Results:** Simple regression analyses demonstrated a strong positive association systolic BPV and superior cognitive performance in working memory (p = 0.001) and processing speed (p = 0.001). Diastolic BPV was significantly and positively related to all cognitive domains, including episodic memory (p < 0.001), working memory (p < 0.001), processing speed (p < 0.001), and verbal fluency (p < 0.001). Multivariate regression analyses controlling for demographic (age, sex, education), behavioral (exercise) and clinical (BMI, disease status, medications) covariates yielded similar results.

**Conclusion:** These findings, showing a direct, positive association of beat to beat BPV and cognitive function, contradict the majority of studies showing inverse relationships between visit-to-visit BPV and cognitive performance. However, no studies have directly examined the link between beat-to-beat BPV and cognition in a large, representative sample until now. These novel findings suggest increased beat-to-beat BPV may have a beneficial influence on cognition.

**Individual Abstract Number:** 1229

## The Aging Baroreflex and its Association with Cognitive Function and Mortality Risk

Tara Gruenewald, PhD, Gerontology, California State University, Long Beach, Long Beach, CA, Diana Wang, BS, USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, Paula McKinley, PhD, Medicine, Montefiore Medical Center, New York, NY, Teresa Seeman, PhD, Medicine/Geriatrics, University of California, Los Angeles, Los Angeles, CA, Gayle Love, PhD, Institute on Aging, University of Wisconsin, Madison, Madison, WI, Maxine Weinstein, PhD, Graduate School of Arts and Sciences, Georgetown University, Washington DC, DC, Richard P. Sloan, PhD, Psychiatry, Columbia University Medical Center, New York, NY

Autonomonic nervous system (ANS) dysregulation is hypothesized to play an important role in cognitive and physical health. Accumulating evidence indicates that spontaneous baroreflex sensitivity (BRS), an indicator of cardiac ANS regulation, is linked to cardiovascular disease morbidity and cardiovascular- and all-cause mortality. However, BRS and its health correlates are often assessed in small community or patient samples. The current analyses utilize measures of BRS assessed in a large subsample of 1,097 individuals from the Biomarker Substudy of the Midlife in the United States (MIDUS) Study, a national sample of adults aged 35-84, to examine demographic (age, sex, race, socioeconomic status) variations in BRS and associations with cognitive function and mortality. MIDUS Biomarker Substudy participants visited one of three general clinical research centers in the U.S. for an overnight stay which included a medical exam, biomarker assessment, and a psychophysiology challenge. BRS was assessed during a baseline resting period, during a psychological/cognitive challenge protocol, and during a resting recovery period using the sequence calculation method from continuous Finapress finger arterial blood pressure monitoring. Demographic variables included age, sex, race and an index of life course SES. Cognitive function was assessed with a battery of measures of memory and executive function. Mortality was assessed over a subsequent 5-year follow-up period. BRS was significantly lower in those of older age, in males as compared to females, and in those with lower levels of socioeconomic status. BRS decreased during psychological challenge and rebounded during a recovery phase although challenge-induced BRS modulation was lower in those of older age and lower socioeconomic status. Greater resting BRS was associated with better memory function and greater resting, reactivity and recovery BRS was associated with better executive

function in older individuals. Greater BRS recovery also predicted lower odds of mortality 5 years later. Findings suggest that ANS regulatory capacity as measured via BRS may be an important indicator of risk for age-related health conditions.

## Symposium

1316

Thursday, March 16 from 2:00 - 3:15 pm

## How will the genomics era inform the link between soma and psyche?

Eco J. de Geus, PhD, Biological Psychology, Vrije Universiteit, Amsterdam, NH, Netherlands, Brenda W. Penninx, PhD, Department of Psychiatry, VU medical center, Amsterdam, NH, Netherlands, Viola Vaccarino, MD, PhD, Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, Antonio Terracciano, PhD, Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, Brenda W. Penninx, PhD, Department of Psychiatry, VU medical center, Amsterdam, NH, Netherlands, Eco J. de Geus, PhD, Department of Biological Psychology, Vrije Universiteit, Amsterdam, NH, Netherlands, Peter J. Gianaros, PhD, Department Psychology, University of Pittsburgh, Pittsburgh, PA

Large-scale consortia have successfully used meta-analyses on genome-wide association studies to identify genetic variants that influence traits of importance to Biobehavioral Medicine, including aspects of personality and depression, as well as blood pressure, heart rate and heart rate variability. These genetic variants provide unique opportunities for the APS community.

First, they offer solid candidate genes for use in Gene-by-Stress designs. Second, they can be used to test potential shared biological pathways between psychological and behavioral traits on the one hand, and somatic disease risk factors and outcomes on the other. Third, if a genetic variant, or a combination of multiple variants in a polygenic risk score, explains sufficient variance in a behavioral trait, it can be used to estimate the (non-confounded) causal effect of the behavioural trait on disease outcomes through Mendelian Randomization.

In this symposium we begin with an example of a Gene-by-Stress design using candidate gene testing of stress-induced ischemia (Viola Vaccarino). We then review the main methodological developments in genome-wide association studies and the most recent results of large international consortia focused on the genetics of personality traits (Antonio Terracciano), depression (Brenda Penninx), and heart rate variability (Eco de Geus). Pete Gianaros will discuss the larger impact of these findings for our field.

**Individual Abstract Number:** 1321

## Meta-analysis on genome-wide association studies on heart rate variability

Eco J. de Geus, PhD, Department of Biological Psychology, Vrije Universiteit, Amsterdam, NH, Netherlands

Loss of cardiac vagal control as indexed by low HRV is associated with mortality in patients with cardiovascular disease. Animal research further supports a role for cardiac vagal activity in preventing sudden death and ventricular fibrillation. In addition, hypertension, end-stage renal disease and diabetes are all associated with low HRV. Although the above associations may partly reflect impaired cardiac vagal control caused by these diseases, lowered HRV does not simply indicate disease severity as it also predicts all-cause mortality and cardiac morbidity and mortality in apparently healthy individuals. Large inter-individual differences in HRV exist in the basal resting state. Family and twin studies have uniformly confirmed a substantial genetic contribution to resting HRV with heritability estimates between 25% and 71%. Candidate gene studies based on current knowledge of parasympathetic nervous system biology have not yielded results that hold up in replication.
To improve our understanding of the genetic basis of HRV, we
performed a two-stage meta-analysis of genome-wide association
studies (GWAS) in up to 53,174 individuals of European ancestry on
three HRV traits (the standard deviation of the normal-to-normal inter
beat intervals [SDNN], the root mean square of the successive
differences of inter beat intervals [RMSSD], and the peak-valley
respiratory sinus arrhythmia or high frequency power [pvRSA/HF]).
These HRV traits were measured during resting, basal recordings
ranging in length from ultrashort 10-s ECGs to up to 90 minutes of
sitting or from 2-12 hours of daytime recording. Genome-wide
significant associations were detected in eight loci in 17 SNPs tagging
non-synonymous SNPs (in *NDUFA11* and *KIAA1755*),

eQTLs (influencing *GNG11*, *RGS6*, and *NEO1*), and genes preferentially expressed in the sinoatrial node (*GNG11*, *RGS6*, and *HCN4*). Genetic risk scores accounting for 0.9 to 2.6% of the HRV variance were significantly associated with higher heart rate and lower atrial fibrillation risk, compatible with clinical relevance. These findings provide biological insight into heritable variation in vagal heart rhythm regulation, suggesting a key role for genetic variants that influence G-protein heterotrimer action in GIRK-channel induced pacemaker membrane hyper-polarization.

**Individual Abstract Number: 1320**

Genetics of depression: state-of-the art and implications for psychosomatic medicine

Brenda W. Penninx, PhD, Department of Psychiatry, VU medical center, Amsterdam, NH, Netherlands

Depression is a common condition often examined in the psychosomatic research community. Depression is both a risk factor as well as a consequence of many different somatic conditions. Although there are multiple physiological and behavioral mechanisms that may explain the link between depression and somatic health, there is another route that is much less often considered. This route is genetics. There is evidence that part of the link between depression and somatic health could be due to shared genetic variants that increase both the vulnerability for depression as well as for somatic conditions. The heritability of depression is 35%.

Various recent genome-wide meta-analyses, involving data of amongst others the Psychiatric Genomics Consortium (PGC), the UK Biobank and 23andMe, involving more than 19,000 depression cases and even larger numbers of controls, have revealed for the first time several genome-wide significant genetic variants (e.g. variants in the *OLFM4*, *MEF2C* or *TMEM161B* genes, all p<10⁻⁸). A number of these hits lead to interesting genetic pathways, e.g. in the immunometabolic mechanism, which are also relevant for somatic conditions such as cardiometabolic diseases. In addition, genome-wide analyses allow to test whether, averaged over the genome, there is enriched overlap in the genetic basis of depression and that of various somatic and behavioral conditions. These first analyses show that there is a significant shared genetic overlap between e.g. depression and smoking behavior and obesity. This indicates that genetics contribute to observed links between these conditions.

Finally, genome-wide data have provided us with novel insights into clinical subtypes of depression that have a differential genetic basis. Using recent results from the PGC, other genome-wide meta-analyses and our data from the Netherlands Study of Depression and Anxiety, I will present the newest evidence on significant genetic variants involved in (subtypes of ) depression and to what extent depression does or does not share a genetic basis with a range of somatic and behavioral conditions. This presentation aims to illustrate that genetics informs us about the extent to which genetic pathways are shared between depression and somatic conditions, and to which key underlying physiological mechanisms genetics is pointing us for this.

**Individual Abstract Number: 1319**

Findings from genome-wide association analyses for personality traits

Antonio Terracciano, PhD, Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL

A large literature indicates that major dimensions of personality (neuroticism, extraversion, openness, agreeableness, and conscientiousness) are linked to health behaviors such as cigarette smoking and physical inactivity. There is also robust evidence that personality traits are associated with health conditions such as obesity, chronic obstructive pulmonary disease, and Alzheimer's disease, and that personality traits are strong predictors of mental health outcomes, such as major depression. Despite their relevance for health and well-being, the source of individual differences in personality remains elusive. A genetic component for personality is supported by several lines of research, including the universality of traits in cross-cultural studies and the relative stability of personality in longitudinal studies. Over the past decade, significant advances on the genetics of personality have been made through genome-wide association studies. Meta-analyses inclusive of tens of thousands of participants have recently converged on genome-wide significant hits, especially for neuroticism. The combined results from the Genetics of Personality Consortium and the UK Biobank (max N = 170,911) identified 11 lead SNPs, with the strongest associations found for an inversion-tagging polymorphism on chromosome 8 (p=4x10⁻¹⁶) and one on chromosome 17 (p=6x10⁻¹¹). Given the extremely small effect sizes of the identified associations (max R²= 0.04), independent large samples are still needed to determine whether these associations are replicable. These analyses, however, have made it clear that the genetics of personality is complex, highly polygenic, and no single common variant accounts for a large share of the genetic variance in personality traits. Given the extremely small effect of any single variant, genetic correlations based on genome-wide data have been used to examine shared genetic influences between traits and diseases. These studies have found large genetic correlations between neuroticism and mental health conditions such as major depression. More genotyped or fully sequenced samples will help further advance knowledge on the genetics of personality and on the extent to which the observed phenotypic associations between personality and health are due to shared genetic influences.

**Individual Abstract Number: 1318**

Genetic Determinants of Mental Stress Induced Myocardial Ischemia

Viola Vaccarino, MD, PhD, Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA

**Introduction:** Mental stress-induced myocardial ischemia (MSIMI) is a transient myocardial ischemic response to a standardized mental stress challenge, which is common among patients with coronary artery disease (CAD). MSIMI has a similar prognostic value compared to conventional exercise or pharmacological stress ischemia, with a 2-fold average increased risk of future cardiac events or mortality. Several stress-related mechanisms have been postulated for MSIMI, but the role of genetics in MSIMI occurrence, especially genes involved with ANS and vascular response to stress, have not been studied in detail.

**Methods:** We studied 376 white and 161 black individuals with established CAD. Participants underwent myocardial perfusion SPECT imaging before and after a laboratory mental stress challenge (speech task). MSIMI was defined as a reversible perfusion defect after mental stress compared to the rest scan. Genotyping (Illumina) was performed for 90 candidate genes selected for their known role in stress-responses (38 genes), and those with established association with CAD (52 genes). The analysis was stratified by race and Bonferroni corrected P-value cut-off was set at 5*10⁻⁴.

**Results:** In whites, MSIMI was associated with genetic polymorphisms in three genes: 1) EDN2 gene, coding for endothelin (rs12133441, P = 9*10⁻⁵), 2) PHACTR1 gene, coding for an actin regulator protein involved in endothelial cell survival and previously associated with
CAD (rs2496132, P = 2.5*10⁻⁴), and 3) PDGFD gene that codes for platelet-derived growth factor (rs488753, P = 4.4*10⁻⁴). In blacks, MSIMI was associated with genetic polymorphisms in 1) TRIB1, a gene coding for kinase enzyme involved in cellular function (rs10111919, P = 5.4*10⁻⁵), 2) ADRA1B gene, coding for alpha 1B adrenergic receptor (rs31693, P = 1.9*10⁻⁴), 3) KCNK5 gene, coding for a potassium channel protein (rs4711589, P = 2.7*10⁻⁴), and 4) DBH gene, coding for an enzyme converting dopamine to norepinephrine in sympathetic neurons (rs2428103, P = 2.8*10⁻⁴).

**Conclusion:** Genetic polymorphisms mostly related to vascular responses to stress and previously associated with CAD appear to play a role in MSIMI susceptibility, and these associations are race specific. Future studies are needed to replicate these findings.

## Symposium 1361

Friday, March 17 from 1:15 - 2:30 pm

## eHealth for HIV prevention

Brian Mustanski, PhD, Medical Social Sciences, Northwestern University, Chicago, IL, Brian Mustanski, PhD, Medical Social Sciences, Northwestern University, Chicago, IL, Michael Newcomb, PhD, Medical Social Sciences, Northwestern University, Chicago, IL, Jeffrey T. Parsons, PhD, Psychology, Hunter College, New York, NY, Patrick Sullivan, PhD, DVM, Epidemiology, Emory University, Atlanta, GA

Men who have sex with men (MSM) are disproportionately affected by HIV in the United States (US) and Western Europe. In 2014, MSM accounted for 67% of new diagnoses in the US and 43% of diagnoses in Western Europe (CDC, 2016; WHO, 2015). In the US, young MSM account for 80% of HIV diagnoses among all young people, and Black and Latino MSM account for more than 60% of HIV diagnoses among all MSM (CDC, 2016). In Western Europe, foreign born MSM represent a significant proportion of HIV diagnoses (WHO, 2015). Utilizing eHealth strategies for delivering or supporting behavioral and biomedical HIV prevention research is a promising way to impact populations that are at high risk for HIV infection. Internet and mobile based technologies are tools that may be especially helpful in disseminating interventions that focus on sensitive topics such as sexual behavior and HIV/STIs, and connecting with hard to reach populations (e.g. MSM who are not out, undocumented MSM, and rural MSM). This symposium will give an overview of innovative eHealth approaches that are being used to engage and promote behavior change in MSM. Speaker 1 will present interim behavioral, motivational, and skill outcome data from an ongoing, online HIV prevention randomized control trial for YMSM. Speaker 2 will present on the development of the SMART program, a stepped care package of interventions for adolescent gay and bisexual boys aimed at improving sexual health knowledge, increasing motivation to reduce HIV risk, and teaching skills for preventing HIV acquisitions. The package will be evaluated in an adaptive RCT. Speaker 3 will present preferences of MSM for sexual health features integrated into smartphone apps. Speaker 4 will present data from a smartphone prevention app that promotes uptake of basic HIV prevention services. Through this symposium, we hope to demonstrate the ways in which eHealth interventions can be harnessed to increase access to and dissemination of HIV prevention programs and services.

## References

https://www.cdc.gov/hiv/group/msm/

http://ecdc.europa.eu/en/publications/Publications/hiv-aids-surveillance-in-Europe-2014.pdf

## Individual Abstract Number: 1418

## Interim Outcomes from an Online HIV Prevention Program for Diverse Young Men who Have Sex with Men

Brian Mustanski, PhD, Krystal Madkins, MPH, Medical Social Sciences, Northwestern University, Chicago, IL, Jeffrey T. Parsons, PhD, Psychology, Hunter College, New York, NY, Patrick Sullivan, PhD, DVM, Eli Rosenberg, PhD, Epidemiology, Emory University, Atlanta, GA

Young men who have sex with men (YMSM) are disproportionately affected by HIV. In 2014, YMSM accounted for 80% of HIV diagnoses among all young people (CDC, 2016). Black and Latino YMSM were especially affected, representing 55% and 23%, respectively, of diagnoses among YMSM (CDC, 2016). Despite this burden of HIV, there are few proven HIV prevention programs tailored to diverse YMSM. Keep It Up! (KIU!) was developed in response to this dearth of culturally appropriate evidence-based interventions. It is targeted at YMSM that recently tested HIV negative to capitalize on the clinical interaction as a "teachable moment." KIU! is an on-going RCT based on principles of E-learning and the Information-Motivation-Behavior Skills (IMB) model of HIV risk behavior change. The intervention uses diverse delivery methods (e.g., videos, animation, games) to address HIV knowledge, motivate safer behaviors, teach behavioral skills, and instill self-efficacy for preventive behaviors. HIV negative YMSM were primarily recruited through community-based HIV testing centers in Atlanta, Chicago, and New York as well as local and national ads posted to online sites and dating apps. Participants complete assessments with questions on risk and preventive behaviors at baseline and 3, 6, and 12 months post-intervention. All participants complete distance self-testing for urethral and rectal chlamydia and gonorrhea at baseline and 12 month follow-up. 3-month follow-up data is fully collected and interim results will be reported for condomless anal sex and IMB factors theorized to mediate behavior change. The enrolled sample (n = 901) is diverse: 37% White, 29% Latino, 24% Black, and 10% other or multiracial. The mean age of the sample at baseline was 24.2 years and most participants identified as gay (87%), single (56%), and having at least some college education (88%). At baseline, 3.4% tested positive for urethral STIs and 13% for rectal STIs. Retention 3 months post-intervention was high with 86% of participants completing their assessment. Interim analysis using 3 month follow-up data will be presented. The presentation will report behavioral, motivational, and skill outcome data collected 3 months post-intervention. The data will provide insight into how eHealth interventions such as KIU! may promote behavior change among YMSM.

## Reference:

http://www.cdc.gov/hiv/group/age/youth/

## Individual Abstract Number: 1363

## A Stepped-Care Evaluation of a Package of eHealth HIV Prevention Programs for Adolescent Gay and Bisexual Boys: The SMART Program

Michael Newcomb, PhD, Medical Social Sciences, Northwestern University, Chicago, IL, Eric Laber, PhD, Marie Davidian, PhD, Statistics, North Carolina State University, Raleigh, NC, Carlos Rodriguez-Diaz, PhD, School of Public Health, University of Puerto Rico, San Juan, PR, Kenneth Weingardt, PhD, 4Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, Jeffrey T. Parsons, PhD, Psychology, Hunter College, New York, NY, Brian Mustanski, PhD, Medical Social Sciences, Northwestern University, Chicago, IL

Young gay and bisexual men are at high risk for HIV, and those under age 18 lack access to accurate and comprehensive sex education and prevention services, leaving them particularly vulnerable to HIV acquisition. This lack of access is perhaps most pronounced in minority populations, including racial minorities, native Spanish speakers, and rural residents, because existing programs are not culturally adapted to their needs. eHealth approaches are ideally suited to reaching underprivileged populations due to their broad reach and the ubiquity
of internet use. To address these gaps in education and prevention, we developed the SMART Program, which is a suite of interventions aimed at improving sexual health knowledge, increasing motivation to reduce HIV risk, and teaching skills for preventing HIV. Further, these interventions are culturally and linguistically adapted to meet the needs of racial minorities, native English and Spanish speakers, and urban and rural young men. SMART consists of three empirically-supported interventions: Queer Sex Ed (QSE; online sex education for gay and bisexual boys), Keep it Up! (KIU; eHealth HIV prevention for at-risk youth), and Young Men's Health Project (YMHP; motivational interviewing for sexually risky and substance-using youth administered remotely via video chat). We are utilizing the sequential multiple assignment randomized trial (SMART) design to evaluate the SMART Program. This design mimics real-world clinical care by utilizing a stepped-care approach. Non-responders receive increasingly intensive interventions to maximize efficacy and minimize needed resources (i.e., early responders receive no further intervention). In this trial, all participants receive QSE (comprehensive sex education). QSE non-responders (i.e., continue to engage in HIV risk behaviors) are then randomized to the more intensive KIU eHealth intervention or a control condition. KIU non-responders are further randomized to receive the YMHP motivational interviewing program or control. By trial end, we will describe the optimal staging of intervention content for maximizing efficacy, as well as understand which subgroups benefit most from different treatment combinations. This presentation will focus on describing the SMART Program methodology, emphasizing its potential for optimizing eHealth interventions.

**Individual Abstract Number: 1413**

**Give Them What They Want: Preferences for Sexual Health Apps for Gay and Bisexual Men**

Jeffrey T. Parsons, PhD, Psychology, Hunter College, New York, NY, Ana Ventuneac, PhD, Medicine, Mount Sinai, New York, NY, Steven A. John, PhD, Thomas Whitfield, BA, Center for HIV Educational Studies and Training, H. Jonathan Rendina, PhD, Psychology, Ruben Jimenez, BA, Center for HIV Educational Studies and Training, Hunter College, New York, NY, Krystal Madkins, MPH, Michael Newcomb, PhD, Brian Mustanski, PhD, Medical Social Sciences, Northwestern University, Chicago, IL

**Background:** Gay, bisexual and other men who have sex with men (GBM) use geospatial networking smartphone applications ("apps") to meet sex partners. Integrating sexual health features in apps GBM are already using could be instrumental in reaching those at greatest risk for HIV/STIs. No studies to date have reported the types of features GBM would be willing to use.

**Methods:** Participants (557 GBM) recruited via a sexual networking app completed an online survey, including demographics, sexual behavior, and 9 items on sexual health (e.g., receive STI results) and behavior-tracking features (e.g., daily sexual behavior and substance use). Items were analyzed using the Mann-Whitney or the Kruskal-Wallis rank test. Because sexual health apps will need to be highly adaptable to GBM's needs, predictors of each feature were examined using adjusted logistic regressions.

**Results:** GBM were ages 18-74; most identified as gay (84.6%), Caucasian (74.5%), and reported a negative HIV status (77.4%). Finding LGBT-friendly providers (82.8%) and receiving lab results (67%) and appointment reminders (66.7%) were popular, while tracking and receiving feedback about substance use were less favorable (31.5% and 25.8%, respectively). Overall, 84.5% were interested in features being integrated into apps already used. Younger GBM and those with lower income chose a greater number of features. College educated and F/T employed GBM chose fewer tracking features. Mean rank tests showed that some features were more acceptable among some subgroups (e.g., scheduling visits and receiving medication alerts were ranked higher among GBM of color). GBM reporting recent condomless anal sex had higher odds on willingness to track their sexual behavior (AOR=1.56, 95%CI 1.07-2.28) and receive

medication alerts (AOR=1.89, 95%CI 1.27-2.81). GBM who engaged in group sex had higher odds on willingness to track (AOR=2.73, 95%CI 1.84-4.06) and receive feedback (AOR=1.79, 95%CI 1.22-2.64) about their sexual behavior. However, HIV-positive GBM had lower odds on willingness to receive lab results (AOR=56, 95%CI .31-.98) or visit alerts (AOR=56, 95%CI .31-.99).

**Conclusions:** Intervention approaches integrating sexual health features into existing apps are acceptable to many GBM. A more nuanced understanding of app preferences will help tailor efforts targeting specific at-risk subgroups of GBM.

**Individual Abstract Number: 1423**

**Providing a Basic Package of HIV Prevention Services for At-Risk Men Who Have Sex With Men in the United States**

Patrick Sullivan, PhD, DVM, Epidemiology, Emory University, Atlanta, GA, Joanne Stekler, MD, Medicine, University of Washington, Seattle, WA, Rob Driggers, MSPH, School of Public Health, Emory University, Atlanta, GA, Rob Stephenson, PhD, Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI

The US National HIV/AIDS Strategy aims to reduce new HIV diagnoses among men who have sex with men (MSM) by 25% by 2020. Agent-based modeling suggests that achieving this goal requires reaching 40%-50% of MSM with a package of basic HIV prevention services, including routine HIV and STI testing, distribution of condoms and lubricants, and pre-exposure prophylaxis (PrEP) screening and referrals. We developed a mobile prevention app based on Social Cognitive Theory that included functions of risk assessments, service scheduling modules, and ordering of commodities (home HIV test kits, and condoms and lubricants). We tested the app in 121 Atlanta and Seattle MSM who were HIV-negative or did not know their HIV status and allowed them to use the app for a 4-month period. The median age of all participants was 31 (IQR or range); 49% were non-white; 16% had never been tested for HIV, and 38% did not know of a place to seek HIV testing. Respondents had spent a mean of 17.7 minutes interacting with the app over 4 months. After 4 months, men were invited to complete a survey on their experiences using the app; 99 men (82%) completed the assessment. Subsequent data are from these 99 participants. During this period, 53% of men ordered at-home HIV test kits, of whom 78% reported using the kits; 64% of men ordered condoms and sexual lubricant, of whom 87% reported using the condoms they ordered. 80 met behavioral eligibility for PrEP, of whom 10% reported initiating PrEP during the 4 month period. Of the 8 PrEP initiators, 7 reported that app influenced their decision to start PrEP. Among 69 participants who did not have a plan to test for HIV regularly at the start of the study, 47 (76%) used the app to develop an HIV testing plan. Participants were asked to assess the app using the System Usability Scale, a standard measure of acceptability and usability for which a score of 68 is considered to be above average; the score for the app was 73, indicating above average acceptability and usability. 70% of participants reported that they would recommend the app to a friend. A mobile prevention app for promoting uptake of basic HIV prevention services is acceptable and increased uptake of routine HIV testing and PrEP. We recommend extending the app to offer at-home STI specimen collection kits and broader distribution of the app for MSM.

**Symposium 1415**

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

**Increasing Therapeutic Precision in Psychosomatic Medicine Through N-of-1 Studies**

Ian Kronish, MD, MPH, Internal Medicine, Columbia University Medical Center, New York, New York, Paige Green, PhD, Basic Biobehavioral and Psychological Sciences Branch, National Cancer
Institute, Rockville, Maryland, David Mohr, PhD, Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Karina Davidson, PhD, Medicine and Psychiatry, Columbia University Medical Center, New York, New York, Ian Kronish, MD, MPH, Medicine, Columbia University Medical Center, New York, New York, Nathalie Moise, MD, MS, Medicine, Columbia University Medical Center, New York, New York

This symposium brings together experts in behavioral medicine and clinical trials to explore the rationale, feasibility, and best use cases for N-of-1 studies as innovative approaches to increasing therapeutic precision in psychosomatic medicine. The current method for obtaining the evidence for a psychosomatic therapy is to conduct a definitive, between-patient, Phase III randomized controlled trial (RCT). This between-patient RCT provides evidence that, all other things equal, the therapy tested in one group of patients is better than the placebo or alternative therapy tested in another group of patients. Yet, between-patient RCTs do not provide precise information on which therapy is optimal for individual patients. Rather, they provide an estimate of the average therapy effect, and even for highly efficacious therapies, some proportion of patients receives little benefit or even *even harm*. Thus, we must look elsewhere for study designs that can better identify the optimal, precise treatment for individual patients. This symposium will reveal how N-of-1 study designs can achieve this goal. During the introduction to the symposium, the history of N-of-1 studies will be reviewed, and the relevance of this study design to psychosomatic medicine will be discussed. The first speaker will present the results of a randomized experiment evaluating the effect of providing intermittent exercisers with their personalized predictors of exercise on subsequent physical activity; the personalized exercise predictors were empirically derived using N-of-1 methodologies. The second speaker will describe the results of a systematic review of N-of-1 trials for the treatment of depressive symptoms. Within this presentation, the criteria for more broadly incorporating N-of-1 trials into psychosomatic medicine will be discussed. The third speaker will present the results from a national poll that assessed patient preferences for N-of-1 trials. These data will be used to provide insight on efforts to incorporate N-of-1 trials more broadly into psychosomatic medicine. The symposium will conclude with the discussant highlighting how recent advances in mobile health technology have created exciting opportunities for N-of-1 studies that promise to revolutionize the practice of psychosomatic medicine.

**Individual Abstract Number: 1421**

**Acceptability and preferences for participating in N-of-1 trials: A national survey of patients with multiple chronic comorbidities**

Nathalie Moise, MD, MS, Medicine, Karina Davidson, PhD, Medicine and Psychiatry, Joan Duer-Hefele, RN, Tara St. Onge, B.A., Medicine, Columbia University Medical Center, New York, New York, Ty Ridenour, PhD, Division of Behavioral Health and Criminal Justice Research, RTI International, Research Triangle, North Carolina, Ying Kuen Cheung, PhD, Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, Elizabeth Cohn, PhD, Nursing, Scott Kelly, BA, Ian Kronish, MD, MPH, Medicine, Columbia University Medical Center, New York, New York

**Introduction:** N-of-1 trials are multiple crossover experiments comparing two or more treatments across time for a single patient, and help personalize the selection of treatments. The circumstances under which patients would participate in N-of-1 trials are unknown.

**Methodology:** We recruited 500 participants from the Harris Poll Online Chronic Illness Panel and pre-screened to include those with 2 or more relevant conditions (hypertension, hyperlipidemia, diabetes, asthma, osteoporosis, and depression) who resembled the general population in age, gender, income and region. Questions elicited preferences for health conditions/symptoms, and attitudes toward design features including use of mobile health devices.

**Results:** Participants were on average 56 years old; 57% were female, 8% black. After reading a description of N-of-1 trials, 82% were interested in participating; 23% of those uninterested would participate

if paid. The most preferred conditions/symptoms for N-of-1 trials were pain (58%), hypertension (39%), diabetes (29%), sleep problems (27%), and depression (23%). A majority of participants were willing to participate even if there was a chance they would receive placebo (58%) or usual care (70%). Design features that increased participation willingness were allowing patients to choose treatment options (88%) and receive the more effective treatment at trial end (50%), and close monitoring by clinician (86%). Some participants were less willing to participate if they (25%) or their physicians (41%) did not know treatment order. Most were willing to answer up to 20 questions (78%) 1-3 times per day (76%) and use mHealth devices to track outcomes (83%). Of those with devices, 92% would share data with the trial. Most preferred to hear about N-of-1 trials from their physicians (63%).

**Discussion:** This is one of the first studies to elicit patient preferences for N-of-1 trials. We found high acceptability for N-of-1 trials, particularly for pain, hypertension and diabetes. Placebo or usual care comparators and blinding were mostly acceptable. Passively obtaining outcomes data through mHealth devices was widely acceptable. Financial incentives and enabling patients to choose their treatment options might foster uptake of N-of-1 trials. Designing patient and provider materials to facilitate communication about these preferred features will be key.

**Individual Abstract Number: 1420**

**Are N-of-1 trials useful for achieving therapeutic precision in the treatment of depression? A systematic review of N-of-1 trials for depressive symptoms**

Ian Kronish, MD, MPH, Louise Falzon, PG DipInf, Meghan Hampsey, BA, Beatrice Konrad, BA, Medicine, Karina Davidson, PhD, Medicine and Psychiatry, Columbia University Medical Center, New York, New York

**Background:** N-of-1 trials are single-patient, crossover-design experiments with systematic assessments that may be useful for increasing treatment precision. A comprehensive review of N-of-1 trials for depressive symptoms is lacking and may provide insight into the potential for this personalized approach to improving depression care.

**Methods:** We conducted a systematic review of N-of-1 trials for depressive symptoms published from electronic database inception through October 15, 2015. Studies were eligible if they enrolled depressed patients, included a within-subject crossover design, and systematically assessed individual treatment effects on depressive symptoms.

**Results:** We identified 4 eligible studies, published between 1992 and 2001, reporting on 32 adult patients. Three studies compared fast-onset/rapid washout stimulants (methylphenidate versus placebo in two studies, d-amphetamine versus methylphenidate in one study). One study compared sulpiride, an atypical antipsychotic, to placebo in patients with chronic depression. Trial duration ranged from 2 days to 28 weeks. Patients were blinded to treatment in all 4 studies. Outcomes were assessed by patients and/or clinicians using paper and pen diaries. All studies provided useful data to patients and clinicians, either showing that the depression treatment was superior to placebo or that there were clinically significant inter-individual differences in treatment benefits.

**Conclusion:** The feasibility of N-of-1 trials for depression has been demonstrated for a limited number of pharmacologic treatments that are not commonly used in the contemporary management of depression. Additional research is needed to determine whether N-of-1 trials can be useful for helping patients identify the best depression treatments for them.