## 219) Abstract 1433

### DOES RACIAL IDENTITY MODERATE THE ASSOCIATION BETWEEN RACIAL DISCRIMINATION AND SLEEP QUALITY?

Natasha J. Williams, EdD, MPH, MSW, Population Health, New York University School of Medicine, New York, NY, Amani Nuru-Jeter, PhD, MPH, Divisions of Community Health & Human Development; and Epidemiology, University of California, Berkeley, Berkeley, CA

**INTRODUCTION:** There has been growing interest in the association between racial/ethnic discrimination and sleep quality. Additionally, racial identity has been associated with racial discrimination. However, to the best of our knowledge, no study has explored the extent to which racial identity can exacerbate or buffer poor sleep quality. The aim of the present study was to examine the association between experiences of racial discrimination and sleep quality, and the moderating effects of racial identity on this association.

**METHODS:** We utilized data from the African American Women's Heart and Health study, a community sample ages 30-50 in the San Francisco Bay area, which examines the effects of stress and cardiovascular disease. Participants completed the Experiences of Discrimination Scale (EOD), and the Multidimensional Inventory of Black Identity (MIBI). The MIBI assesses racial identity across dimensions of centrality, regard, and ideology. Subjective sleep quality was taken from the Pittsburgh Sleep Quality Index using the item "During the past month, how would you rate your sleep quality overall?" **RESULTS:** 208 women (Mage = 41.76 ± 6 years) completed baseline measures. The mean discrimination score was 19.38 ± 9.10. Multivariable logistic regression (controlling for age, poverty, education, employment, neuroticism, marital status, and health insurance) revealed a significant relationship between experiences of discrimination and sleep quality (t=1.88, p=0.060). A positive interaction was found with the public regard dimension of the MIBI, the extent to which an individual believes others view African Americans positively or negatively has a positive or negative racial identity, and discrimination on sleep quality (t=1.99, p=0.046). There were no other significant findings of the other dimensions of the MIBI.

**CONCLUSION:** These results reveal that racial discrimination and racial identity may be important targets for intervening on sleep quality among this population. This is considerably important, given the high correlation of sleep quality and the number of adverse health consequences that impact African American women including obesity and diabetes. Dr. Williams was supported by NIH K23HL125939

## 220) Abstract 1082

### CHILDHOOD MALTREATMENT IS ASSOCIATED WITH A DOSE-DEPENDENT REDUCTION OF THE OXYTOCIN RECEPTOR IN PERIPHERAL BLOOD MONONUCLEAR CELLS OF MOTHERS

Sabrina Krause, Master of science, Psychosomatic Medicine, Ulm University, 89081 Ulm, Baden-Württemberg, Deutschland, Christina Böck, Master of science, Anja Gumpp, Master of science, Psychology, Edit Rottler, -, Psychosomatic Medicine, Katharina Schury, Master of science, Alexander Karabatsiakis, Post doc, Psychology, Ulm University, 89081 Ulm, Baden-Württemberg, Germany, Anna Buchheim, Prof., Psychology, University of Innsbruck, Innsbruck, -, Austria, Harald Gündel, Prof., Psychosomatic Medicine, Iris-Tatjana Kolassa, Prof., Psychology, Christiane Waller, Prof., Psychosomatic Medicine, Ulm University, 89081 Ulm, Baden-Württemberg, Germany

**Introduction:** Childhood maltreatment (CM) has been related to alterations in the oxytocin (OXT) system. However, contradictory results were found with respect to OXT peptide hormone analyses. Recent literature shows e.g. a stress-induced elevation of urine OXT in maltreated children just as well as lower OXT levels in women with a history of CM. One reason for these contradictory results might be that not only the OXT hormone level, but also the expression of the OXT receptor (OXTR) needs to be taken into consideration. Therefore, we

hypothesize that OXTR alterations in adulthood may reflect CM experiences, additionally to peripheral OXT levels.

**Methods:** Peripheral blood mononuclear cells (PBMCs) of 44 mothers 3 months after parturition were analyzed with western blot and OXT plasma levels were determined by radioimmunoassay. The childhood trauma questionnaire (CTQ) was used to assess adverse childhood experiences.

**Results:** OXTR protein levels showed a significant negative correlation with the CTQ sum scores, ($R^2$ = -.36, *p*-value = .015) whereas OXT plasma levels were not related to CM ($R^2$ = -.07, *p*-value = .667).

**Conclusion:** The study demonstrates for the first time to our knowledge that OXTR protein can be semi-quantitatively assessed in human PBMC. This technique allows the detection of OXTR system modulations in relation to CM experiences in a long-term way until adulthood. Alterations in the OXTR in immune cells might have consequences for physical health of affected mothers.

## 221) Abstract 1161

### PATTERNS OF ILLNESS PERCEPTION IN PATIENTS WITH CORONARY ARTERY DISEASE

Evelyn Kunschitz, MD, Cardiology, Hanusch Hospital, Vienna, Austria, Oliver Friedrich, PhD, Karl Landsteiner Institut for Scientific Research in Clinical Cardiology, Karl Landsteiner Institut for Scientific Research in Clinical Cardiology, Vienna, Vienna, Austria, Johann Sipoetz, MD, Cardiology, Hanusch Hospital, Vienna, Austria, Austria

**Methods**

166 patients (age: 64.4 ±12.1, 80.7% male) were recruited after angiography at the cathlab of an hospital. Cluster analysis on the items of the Brief Illness Perception Questionnaire was used to identify distinct patterns of IP. The resulting groups were characterized with regard to Quality of Life (MacNew questionnaire), anxiety and depression (GAD-7 and PHQ-9) and resilience (RS-13).

**Results:** Cluster analysis revealed 4 distinct groups (see Fig.). They differed significantly with regard to the items covering the perception of the physical (identity, consequences) and emotional impact of disease (emotional response and concern). Stronger perceptions in these domains were associated with lower Health Related Quality of Life and higher levels of emotional distress. Group 1 included the patients with the strongest perceptions of the physical and emotional impact of disease. They expressed low treatment control, high chronic timeline and significantly higher levels of depression than the other groups. This pattern comprised 33.1% of the sample and was labelled as "high distress".

Group 2 was characterized by more moderate perceptions of the emotional and physical impact of disease together with low scores on illness coherence and chronic timeline. The group included 27.7% of the patients and was labelled as "moderate distress with poor illness understanding". Groups 3 and 4 reported smaller physical and emotional impact of illness. The decisive difference existed with regard to chronic timeline: While patients of group 3 reported the highest, patients of group 4 showed the lowest scores in chronic timeline of all groups. The optimistic outlook on the course of disease of group 4 was associated with a significantly higher level of resilience compared to all other groups. Group 3, comprising 25.3%, we labelled as "low distress with long-time expectation" and Group 4, comprising 13.9%, as "very low distress with short-time expectation".

**Conclusion:** We identified 4 groups of CAD-patients sharing similar patterns of IP. Our result corresponds largely to recent findings in patients with COPD and chronic muscle disease thereby indicating parallels of IP in patients with different kinds of chronic illness. Further research is needed to explore if stratification of patients according patterns of IP can help to inform targeted psychosomatic interventions.
<figure><img src="image_30.png" /><figcaption>Fig. Comparative mean (z-scores) of illness perception domains.</figcaption></figure>

## 222) Abstract 1081

### DO CARDIAC HEALTH: ADVANCED NEW GENERATION ECOSYSTEM (DO CHANGE) - FIRST RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Eva R. Broers, PhD Student, Jos Widdershoven, MD, Mirela Habibovic, Assistant Professor, Medical and Clinical Psychology, Tilburg University; TweeSteden Ziekenhuis Tilburg, Tilburg, Noord-Brabant, The Netherlands

**Purpose:** Cardiac diseases are one of the leading causes of death worldwide. Changing patients' lifestyle (e.g. diet, physical activity, distress) could be one means by which the onset and/or deterioration of cardiac diseases could be addressed. However, living with a chronic disease can be very challenging for patients and requires high patient involvement and self-management.

The Do CHANGE ecosystem for cardiac patients is developed in order to assist patients in living with the heart condition and changing their lifestyle. This study investigates the treatment effectiveness at 3 months follow-up for improving lifestyle and disease self-management.

**Methods:** A total of 150 coronary artery disease, heart failure and hypertension patients will be recruited from the Elisabeth-TweeSteden Ziekenhuis, the Netherlands (N=75) and the Hospital Municipal de Badalona, Spain (N=75). They will be randomized to either the Do CHANGE intervention or the care as usual group. Patients will receive an online 3-months behavioral intervention, integrating new technologies to facilitate lifestyle change and improve disease management.

**Results:** Results of the primary outcomes at 3 months follow up will be presented at the meeting. By that time, we expect to have complete data for 150 patients (N=75 intervention; N=75 care as usual) on the effect of the intervention on patients' disease self-management and lifestyle improvement.

**Conclusions:** Current findings will inform the clinical practice on the effectiveness of an online, technology supported, personalized intervention for improving lifestyle and disease self-management in cardiac patients.

## 223) Abstract 1473

### PROCOAGULANT MARKERS IN A PSYCHO-THERAPEUTIC INTERVENTION WITH DEPRESSED CAD-PATIENTS - RESULTS OF THE SPIRR-CAD STUDY

Hans-Christian Deter, MD., Medical Clinic Psychosomatic, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany, Kristina Orth-Gomér, MD., Clinical Neuroscience, Karolinska Institutet, Stockholm, Stockholm, Sweden, Christoph Herrmann-Lingen, MD., Dept. of Psychosomatic Med. & Psychotherapy, Univ. of Goettingen Medical Center, Goettingen, Low-saxony, Germany, Christian Albus, MD., Dept. of Psychosomatic Med. & Psychotherapy, University of Cologne,

Cologne, NRW, Germany, Karl-Heinz Ladwig, PhD., Dept of Epidemiology, Helmholtz-Zentrum, Munich, Bavaria, Germany, Joram Ronel, MD., Dept. of Psychosomatic Med. & Psychotherapy, Technical University Munich, Munich, Bavaria, Germany, Anna-Sophia Grün, Dipl.Psych., Cora S. Weber, MD., Medical Clinic Psychosomatic, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany

Depression influences different pathways of progression of coronary artery disease (CAD) and worsens autonomic imbalance and inflammation in CAD patients. In the present study we examined a) if there are associations between pro-coagulant markers (PM) and depression, anxiety or vital exhaustion and (b) if there is a change of PM during a psychosocial intervention in depressed CAD patients.

In a multicenter trial, 450 male and 120 female CAD patients aged 18-75 y with HADS depression scores >7 were randomized into psychotherapy intervention (I; 3 individual sessions and 25 group sessions over 12 months) or usual care (UC). In this substudy we analyzed levels of PM (fibrinogen, D-dimer, v.Willebrand Factor (vWF), Factor VII, PAI-1, and a sum score of these markers: prothrombotic index (PI)) in 137 patients (age <61 y; 30 f) at baseline and 18 months later. We checked for correlations with indicators of depression (HADS, PHQ-9, HAM-D), vital exhaustion (MQ) and anxiety (HADS).

We found a) a highly significant correlation of fibrinogen with HADS anxiety (r=0.27; p<0.001) but no significant correlations between levels of PM and depressive symptoms. In regression analysis, fibrinogen was predicted by anxiety (HADS) and BMI. With regard to question b) there was no significant correlation between depression change and PM change over time. fibrinogen decreased (time effect p=0.05) but PM change did not differ significantly between I and UC. Patients with high vital exhaustion (MQ<28) significantly differed from low MQ (<28 patients in the course of fibrinogen (time x exhaustion, p=.009) and of PI (time x exhaustion, p=.01).

In depressed CAD patients we found correlations of anxiety (but not depression) with fibrinogen, but no other clotting factors. The change of PM was unrelated to the psychosocial intervention and did not correlate with the reduction of anxiety or depression. However, vWF and PI showed a significant reduction in patients with high compared to low vital exhaustion. This positive effect on coagulation in a subgroup of CAD patients with high exhaustion and therefore high cardiac risk (Zimmermann et al 2013) should be replicated in further analyses of the complete SPIRR-CAD study sample. The detection of coagulation pathways as possible mediators for CAD progression during more time points and over longer time, seems a demanding task for the future.

## 224) Abstract 1152

### ILLNESS PERCEPTIONS IN PATIENTS WITH HEART FAILURE: DIMENSIONAL STRUCTURE, VALIDITY AND CORRELATES OF THE BRIEF ILLNESS PERCEPTIONS QUESTIONNAIRE.

Ivy Timmermans, MSc, Henneke Versteeg, PhD, Mathias Meine, PhD, Cardiology, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands, Susanne Pedersen, PhD, Psychology, University of Southern Denmark, Odense, Funen, Denmark, Johan Denollet, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands

**Background:** Patients' illness perceptions are associated with psychological wellbeing and can be measured with the Brief Illness Perceptions Questionnaire (B-IPQ). However, little is known about illness perceptions in heart failure patients. We examined the dimensional structure, validity and clinical and psychological correlates of the Dutch, French and German official translations of the B-IPQ in patients with heart failure and an implantable cardioverter defibrillator (ICD).

**Method:** 585 European heart failure patients participating in the REMOTE-CIED study completed a set of questionnaires 1-2 weeks post ICD-implantation, including the B-IPQ. Clinical data were captured from patients' medical records.
**Results:** A 2-factor structure (I='Consequences'; II='Control') represented 7 out of 8 B-IPQ items in the total sample and Dutch, German and French subgroups. The B-IPQ had a Cronbach's α of .69, with the 4-item 'Consequences' subscale being more internally consistent (α=.80). Both the B-IPQ and its 'Consequences' subscale were significantly correlated with a variety of psychological characteristics, but not with clinical characteristics. Multivariable logistic regression analysis indicated that poor health status (OR=2.66, 95%CI=1.72-4.11), anxiety (OR=1.79, 95%CI=1.001-3.19), depression (OR=2.81, 95%CI=1.65-4.77), negative affectivity (OR=1.93, 95%CI=1.21-3.09) and poor ICD acceptance (OR=2.68, 95%CI=1.70-4.22) were independently associated with threatening illness perceptions as indicated by total B-IPQ scores.

**Conclusion:** The B-IPQ demonstrated good psychometric properties in Dutch, French and German patients with heart failure. Psychological factors were the most important correlates of patients' perceptions of their heart failure, emphasizing the importance of targeting maladaptive illness perceptions in this patient group, due to their impact on patients' well-being and quality of life.

## 225) Abstract 1645

### SOCIAL ENVIRONMENT AND CORONARY ARTERY DISEASE - RESULTS FROM THE SPIRR-CAD STUDY

Kristina Orth-Gomér, MD., Clinical Neuroscience, Karolinska Institutet, Stockholm, Stockholm, Sweden, Hans-Christian Deter, MD., Anna-Sophia Grün, Dipl.Psych., Medical Clinic Psychosomatic, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany, Christoph Herrmann-Lingen, MD., Dept. of Psychosomatic Med. & Psychotherapy, Univ. of Göttingen Medical Center, Goettingen, Low-saxony, Germany, Christian Albus, MD., Dept. of Psychosomatic Med. & Psychotherapy, University of Cologne, Cologne, NRW, Germany, Alexandra Bosbach, Dipl.Psych., Dept. of Psychosomatic Med. & Psychotherapy, Univ. of Göttingen Medical Center, Goettingen, Low-saxony, Germany, Karl-Heinz Ladwig, PhD., Dept of Epidemiology, Helmholtz-Zentrum, Munich, Bavaria, Germany, Joram Ronel, MD., Dept. of Psychosomatic Med. & Psychotherapy, Technical University Munich, Munich, Bavaria, Germany, Wolfgang Soellner, MD., Dept. of Psychosomatic Med. & Psychotherapy, Nuremberg Clinics, Nuremberg, Bavaria, Germany, Martina DeZwaan, MD., Dept. of Psychosomatic Med. & Psychotherapy, Hannover Medical School, Hannover, Low-saxony, Germany, Katja Petrowski, PhD., Dept. of Psychosomatic Med. & Psychotherapy, Technical University of Dresden, Dresden, Saxony, Germany, Cora Weber, MD., Medical Clinic Psychosomatic, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany

Low socio-economic status (SES) has been associated with an increased coronary risk in both women and men in Western countries. Women have been less often studied than men, but it is suggested, that their coronary risk by low SES is even higher in men. All stress experiences are more pronounced in low SES women with stress emanating both from family and marriage (marital stress) problems and from problems with job and money.

The SPIRR-CAD study offered an excellent opportunity to examine this risk in German speaking mildly and medium depressed patients with CAD. In this German multi-centre randomized controlled trial of 450 male and 120 female coronary patients, we examined the standard risk factors and the psycho-social risk factor profiles in relation to SES, as assessed by educational level. All differences between low and high SES were in the inverse direction. Of standard risk factors, only smoking and obesity were socially graded. Smoking was more common in low SES and there was a trend towards a higher mean body mass index (BMI) in low SES. Of psycho-social factors and emotions, exhaustion showed the strongest and most consistent inverse social gradient, but also anger, anxiety and depression were socially graded. The findings suggest that in German patients, as in other national groups, social gradients in CHD risk factors are strong. They are found

for both psycho-social and standard risk factors. In two year follow, up the prospective significance of social risk factors was analyzed. Low SES patients had more disease events at follow up, but the differences between low and high SES were not statistically significant and therefore firm conclusions from follow up were not possible.

## 226) Abstract 1242

### THE PREDICTIVE VALUE OF TYPE D PERSONALITY AND POSITIVE AFFECT FOR ADVERSE CARDIOVASCULAR OUTCOMES IN PATIENTS WITH NON-OBSTRUCTIVE CORONARY ARTERY DISEASE.

Maria T. Bekendam, Msc., Simone Barzilay, Bsc., Jos W. Widdershoven, MD, PhD, Willem J. Kop, PhD., Johan Denollet, PhD., Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands, Wilbert Aarnoudse, MD, PhD, Department of Cardiology, Elizabeth-Tweesteden hospital, Tilburg, Noord-Brabant, The Netherlands, Paula Mommersteeg, PhD., Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands

**Background:** Patients with non-obstructive coronary artery disease (NOCAD) have a relatively favorable prognosis for future adverse cardiac events, but continue experiencing disabling symptoms. NOCAD was defined as coronary artery disease with coronary stenosis < 60%. Psychological risk factors such as Type D personality have been associated with adverse outcomes in diverse cardiac populations. Positive affect (PA) has shown a cardioprotective potential. Little is known about the predictive value of Type D personality and PA for long-term outcomes in patients with NOCAD. We investigated Type D personality and PA on need for recurrent cardiac testing, emergency department (ED) visits and, as a secondary outcome, major adverse cardiac events (MACE).

**Methods:** A total of 547 patients (mean age 61 years ± 9, 48% male) who underwent a coronary angiography or CT-scan between January 2009 and February 2013 answered questionnaires concerning Type D personality (DS14) and PA (GMS). Chi-square tests, ANOVA's and Cox proportional hazards analyses, adjusting for covariates, were performed. Multivariable analyses were used to adjust for age, sex, education, diagnosis by group, BMI and hypertension.

**Results:** After a mean follow-up of 3.8 years, 98 (18%) patients needed cardiac tests, 90 (17%) had ED admissions and 25 patients (5%) experienced MACE. Cox proportional hazard regression showed that Type D personality was not significantly associated with need for cardiac testing (HR = 1.10, 95%CI 0.70-1.71), ED admissions (HR =1.14, 95%CI 0.71-1.84), or MACE (HR =1.63, 95%CI 0.70-3.82). PA was a significant predictor of need for cardiac testing after adjustment for age, sex, education, diagnosis by group, BMI and hypertension (HR= 0.64, 95%CI: 0.41-0.99, p= 0.046), but none of the other outcomes (ED; HR= 0.83, 95%CI: 0.52-1.32) (MACE; HR= 0.51, 95%CI: 0.22-1.15).

**Conclusion:** Patients with NOCAD with more PA were less at need for recurrent cardiac testing, whereas Type D personality was not predictive of adverse events in the present study. Research on psychosocial factors in NOCAD patients should consider the importance of choices of endpoint, given the heterogeneity of NOCAD patients.

## 227) Abstract 1400

### SLEEP RESTRICTION UNDERMINES CARDIOVASCULAR ADAPTATION TO STRESS, CONTINGENT ON EMOTIONAL STABILITY

Wei Lü, PhD, Psychology, Shaanxi Normal University, Xi'an, Shaanxi province, China, Brian M. Hughes, PhD, Psychology, National University of Ireland, Glaway, Galway, Co. Galway, Ireland, Siobhán Howard, PhD, Psychology, University of Limerick, Limerick, Co.Limerick, Ireland, Jack E. James, PhD, Psychology, Reykjavík University, Reykjavík, Iceland
Sleep restriction is associated with poor cardiovascular health although the exact pathogenic disease mechanisms remain unclear. This study sought to examine whether sleep-restriction disrupts the natural ability to habituate to stress, while taking account of individual differences in personality, specifically trait emotional stability (ES).

Eighty-eight female participants underwent a standardized laboratory stress protocol on two occasions, either rested or following sleep-restriction. Order of rest/sleep-restriction sessions were counterbalanced across the sample. During the stress protocol, participants engaged in a challenging visual tracking task on a computer in order to elicit a stress response. Throughout the protocol, cardiovascular function was recorded photoplethysmographically using a Finometer beat-to-beat cardiovascular monitor. ES was derived using the Ten-Item Personality Inventory.

The impact of ES on habituation was examined using a general linear model, with all five personality traits entered as continuous variables. Rest/sleep-restriction was a within-groups variable in a factorial model. Profiles of habituation during the seven-minute stress exposure were examined as the mean recordings taken during the first, fourth, and seventh minutes, entered in the model as a repeated-measures factor.

As predicted, ANCOVA revealed a significant sleep × ES × time interaction, indicative of an effect for personality on habituation while sleep deprived. Specifically, all participants exhibited habituation during stress while rested. However, while sleep-restricted, participants high in ES exhibited sharp increases in SBP during stress, indicative of response sensitization (F(2,80) = 5.47, p = .02). Scrutiny of profiles of cardiac output and total peripheral resistance suggested that this sensitization of SBP was driven by disproportionate elevations in TPR, i.e., vascular responding.

Overall, the results suggest that disrupted ability to habituate to stress may account for the impact of sleep-restriction on cardiovascular health. This effect is contingent on personality such that it is exacerbated by low trait emotional stability.

## 228) Abstract 1624

# ETHNIC DIFFERENCES IN HEMODYNAMIC PROFILE AND COMPENSATION DEFICIT TO ORTHOSTATIC CHALLENGE: EVIDENCE FOR THE CARDIOVASCULAR CONUNDRUM IN AFRICAN AMERICANS

DeWayne P. Williams, PhD, Psychology, The Ohio State University, Columbus, Ohio, Cristina Ottaviani, PhD, Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy, LaBarron K. Hill, PhD, Department of Psychiatry and Behavioral Sciences Medicine, Duke University Medical Center, Durham, NC, Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, Ohio

African Americans (AA) have higher rates of hypertension and hypertension-related disorders than European Americans (EA). However despite years of research the exact basis of this health disparity remains poorly understood. One factor that has been proposed is greater vascular activity in AAs compared to EAs. Moreover, a growing literature suggests that AAs may show a paradoxical pattern of elevated peripheral resistance and elevated vagally-mediated heart rate variability (vmHRV). In the present study we utilized the hemodynamic profile (HP)-compensation deficit (CD) model to examine ethnic differences in cardiovascular responses to orthostatic challenge in a sample of healthy, young AAs (n=24) and EAs (n=31). Hemodynamics [cardiac output (CO) and total peripheral resistance (TPR)] and heart rate were recorded continuously during a 5 minute seated baseline, a 5 minute stand, and a 5 minute seated recovery. HP (higher values indicate more vascular response) and CD (higher values indicate increased TPR that is not associated with commensurate decreased CO) as well as the log of high frequency HRV derived from spectral analysis were calculated for the stand and seated recovery conditions. During the stand condition, AAs had greater HP [t(52)=2.95, p=0.005] and CD [t(52)=2.01, p=0.05] as well as greater vmHRV [t(50)=2.36, p=0.02] compared to EAs. These results suggest that AAs have greater vascular responses to orthostasis that are not

adequately compensated by either decreased CO or decreased vmHRV. These findings provide further support for the “cardiovascular conundrum” pattern that we have previously identified in AAs and help elucidate the physiological basis of the health disparity in hypertension and related disorders in AAs.

## 229) Abstract 1629

# ETHNIC DIFFERENCES IN ENDOTHELIAL-DEPENDENT ARTERIAL DILATION: FURTHER UNRAVELING OF THE CARDIOVASCULAR CONUNDRUM

DeWayne P. Williams, M.A., Psychology, The Ohio State University, Columbus, Ohio, LaBarron K. Hill, PhD, Department of Psychiatry and Behavioral Sciences Medicine, Duke University Medical Center, Columbus, Ohio, Julian Koenig, Dr. sc. Hum., Section for Translational Psychobiology in Child and Adolescent, Heidelberg University, Heidelberg, Thibautstraße 6, Germany, Gaston Kapuku, PhD, Georgia Prevention Institute, Georgia Health Sciences University, Augusta, GA, Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, Ohio

In comparison to European Americans (EAs), African Americans (AAs) show greater blood pressure (BP) mediated by elevations in total peripheral resistance (TPR). A recent meta-analysis found AAs to have greater high frequency heart rate variability (HF-HRV), an index of cardiac vagal activity, at rest in comparison to EAs – a factor that is considered cardio-protective and is associated with lower TPR and BP. We termed this counterintuitive pattern of findings in AAs the *Cardiovascular Conundrum*; we recently showed that in a resting state, the baroreflex – responsible for reflexively adjusting cardiac and vascular activity in response to changes in BP – was less effective in AAs in modulating TPR compared to EAs. Interestingly, endothelial-dependent arterial dilatation (EDAD) represents nitric oxide (NO) mediated vasodilation, however research has not yet investigated ethnic differences in EDAD, hemodynamics, and HF-HRV simultaneously. The following study sought to rectify this situation in a sample of 306 individuals (mean age = 29.43, SD = 2.98, 160 AAs). Baseline hemodynamics and heart rate were measured for 15 minutes using an impedance cardiogram while participants rested in a supine position. Resting-state HF-HRV (0.15-.4 Hz) was calculated, in addition to mean arterial pressure (index of BP) and TPR. Artery diameters were calculated via an automated border detection system. EDAD was expressed as percent (%) change of brachial artery diameter to reactive hyperemia induced by pressure cuff constriction and release, with lower scores reflecting less EDAD. Directional t-tests showed AAs had higher resting TPR (t(298) = -5.54, p < .001), BP (t(298) = -6.43, p < .001), and HF-HRV (t(298) = -1.39, p = .082). AAs also had less EDAD (t(298) = 1.73, p = .042) compared to EAs. Our data fit the previously identified *Cardiovascular Conundrum*, showing AAs to have higher BP, TPR, and HF-HRV in comparison to EAs. Novel results showed AAs showed lesser EDAD compared to EAs. The current data, in combination with our research on baroreflex effectiveness, suggests that AAs may maintain both higher HF-HRV and greater TPR and BP by way of a less effective baroreceptor which, importantly, is likely mediated by lesser NO. In sum, NO may be a primary target in helping minimize the mortality rate from cardiovascular and other related diseases amongst AAs.

## 230) Abstract 1619

# TIME DOMAIN ASSESSMENT OF THE THREE BRANCHES OF THE BAROREFLEX: A VALIDATION STUDY IN SEDENTARY VERSUS FIT INDIVIDUALS

Gustavo Reyes del Paso, PhD, Pablo de la Coba Gonzalez, Mr, María Martín-Vázquez, Ms, Psychology, University of Jaén, Jaén, Andalucía, Spain, DeWayne P. Williams, MA, Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, Ohio

The spontaneous sequence method in time domain was used for the evaluation of the cardiac, vasomotor and myocardial branches of the
baroreflex. Obtained estimates were compared between two samples of young physically active vs. sedentary participants and between rest and mental stress periods. Blood pressure (BP), inter-beat interval (IBI), stroke volume (SV), Total Peripheral Resistance (TPR), and pre-ejection period (PEP), (impedance cardiography) were continuously recorded in 33 physically active and 25 sedentary participants at rest and during a mental arithmetic task. Spontaneous sequences of three to six consecutive cardiac cycles were located in which Systolic BP (SBP) increases were accompanied by increases in IBI or PEP and decreases in TPR or SV and those in which SBP decreases were accompanied by decreases in IBI or PEP and TPR or SV increases. The slope of the regression line between the SBP and IBI-TPR-SV-PEP values produced an estimate of baroreflex sensitivity (BRS). The proportion between the number of progressive SBP changes followed by reflex effects and the total number of progressive SBP changes yielded an estimate of baroreflex effectiveness (BEI). For BRS results showed greater cardiac, vasomotor and myocardial (obtained with the PEP measure, not with SV) sensitivity in the active than in the sedentary group. However, only the cardiac branch was sensitive to mental stress, decreasing BRS during the arithmetic task. Cardiac, vasomotor, and myocardial (computed with PEP) BEI decreases during mental stress but in the firsts two measures only in the sedentary group not in the active individuals. High correlations were observed between BRS in the three branches and their output measures (IBI for the cardiac, TPR for the vasomotor and PEP for the myocardial). Cardiac BRS was associated with BRS in the vasomotor and myocardial (PEP) branches. In conclusion, the method appears appropriate and valid for the simultaneous assessment of the three baroreflex branches. The assessment of the vascular branch of the baroreflex may have clinical relevance as a vulnerability or prognostic factor in the development of hypertension or arteriosclerosis diseases.

This work was supported by a grant from the Spanish Ministry of Science and Innovation, co-financed by FEDER funds (Project PSI2015-69235).

## 231) Abstract 1492

### ELEVATED HPA AXIS RESPONSE DUE TO AN ATTACHMENT-RELATED STRESSOR IN PATIENTS WITH PRIMARY HYPERTENSION

Elisabeth M. Balint, MD, Dominik Langgartner, M.Sc., Stefan O. Reber, PhD, Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Baden-Württemberg, Germany, Johannes C. Ehrenthal, PhD, Psychology, Psychotherapy and Psychoanalysis, Alpen-Adria-University of Klagenfurt, Klagenfurt am Wörthersee, Kärnten, Austria, Susanne Campbell, MS, Alexandra Funk, MS, Julia Klinghammer, MS, Dan Pokorny, PhD, Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Baden-Württemberg, Germany, Manuela Gander, PhD, Anna Buchheim, PhD, Institute of Psychology, University of Innsbruck, Innsbruck, Innsbruck, Austria, Christiane Waller, MD, Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Baden-Württemberg, Germany

**Background:**

Primary hypertension is linked to heightened stress responsiveness as well as to a higher prevalence of attachment difficulties. If attachment-related stress which often occurs in daily life would also trigger a heightened stress response has not been analyzed yet. Therefore, we aimed to investigate the effects of attachment-related stressors on the stress response of patients with hypertension compared to healthy participants.

**Material and Methods:**

50 patients with primary hypertension, treated with at least one antihypertensive drug, and 25 healthy individuals were recruited. Attachment-related stress was induced with the Separation Recall (SR), a short-time stressor, which activates attachment-related emotions and thoughts by talking five minutes about a personal experience of loneliness. Blood samples were taken and measurements of blood pressure were performed before and after the SR as well as 10 minutes

after recovery. Areas under the curve with respect to increase (AUCi) were calculated for adrenocorticotropic hormone (ACTH), cortisol and mean arterial pressure (MAP). Parameters were compared using Wilcoxon signed rank test, Mann-Whitney-U-test and (related samples) t-test where appropriate.

**Results:**

In response to the SR, MAP, ACTH and Cortisol significantly increased (all p-values <.001). Comparing hypertensive patients and healthy participants, baseline levels of cortisol were significantly higher (p=.002) in hypertensive than in healthy participants whereas MAP and ACTH did not differ between the groups. AUCi of cortisol and MAP was significantly higher (p=.006 and p=.022, respectively) in hypertensive than in healthy participants with no differences in AUCi of ACTH.

**Conclusion:**

The attachment related stressor SR elicited a significant response of the hypothalamus pituitary adrenal (HPA) axis, which was remarkably enhanced in patients with hypertension. Our data suggest that attachment-related stress aggravates cortisol reactivity in hypertensive patients which may contribute to a stress-related progression of the hypertensive disease.

## 232) Abstract 1626

### SYNERGISTIC IMPACT OF PERCEIVED DISCRIMINATION AND HOSTILITY ON ADRENERGIC RESPONSIVITY

LaBarron K. Hill, PhD, Department of Psychiatry and Behavioral Sciences Medicine, Duke University Medical Center, Durham, NC, Andrew Sherwood, PhD, Psychology, Department of Psychiatry and Behavioral Sciences Medicine, Durham, NC, James A. Blumenthal, PhD, Department of Psychiatry and Behavioral Sciences Medicine, Duke University Medical Center, Durham, NC, Alan L. Hinderliter, MD, Department of Medicine, University of North Carolina, Chapel Hill, NC

Racial discrimination is increasingly recognized as an important factor in cardiovascular disease risk among African Americans. Previous research has shown that there is significant overlap between perceived discrimination (PD), and hostility (HO), an established predictor of vascular dysfunction and CVD mortality. Amid growing evidence that discrimination also is associated with vascular impairment, the present study sought to examine the effects of PD and HO on adrenergic receptor responsiveness. In a sample (N=57) of African American adults with normal and mildly elevated blood pressure, α₁- and β-adrenergic receptor responsiveness were assessed via the requisite change in either blood pressure, or heart rate following consecutive bolus doses of phenylephrine and isoproterenol, respectively. Lifetime perceived discrimination was measured using the Perceived Discrimination Scale, and hostility was assessed using the Cook-Medley hostility scale. PD was correlated with HO (r=.50, p=.001), and both HO (r=.28, p=.033) and lifetime perceived discrimination (r=.43, p=.001) were significantly associated with β-, but not α₁-adrenergic responsiveness. In hierarchical regression models, PD emerged as a significant predictor of β-adrenergic receptor responsiveness and this effect remained robust after HO was included in the model. Moderation analysis further revealed that the association between PD and β-adrenergic receptor responsiveness was strongest among those with higher hostility. These findings suggest that the effects of PD on vascular function is due in part to blunted β-adrenergic receptor responsiveness and may be compounded by other negative psychosocial traits.

## 233) Abstract 1270

### SELF-MANAGEMENT SUPPORT FOR PATIENTS WITH HYPERTENSION USING ONLINE VIDEOS AND AUTOMATED, BIDIRECTIONAL TEXT-MESSAGING

Matthew E. Allen, BA, Julian Einhorn, BA, Medicine, Brian P. Suffoletto, MD, Emergency Medicine, University of Pittsburgh School
of Medicine, Pittsburgh, PA, Lora Burke, PhD, Nursing, Thomas Kamarck, PhD, Health Psychology, University of Pittsburgh, Pittsburgh, PA, Bruce L. Rollman, MD, Matthew F. Muldoon, MD, Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA Hypertension is a leading cause of heart disease, stroke and kidney failure yet the US control rate is approximately 50%. Home blood pressure monitoring (HBPM) has been shown in clinical trials to lower BP but its mechanism(s) of effect are unknown and no patient-centered programs facilitating HBPM are in widespread use. The current pilot project sought a) to develop a convenient aide for patients attempting HBPM, and b) to explore putative behavioral mechanisms potentially linking HBPM with BP changes. We recruited 33 patients with hypertension (31-70 years old, 52% female, 55% black) from an urban emergency department (ED) and a hypertension referral center. Basic hypertension knowledge was delivered at enrollment via online videos. An automated, bidirectional text-message system designed by physicians and patients sent prompts instructing the participant to measure and text back their BP at 4 self-selected times per week for 6 weeks. Participants received rolling average BP feedback with each submission and summary reports at the end of each 2-week period. An exit interview included open-ended questions about personal beliefs about one's hypertension and experience with the program, as well as specific questions about behavior change and self-efficacy. Compared to those from the hypertension center, patients from the ED had higher BP at enrollment (168/98 vs 136/83 mmHg, p<.01), marginally less college (41% vs 73% p=.09), fewer medications (1.6 vs 3.1 p<.01) and lower baseline HBPM (33% vs 100%, p<.01). Overall, 94% of patients submitted at least one self-measured BP, and response rates (100% * #BP readings/24 prompts) in patients from the ED and hypertension center averaged 70% and 91%, respectively. Response rate did not vary as a function of age, gender, race, or education. Qualitative analysis of exit interview data revealed that the large majority of participants viewed the program very positively and favor longer term participation. Most attempted to improve diet, exercise, or stress-reduction behaviors, with patients recruited through the ED also reporting increased self-efficacy with regard to measuring and controlling their BP. These results indicate that automated programs facilitating HBPM are acceptable and useful to an inclusive and diverse sample of patients with hypertension and, further, that HBPM may elicit healthy behavior change.

## 234) Abstract 1522

### INTERACTIVE RELATIONS OF RACIAL DISCRIMINATION AND POVERTY STATUS TO BLOOD PRESSURE LEVELS AMONG AFRICAN AMERICANS: HANDLS

Taylor M. Darden, Counseling Psych, M.A., Danielle L. Beatty Moody, Ph.D., Social Personality Psych, Antione D. Taylor, M.A., Clinical Psychology, M.A, Shari R. Waldstein, Ph.D., Clinical Psych, Ph.D., Human Services Psychology, University of Maryland, Baltimore County, Baltimore, MD, Michele K. Evans, M.D., Oncology, M.D., Geriatric Research Education and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, MD, Alan B. Zonderman, Ph.D., Psychology, Ph.D., Laboratory of Epidemiology and Population Sciences, National Institute of Aging, Baltimore, MD

Cardiovascular disease (CVD) disproportionately affects the African-American (AA) community. Previous research indicates that perceived racial discrimination (RD) is a source of chronic stress for AAs and is related to CVD, at least in part, via hypertension. Little is known about whether lower socioeconomic status (SES) exacerbates the connection between RD and blood pressure (BP). Thus, AAs living below the poverty line and experiencing RD–both of which are independently linked to BP–may be facing greater stress. In this study, we examined whether the association between RD and BP was moderated by poverty status. The sample included 1393 AAs (mn age 30-64 years, SD = 9.2: 56% women) participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Approximately 46% of participants had household incomes below 125 % of the poverty

threshold. Participants rated experiences of RD across 6-items which inquired about experiences in housing, at work, or with the police/courts. BP was assessed using a standard brachial artery auscultation method following a 5 min rest in a seated position. Multiple regression analyses addressed independent and interactive relations of RD and poverty status to systolic and diastolic BP after adjustment for age, sex, depressive symptoms, body mass index, cigarette and alcohol use. A significant two-way interaction of RD by poverty status was observed for SBP, $B = -.94, SE = 0.45, p = .04$. Among AAs living above the poverty line, higher RD was associated with higher SBP whereas among AAs living below the poverty line this association was reversed. Despite greater opportunities and resources typically associated with living above the poverty line, higher levels of RD in different areas of life (e.g., school, work, medical settings) are linked with higher SBP among AAs. However, it is unclear why RD and SBP were inversely related for AAs living below the poverty line despite similar levels of reported RD (above poverty = 7.6, SD = 1.9; below poverty = 7.7, SD = 1.9). Perhaps coping mechanisms utilized among AAs exposed to both sources of stress contributes to a blunting of their link to blood pressure. Further research should explore whether coping processes shape the linkages among RD, poverty level, and BP.

## 235) Abstract 1517

### MARITAL RELATIONSHIP QUALITY BEGINS WITH ME: THE IMPACT OF ONES OWN BEHAVIOR TOWARD SPOUSE ON AMBULATORY BLOOD PRESSURE

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

**Background:** Marriage has been associated with better health outcomes although quality of the marriage matters. Relationships which contain both high levels of positivity and high levels of negativity (ambivalence) may not be as protective as more positive relationships. However, measures of supportiveness or ambivalence generally only examine an individual's perception of the partner's behavior, ignoring one's own behavior. The current study aims to elucidate physiological pathways by which one's own supportive (high positivity) or ambivalent (high positivity and high negativity) behavior toward one's spouse may influence long-term health via daily ambulatory blood pressure (ABP), an independent predictor of cardiovascular (CV) health.

**Methods:** 46 married working couples (n=92) aged 21-37 (M=24) were fitted with ambulatory blood pressure monitors, assessing ABP randomly twice an hour during wake hours and once an hour during sleep, for a 24-hour period. Participants completed a Survey Monkey diary reading within 5 minutes of cuff inflation on their smart phone; diary readings assessed BP variables at time of reading for analysis control (i.e., position, consumption, activity level). No diary entries were required during sleep.

**Results:** Participants were mostly middle-income, educated and White (88%). We used SAS proc mixed and modeled the covariance structure for the two repeated measure of dyad and measurement occasion (i.e., number of ABP readings). We examined potential covariates that influenced ABP (i.e., age, posture, activity) in our analyses. Our analysis indicated that one's own ambivalent behavior toward one's spouse was significantly associated with increased systolic blood pressure (p=.008) and increased diastolic blood pressure (p=.04). Additionally, feeling mixed and conflicted about one's own ambivalent behavior toward the spouse was associated with increased DBP (p=.01).

**Conclusions:** Despite the positive behaviors they report in their own behavior toward their spouse, ambivalent participants' negative behavior may be creating stress through such processes as cognitive dissonance as they treat someone whom they love poorly. Individuals who behave ambivalently in their interactions with their spouse may be
at increased risk for poor CV health. Interventions aimed to decrease
negativity in one's own behavior may provide CV protection.

## 236) Abstract 1160

### PREDICTING THE COURSE OF DEPRESSION AND STRESS AND THE LINK WITH MORTALITY IN PATIENTS WITH GASTROINTESTINAL CANCERS

Paul W. Scott, M.S., Meng Hua, M.S., Psychology in Education, University of Pittsburgh, Pittsburgh, PA, David A. Geller, MD, FACS, Yisi Wang, MPH, James W. Marsh, MD, Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, Michael Antoni, PhD, Psychology, Psychiatry, Behavioral Sciences, University of Miami, Miami, Florida, Lora Burke, PhD, MPH, Epidemiology Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, Lisa H. Butterfield, PhD, Immunology, Yoram Vodovotz, PhD, Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, Frank J. Penedo, PhD, Medical Social Sciences, Northwestern University, Chicago, IL, Allan Tsung, MD, Jennifer Steel, PhD, Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA

**Background:** The chronicity of stress and/or depression is thought to be important with regard to the impact on health. The aims of this study were to examine the course of sgstress and depression, understand demographic, disease-specific, and psychological/behavioral predictors, and test the link of trajectories of stress and depression with survival in a cohort of advanced cancer patients.

**Methods:** A cohort of gastrointestinal cancer (GI) patients were assessed for depression, stress, pain, fatigue, optimism, and social support, and circulating cytokines every 4 months for 18 months. Demographic and disease specific factors were collected from the patients' medical chart. We used cross-lagged panel analyses, semi-parametric trajectory analyses, multinomial logistic regression, and Cox regression to test our aims.

**Results:** Of the 568 patients, the majority were male (64.8%) and Caucasian (89.6%), and the mean age was 62. Approximately 35% of patients reported moderate depression (CES-D>18) and 10% reported severe depression (CES-D>32), all of which had trajectories remained consistent over time. Predictors of chronic depressive symptoms included regional or systemic chemotherapy versus surgical intervention (p=0.003), greater levels of fatigue (p=0.001) and pain (p=0.02), and lower levels of optimism (p<0.001). The majority of patients (59%) reported moderate levels of stress and 22% high levels of stress. Predictors of stress included having a diagnosis with poor prognosis (p=0.031), lower levels of social support (p=0.01), higher levels of pain (p=0.031) and lower levels of optimism (p=0.007). None of the circulating cytokines predicted trajectories of stress or depression or survival. The moderate depression group had a 32% higher risk of death than the low depression group and the moderate stress group had a 52% higher risk of death than those in the low stress group. Unexpectedly, depression predicted stress over time and the trajectories of stress and depression were not significantly related.

**Conclusion:** Chronic levels of stress and depression were predictive of increased risk of mortality. Evidence-based interventions to reduce stress and depression are needed to improve the quality of life and possibly survival in patients diagnosed with cancer.

## 237) Abstract 1614

### SYSTEMATIC AMBIENT LIGHT EXPOSURE DURING STEM CELL TRANSPLANT TO REDUCE CANCER-RELATED FATIGUE, DEPRESSION AND SLEEP PROBLEMS

William H. Redd, Ph.D, Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, Mariana G. Figueiro, Ph.D, Lighting Center, Rensselaer Polytechnic Institute, Troy, NY, Alejandro Vega, B.A, Yeraz M. Meschian, Ph.D, Gary Winkel, Ph.D, Oncological Sciences, Eileen Scigliano, MD, Medicine, Natalie Stern, B.A, Ariella Hoffman-Peterson, B.A, Maxwell Segall, B.A, Heiddis Valdimarsdottir,

Ph.D, Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY

**Introduction:** Cancer-related fatigue (CRF) is the most commonly reported negative sequelea of cancer and its treatment. Patients undergoing Autologous Stem Cell Transplantation (ASCT) for Multiple Myeloma (MM) are particularly susceptible to experiencing CRF. It is most severe approximately one week after stem cell infusion (at the point of lowest white blood cell count). There has been no research on inpatients interventions to treat CRF among MM. It hypothesized that disruption in the circadian rhythms, caused by cancer and/or its treatment, is the primary cause of CRF. In the present research we are investigating whether light, one of the strongest synchronizers of circadian rhythms can be used to promote entrainment during ASCT and prevent/reduce CRF.

**Participants:** Mt Sinai Medical Center (MSMC) MM patients scheduled for ASCT are consented and randomly assigned to active or comparison conditions using permuted block randomization.

**Intervention:** Floor lamps with active and comparison ambient conditions were installed in the hospital rooms. The active condition consists of bluish-white (ambient lighting) - 400 lux (lx) provided during the day. Control condition consists of yellow-white lightening - 50 lx provided during the day.

**Procedure:** Participants are assessed at 6 time points: 1-2 weeks before ASCT (baseline), Day 2, Day 7, two days prior to discharge of hospitalization (intervention), and 3 weeks and 3 months after hospital discharge. During these assessments participants complete several measures, including the Functional Assessment of Chronic Illness Therapy- Fatigue scale (FACIT-Fatigue). In addition, participants complete visual analogue scales daily to determine their level of fatigue.

**Results:** Initial findings demonstrate that patients in the active ambient light condition report less CRF during hospitalization as assessed by the visual analogue scales and the FACIT-fatigue scale.

**Discussion:** The present research is the first to explore if light therapy, delivered in MM ASCT patient hospital rooms prevent/reduce CRF and related negative sequelae. Our preliminary findings are promising which suggests that this easy to deliver low cost intervention can reduce CRF among MM patients undergoing ASCT.

## 238) Abstract 1529

### DYADIC INTERNET-BASED HEALTH LIFESTYLE INTERVENTION FOR COLORECTAL CANCER SURVIVORS AND THEIR FAMILY MEMBERS: PILOT STUDY

Youngmee Kim, PhD, Psychology, University of Miami, Coral Gables, FL, Kelly Shaffer, PhD, Psychology, Memorial Sloan-Kettering Cancer Center, New York, NY, Hannah-Rose Mitchell, MPH, Amanda Ting, BS, Charles Carver, PhD, Psychology, University of Miami, Coral Gables, FL

Cancer survivors and their family caregivers, particularly older adults, are at extreme risk for functional decline, yet they have suboptimal lifestyle behaviors. However, currently there is a dearth of healthy lifestyle behavior interventions aim at these at-risk older CRC survivors and their partners. This study aimed to test feasibility and acceptability of dyadic internet-based healthy lifestyle intervention for cancer survivors and their family members.

A pilot sample of five colorectal cancer survivor and their family member dyads participated (4 spousal dyads and 1 mother with cancer and adult daughter dyad; 1 African American, 5 Hispanic, 4 non-Hispanic White: mean age=52). The 12-week healthy lifestyle intervention (Healthy U, Healthy Us) was delivered weekly via Skype. Feasibility and acceptability were evaluated by interventionist records and participant reports, respectively.

Feasibility was established by enrolling 5 CRC survivors and family member dyads within 2 months; retaining 4 dyads (80%) by 6 months post-T1 assessment; 4 dyads completed all 8 main sessions within 12 weeks with the fourth dyad completing 6 of 8 sessions. Adherence with
the 2 booster sessions was 63%. On average, participants received 94% of intervention dosage. No adverse events were noted.

Acceptability was established by participants' evaluation of the informational materials, intervention content and mode of delivery, and the interventionist at greater than 80% satisfaction. Two expressed only 60% satisfaction with visual presentation of study materials, which has been enhanced. No intervention session had to be rescheduled due to technical difficulties with Skype. Brief disruption in Skype connection (total 5 minutes) occurred during a total of 36 intervention sessions (total 1,120 minutes). All participants chose their home for receiving the intervention.

Findings support that the Healthy U, Healthy Us intervention was safe and highly feasible as well as acceptable. This pilot information also provides strong support for popularity and reliability of Skype as an intervention delivery technology for older adult CRC survivors and their family caregivers. The knowledge to be obtained from a larger trial will guide future studies that aim to investigate psychosocial intervention effects on health behavior changes of cancer survivors and their primary support partners.

## 239) Abstract 1609

### RELATIONSHIP OF SYSTEMIC CYTOKINE CONCENTRATIONS TO COGNITIVE FUNCTION OVER TWO YEARS IN WOMEN WITH EARLY STAGE BREAST CANCER

Debra Lyon, PhD, Biobehavioral Nursing Science, University of Florida, College of Nursing, Gainesville, FL, Ronald Cohen, PhD, Psychology, University of Florida, Gainesville, Fl, Colleen Jackson-Cook, PhD, Cytogenetics, Virginia Commonwealth University, Richmond, Va, Debra Lynch-Kelly, PhD, Biobehavioral Nursing Science, University of Florida, College of Nursing, Gainesville, Fl, Angela Starkweather, PhD, Nursing, University of Connecticut, Storrs, Ct, HYOCHOL Ahn, PhD, Nursing, University of Texas Health Science Center at Houston, Houston, Tx, Nancy McCain, PhD, Jaime Sturgill, PhD, Nursing, Virginia Commonwealth University, Adult Health & Nursing Systems, Richmond, VA, Huaihou Chen, PhD, Biostatistics, University of Florida, Gainesville, FL

Cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). While CRCI has been linked to chemotherapy, there is increasing evidence that the condition may start prior to treatment and for some, remain unresolved after active treatment and into survivorship. Alterations in systemic cytokines are a possible mechanism linked to cognitive dysfunction in breast cancer and other conditions.

**Methods:** We assessed 75 women with early-stage breast cancer at five points over two years, starting prior to the initial chemotherapy through 24 months after chemotherapy initiation. Measures included a validated computerized evaluation of domain-specific cognitive functioning and a 17-plex panel of plasma cytokines. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations to each cognitive domain.

**Results:** Levels and patterns of cytokine concentrations varied over time: six of the 17 cytokines (IL-6, IL-12, IL-17, G-CSF, MIPS-1b, and MCP-1) had the most variability. There were multiple relationships among cytokines and cognition, which varied over time. At baseline, elevated concentrations of G-CSF and reduced concentrations of IL-17 were associated with faster psychomotor speed. At the second time-point (prior to the mid-chemotherapy), multiple cytokines had significant associations with psychomotor speed, complex attention, executive function, verbal memory, cognitive flexibility, composite memory and visual memory. Six months after chemotherapy initiation and at the one-year point, there were multiple, significant relationships. At two years, fewer significant relationships were noted; however, lower concentrations of IL-7, a hematopoietic cytokine, were associated with better psychomotor speed, complex attention, and memory (composite, verbal and visual).

**Conclusion:** The associations among cytokines and cognitive performance provides evidence that not only prototypical cytokines

(i.e. IL-6, TNF-α, and IL1-β) but also cytokines from multiple classes may contribute to the inflammatory environment that is associated with cognitive dysfunction. Future studies to better delineate the cytokine changes, both individually and in networks, are needed to precisely assess the mechanistic link between cytokines and cognitive function in women receiving treatments for breast cancer.

## 240) Abstract 1119

### BRUXISM AS A CONSEQUENCE OF CHEMOTHERAPY?

Guida Da Ponte, MD, Psychiatry and Mental Health, João Rato, MD, Cidália Pinto, MD, Oncology, Margarida Lobo, MD, Psychiatry and Mental Health, Centro Hospitalar Barreiro-Montijo, Barreiro, Lisbon, Portugal, Sílvia Ouakinin, MD, PhD, University Clinic of Medical Psychology and Psychiatry, Medical School of Lisbon, Lisboa, Lisbon, Portugal

**Introduction:**

Bruxism is a syndrome with uncertain etiology but with proposed factors: psychosocial, peripheral and central. Treatment is also controversial and one of the options focuses in GABA theory and regularization of ion channels.

Xelox (capecitabine + oxaliplatin) and bevacizumad is indicated for metastatic colorectal cancer, being oxaliplatin the most neurotoxic agent (acute syndrome and/or a chronic sensory neuropathy).

Acute neurotoxicity is very frequent and it's a sensory and/or a motor toxicity (as tongue tingling or jaw spams). The proposed pathogenesis - neuronal hyperexcitability due to alterations of voltage-gated ion channels - is supported by mechanism of action of some treatments.

**Methods:** Description of a clinical case.

**Results:** This is a story of 76 years old men in treatment for metastatic colon cancer that developed toxicity: nausea (treated with haloperidol), bruxism and gingival atrophy.

He was referred to psycho-oncology by involuntary movements of mouth and trunk.

The patient complained of sadness, anhedonia and insomnia since recurrence of cancer and related the movements with CT. At observation he was anxious, tearfulness and agitated.

He was treated for a depressive episode, but the doubt remained about involuntary movements: haloperidol was a confounding factor for oxaliplatin acute neurotoxicity, also aggravated by psychic and peripheral factors.

**Conclusions:**

The authors believe that bruxism is linked to CT in a very complex relation that includes psychic, peripheral and central factors.

Psychiatrists need to keep attention to the patient as a whole, not being seduced by easy answers like psychosocial factors.

## 241) Abstract 1101

### POSITIVE PATIENT EXPERIENCES IN CANCER CARE, SELF-EFFICACY, AND HEALTH-RELATED QUALITY OF LIFE IN LATINO CANCER SURVIVORS

Patricia I. Moreno, PhD, Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, Amelie G. Ramirez, DrPh, MPH, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, Sandra L. San Miguel-Majors, MS, Center to Reduce Cancer Health Disparities, National Cancer Institute, Rockville, MD, Rina S. Fox, PhD, MPH, Leopoldo Castillo, MA, Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, Kipling J. Gallion, MS, Edgar Munoz, MS, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, Ryne Estabrook, PhD, Frank J. Penedo, PhD, Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL

Evidence suggests that Latinos experience significantly greater decrements in health-related quality of life (HRQoL) following the
diagnosis and treatment of cancer than non-Latino whites. The primary aim of the current study was to identify modifiable factors that are associated with improved HRQoL in Latino breast, colorectal, and prostate cancer survivors. Specifically, this study evaluated direct and indirect associations among positive patient experiences in cancer care, self-efficacy, and HRQoL. Analyses were conducted using baseline data (N = 288) from an NCI-funded randomized behavioral clinical trial that aimed to reduce symptom burden and improve adherence to treatment recommendations. Structural equation modeling analyses examining multiple indirect effects revealed that several facets of self-efficacy (i.e., patients' perceived confidence in managing psychological distress, support from close others, hobbies/social activities, and communication with providers) fully explained the relationship between positive patient experiences in cancer care and greater HRQoL (all p's < .01; CFI = 1.00; TLI = .99; RMSEA = .03; SRMR = .01). Importantly, less acculturated and monolingual-Spanish speaking patients reported lower self-efficacy in communication with providers; however, controlling for these relationships did not alter results. These findings suggest that it may be possible to target HRQoL in Latino cancer survivors through modifiable factors such as patient experiences in cancer care and self-efficacy. Ensuring positive patient experiences in cancer care (e.g., timely appointments, ready access to medical advice, patient inclusion in care decisions) may increase self-efficacy, and in turn, HRQoL in Latino cancer survivors. Future research should include longitudinal designs in order to examine how these relationships unfold across time.

## 242) Abstract 1317

# QUALITY OF LIFE FOLLOWING CANCER TREATMENT IN WORKING AGE ADULTS - RELATIONSHIPS TO ILLNESS PERCEPTIONS, DISTRESS, FATIGUE, AND SUBJECTIVE COGNITIVE COMPLAINTS

Oana C. Lindner, PhD, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, Yorkshire, United Kingdom, Martin G. McCabe, PhD, Division of Molecular and Clinical Cancer Sciences, Andrew Mayes, PhD, Deborah Talmi, PhD, School of Biological Sciences, John Radford, PhD, Division of Molecular and Clinical Cancer Sciences, Alison Wearden, PhD, School of Health Sciences, University of Manchester, Manchester, Greater Manchester, United Kingdom

**Objective** Cancer survivors often experience a poor quality of life (QoL). Little is known about which factors are associated with poor quality of life in working age cancer survivors who may be striving to return to work and to former daily activities. In the present study we explored the reciprocal relationships of several factors which have been implicated in QoL studies in other populations, namely illness perceptions, fatigue, subjective cognitive complaints, and emotional distress.

**Methods** Fifty-seven cancer survivors aged 19 to 50, 6 months-6 years following completion of treatment, were matched to healthy controls on age, education, and sex. All participants completed self-report measures for symptoms, physical functioning, overall QoL, emotional distress, fatigue, and subjective cognitive complaints. Patients also self-reported their illness perceptions. Correlation and hierarchical regression analyses were conducted to explore relationships and potential pathways between variables.

**Results** Patients reported higher levels of symptoms, emotional distress, fatigue, cognitive complaints, poorer functioning, and QoL than matched controls; all these variables were intercorrelated. Those with more negative illness perceptions (specifically a higher symptom load and a longer anticipated timeline for their illness) reported higher levels of cognitive complaints, higher levels of anxiety and depression, and fatigue. In a regression model containing all the predictor variables, only depressive symptoms and cognitive complaints were significant independent predictors of overall quality of life.

**Conclusions** This work constitutes the first step in the development of a model that could be used in clinical practice to help us to understand factors associated with a poor QoL in working age cancer survivors.

Negative illness perceptions may be amenable to change and depressive symptoms may be treatable. Further research is needed to determine whether interventions based on modifying these factors will improve quality of life for working age survivors of cancer.

## 243) Abstract 1308

# DEPRESSIVE SYMPTOMS RELATE TO CIRCADIAN DISRUPTION AND INFLAMMATION IN HEAD AND NECK CANCER

Elizabeth Cash, PhD, Otolaryngology-Head & Neck Surgery & Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, Courtney Brinkman, Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, Whitney Rebholz, PhD, Otolaryngology-Head & Neck Surgery & Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky, Christina Albert, BS, Otolaryngology-Head & Neck Surgery & Communicative Disorders, University of Louisville School of Medicine, Louisville, KY, Lauren Zimmaro, MA, Psychological and Brain Sciences, University of Louisville, Louisville, KY, Paula Chilton, PhD, Christine M. Kleinert Institute for Hand & Microsurgery, Louisville, KY, Thomas C. Mitchell, PhD, Institute for Cellular Therapeutics; Microbiology & Immunology, Liz Wilson, BSN, RNC, CCRP, OCN, Jeffrey M. Bumpous, MD, Sandra E. Sephton, PhD, Otolaryngology-Head & Neck Surgery & Communicative Disorders, University of Louisville School of Medicine, Louisville, KY

A diagnosis of head and neck cancer (HNC) introduces numerous unique stressors (e.g., facial pain, trouble eating). Depressive symptoms early in the cancer trajectory are common among HNC patients, and we have previously found these to be predictive of poorer overall HNC survival. To examine potential mediators of these effects, we piloted the collection of circadian, endocrine, and immune data among a sample of HNC patients. We hypothesized that depressive symptoms would be related to circadian disruption and systemic inflammation.

Patients presenting for initial consultation at a Multidisciplinary HNC Clinic (N=56) provided data prior to initiation of chemoradiation. Patients were evaluated for depressive symptoms (PHQ-9), wore actigraphy watches for six days to determine circadian rest/activity rhythm, and provided serum for a discovery panel of cytokine concentrations with markers of angiogenesis (VEGF) and inflammation (IL-6) analyzed here. Preliminary bivariate correlations determined which demographic and/or clinical variables would serve as controls. Hierarchical regressions were used to discover relationships with alpha set at .10 for these pilot data.

Patients (53% male, mean age=56) presented primarily with advanced (66% stage III/IV) oral, hypopharyngeal, oropharyngeal or laryngeal cancers. Patients reported mild depressive symptoms (PHQ-9 mean=6.19, range=0-25). Depressive symptoms were significantly related to circadian rest/activity rhythm (adjusted for income, partial r=-.458, p=.012). Depressive symptoms (adjusted for site of disease, partial r=-.319, p=.025) and rest/activity rhythms (partial r=-.333, p=.077) related to systemic levels of IL-6, but not to VEGF.

These initial data demonstrate that depressive symptoms correlate with both circadian rest/activity disruption and systemic inflammation (IL-6) prior to HNC treatment. Results highlight behavioral and biomarker pathways that may mediate relationships between depressive symptoms and cancer progression. Ongoing work with a larger sample of HNC patients will confirm these findings and examine the role of diurnal salivary cortisol. (Support: University of Louisville Multidisciplinary Research Grant)

## 244) Abstract 1535

# PREDICTORS OF AT-HOME PRACTICE AFTER A MIND-BODY INTERVENTION FOR BREAST CANCER PATIENTS

Marina Mery, Master of Science, Integrative Medicine, Alejandro Chaoul, PhD, Kathrin Milbury, PhD, Department of Palliative Care
**Rehabilitation and Integrative Medicine**, Amy Spelman, PhD,
Department of Radiation Oncology, Karen Basen-Engquist, PhD,
Department of Behavioral Science, Division of OVP, Cancer
Prevention and Population Sciences, MD Anderson Cancer Center,
Houston, Texas, Martica Hall, PhD, Psychology, University of
Pittsburgh, Pittsburgh, Pennsylvania, Qi Wei, Master of Science,
Department of Palliative Care Rehabilitation and Integrative Medicine,
Ya-Chen Tina Shih, PhD, Health Services Research, Banu Arun, M.D.,
Department of Clinical Cancer Prevention, Vicente Valero, M.D.,
Department of Breast Medical Oncology, George Perkins, M.D.,
Department of Radiation Oncology, Gildy Babiera, M.D., Department
of Breast Surgical Oncology, MD Anderson Cancer Center, Houston,
Texas, Tenzin Wangyal, N/A, N/A, Ligmincha Institute, Shipman,
Virginia, Rosalinda Engle, N/A, Department of Palliative Care
Rehabilitation and Integrative Medicine, Carol Harrison, M.Ed,
Department of Behavioral Science, Lorenzo Cohen, PhD, Department
of Palliative Care Rehabilitation and Integrative Medicine, MD
Anderson Cancer Center, Houston, Texas

**Background:** Common side effects of chemotherapy include disrupted sleep, increased fatigue, and decreased quality of life. We previously reported that a Tibetan yoga program (TYP) delivered during chemotherapy for women with breast cancer reduced sleep disturbances for those engaging in out-of-class practice at least 2 times a week or more. This study sought to determine the association between baseline social support and subsequent home practice.

**Methods:** At the start of chemotherapy women were randomized to the TYP or a stretching (ST) or wait-list control groups. The TYP and ST interventions were 4 sessions during chemotherapy and 3 booster sessions over the next 6 months. Participants were encouraged to engage in daily at home practice. Participants reported on their social support at baseline as measured with the MOS Social Support Survey (MOS-SSS), including four subscales (emotional support, tangible support, positive social interaction, and affectionate support) and benefit finding during the follow-up period. At home practice was self-reported at the end of the TYP program, 3, 6, and 12 months later based on how often participants engaged the practices per week, ranging from not at all to more than once a day. Linear regression analyses were run to determine baseline social support and benefit finding during follow-up with at-home practice during the 12-month period.

**Results:** 227 women, average age 49.5, with stage I-III breast cancer (21.3%, 56.6%, and 22.1%, respectively) participated. Most were non-Hispanic Caucasian, employed, married, and highly educated. The majority of participants had undergone surgery and all were receiving chemotherapy. MOS-SSS total score and subscales at baseline were not associated with out of class practice. However, benefit finding during the follow-up period was associated with at home practice (t= 0.22, p=002). After controlling for age and stage of disease, benefit finding remained associated with home practice.

**Conclusion:** Previous research has shown that at home practice of mind-body interventions leads to better outcomes. As benefit finding was associated with home practice, increasing benefit finding may help encourage more at-home practice in participants.

## 245) Abstract 1244

# EXAMINING THE EFFICACY OF PSYCHOSOCIAL INTERVENTIONS FOR THE MANAGEMENT OF FATIGUE IN END-STAGE KIDNEY DISEASE (ESKD): A SYSTEMATIC REVIEW WITH META-ANALYSIS.

Federica Picariello, MSc, Joanna L. Hudson, PhD, Rona Moss-Morris, PhD, Health Psychology Section, Psychology Department, King's College London, London, London, United Kingdom, Iain C. Macdougall, MD, FRCP, Department of Renal Medicine, King's College Hospital, London, London, United Kingdom, Joseph Chilcot, PhD, Health Psychology Section, Psychology Department, King's College London, London, London, United Kingdom

**Background:** Fatigue affects 42-89% of ESKD patients, with huge repercussions on functioning, quality-of-life, and patient outcomes. Its

management represents a clinical priority, yet the majority of currently available interventions revolve around drug-treatments or exercise, with only modest and short-term improvements.

**Aim:** To investigate whether psychosocial interventions are effective at reducing fatigue in ESKD.

**Methods:** MEDLINE, PsycINFO, EMBASE, CINAHL, Global Health, Web of Science, and CENTRAL databases were searched to identify randomized controlled trials (RCTs) and quasi-RCTs that determined the effect of psychosocial interventions on fatigue (primary or secondary outcome), in the renal patient population. All included studies underwent quality assessments. A narrative synthesis and meta-analyses were undertaken.

**Results:** 16 RCTs (N=1,536) were included, predominantly amongst dialysis patients, with fatigue mainly treated as a secondary outcome. Although 10 trials failed to find a significant improvement in fatigue following the delivery of a psychosocial intervention, the quantitative synthesis demonstrated a significant improvement in fatigue (N=14; SMD=0.37, p=0.001; 95% CI 0.15-0.59, I²=69.1%, p<0.001). There was evidence for greater effectiveness of interventions including stress-management/relaxation techniques, evaluated amongst fatigued samples meeting diagnostic thresholds, against passive/non-active comparison groups. The studies were generally of poor quality, with high heterogeneity and some indication of publication bias; therefore, the findings should be interpreted with caution.

**Conclusions:** There is a lack of theory-driven interventions targeted specifically at fatigue in ESKD; however, there is some promising evidence in support of psychosocial interventions, in particular interventions including stress management/relaxation techniques. Development and evaluation of a fatigue-specific psychosocial intervention is warranted in this setting.

## 246) Abstract 1241

# MENTAL AND PHYSICAL HEALTH EFFECTS OF MEANINGFUL WORK AND REWARDING FAMILY RESPONSIBILITIES

Nadya Dich, Ph D, Rikke Lund, Ph.D., Dr. Med., Åse Marie Hansen, Ph.D., Naja Hulvej Rod, Ph.D., D. MSc, Public Health, University of Copenhagen, Copenhagen, -, Denmark

The study assessed the effects of meaningful work and rewarding family responsibilities on depressive symptoms, perceived stress, and physiological functioning in 203 Danish men and women (average age = 50). The study was based on a subsample of Copenhagen Ageing and Midlife Biobank. Participants reported on meaning of work (3 items: *Is your work meaningful?*, *Do you feel that the work you do is important?* and *Do you feel motivated and involved in your work?*). Participants were also asked if they provided regular care to their parents, spouses, children, grandchildren and other persons. For each of the care recipients, they were also asked how physically and emotionally straining it was to provide care to that person, as well as how rewarding it was. Depressive symptoms and perceived stress were reported using validated instruments. Physiological dysregulation (allostatic load, AL) index was based on 8 biomarkers, capturing cardiovascular (blood pressure), metabolic (triglycerides, HDL cholesterol, Total Cholesterol, glycated hemoglobin, and BMI), and immune (C-reactive protein, Interleukin-6) activity. AL was calculated as a number of markers whose values were beyond clinically established norms, with a possible range from 0 to 8.

Most participants provided care to at least one person. On average participants rated their caregiving responsibilities rewarding to a large degree and only a little straining and their work as meaningful to a large degree. For both men and women, there was a moderate reverse association between meaningful work and depressive symptoms. Caregiving reward was moderately associated with lower perceived stress in both men and women, controlling for other aspects of providing care. Significant gender differences were found in the effects of meaningful work and caregiving reward on AL. In men, meaningful work and caregiving reward were unrelated to AL. However, in women
both meaningful work and caregiving reward were related to higher AL (β = .22, SE = .10 and β = .25, SE = .10 respectively). The study adds to the accumulating evidence that particularly in women, the pursuit of meaning and purpose by engaging with work and family, which contribute to psychological well-being and make life worth living, may have a cost in terms of physical health.

## 247) Abstract 1072

**DIABETES-SPECIFIC COGNITIVE BEHAVIORAL THERAPY ADAPTED FOR ELDERLY PEOPLE WITH DIABETES AND MINOR DEPRESSION COMPARED TO INTENSIFIED TREATMENT AS USUAL OR A GUIDED SELF-HELP INTERVENTION. RESULTS OF A MULTICENTER RANDOMIZED CLINICAL TRIAL.**

Frank Petrak, PhD, Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, North Rhine-Westphalia, Germany, Martin Hautzinger, PhD, Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Baden-Wuerttemberg, Germany, Stephan Herpertz, MD, Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, North Rhine-Westphalia, Germany, Kai Kronfeld, PhD, Interdisciplinary Centre for Clinical Trials Mainz (IZKS Mainz), University Medical Centre, University of Mainz, Mainz, Rhineland-Palatinate, Germany, Christian Ruckes, M.Sc., Interdisciplinary Centre for Clinical Trials Mainz (IZKS Mainz), University of Mainz, Mainz, Rhineland-Palatinate, Germany, Matthias J. Müller, PhD, MD, Vitos Clinical Centre Gießen-Marburg and Justus-Liebig-University Gießen, Vitos Clinical Centre Gießen-Marburg and University of Gießen, Gießen, Hesse, Germany

**Objective:** To compare the efficacy of a diabetes-specific cognitive behavioural therapy adapted for the elderly (CBT) vs. intensified treatment as usual (iTAU) vs. a guided self-help intervention (SH) in elderly people with diabetes and minor depression.

**Methods:** The trial was conducted as a multicenter, open, observer-blinded, parallel group (3 groups) randomized controlled trial. We included 166 patients with type 2 diabetes mellitus, 65 to 85 years of age (mean age 71.6 years; ± 4.4), and 3 to 6 depressive symptoms assessed with a SCID interview (minor depression or mild major depression). Patients were allocated to weekly CBT, weekly SH or iTAU. After 12 weeks of open-label therapy, CBT and SH were reduced to one session per month and patients treated with iTAU were contacted every three months during the one-year long-term phase of the trial. Group differences were compared in intention-to-treat analyses regarding the mental quality of life (MCS, SF-36, z-values, primary outcome) and depression symptoms (HAMD-17) after 15 months compared to baseline with analyses of covariance controlled for confounders. Regarding the prevention of major depression we performed Kaplan-Meier analyses and measured the survival times (times-to-first PHQ score ≥ 10).

**Results:** In the 15 months-follow up improvement in quality of life was observed in CBT and iTAU for MCS and regarding depression (HAMD-17) for all treatment groups. However, there were no significant differences regarding the different groups. Completer analyses revealed that patients treated with CBT had a significantly improved mental quality of life compared to the SH group (MCS score difference = 0.53; 95% CI: 0.01-1.06; p=0.046). Results of the Kaplan-Meier analyses displayed a significant advantage for CBT compared to iTAU regarding the prevention of major depression (p-value/logrank=0.038).

**Conclusions:** We observed a general improvement regarding quality of life and depression across the intervention groups but couldn't confirm our hypothesis of an advantage of CBT. Results of the completer analyses can cautiously be interpreted in the way that patients showing up more often to the CBT treatment visits have a higher benefit compared to the other interventions. More clearly, our results demonstrated that CBT is effective regarding the prevention of major depression in elderly patients with minor depression.

## 248) Abstract 1065

**CARDIOVASCULAR RISK FACTORS AND DISEASE IN U.S. HISPANICS/LATINAS WITH AND WITHOUT A HISTORY OF GESTATIONAL DIABETES IN THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL)**

Marisa J. Perera, MS, Samantha A. Reina, MS, Psychology, University of Miami, Coral Gables, FL, JoNell E. Potter, Ph.D., Obstetrics & Gynecology, University of Miami, Miami, FL, Daniela Sotres-Alvarez, DrPH, Biostatistics, University of North Carolina, Chapel Hill, NC, Melissa A. Simon, MD, MPH, Obstetrics & Gynecology, Northwestern University Feinverg School of Medicine, Chicago, IL, Carmen R. Isasi, MD, Ph.D., Epidemiology and Population Health, Albert Einstein College of Medicine, New York City, NY, Alison M. Stuebe, MD, Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC, Neil Schneiderman, Ph.D., Maria M. Llabre, Ph.D., Psychology, University of Miami, Coral Gables, FL

Gestational diabetes (GD) is an increasingly common complication of pregnancy associated with future adverse cardiovascular health outcomes and increased morbidity for the mother. A history of GD is a risk factor for metabolic syndrome (MetS), diabetes, and cardiovascular disease (CVD) in the postpartum.

US Hispanics/Latinas have higher risk for GD compared to non-Latina whites (Bardenheier et al., 2015; Fujimoto, Samoa, & Wotring, 2013) and high burden of CVD risk factors (Daviglus et al., 2012). Few studies have examined to what extent a history of GD is associated with CVD in this population.

HCHS/SOL is a prospective, multi-center (Bronx, Chicago, Miami, San Diego), population-based study of health and disease in 16,415 US Hispanic/Latinos aged 18-74. 8262 are women aged 20-73 years (M=45.3, SE=.29) with at least one live birth. During standardized interviews, women who endorsed she first had diabetes when pregnant were classified as having a history of GD (N = 305). At baseline clinic visit (2008-2011), waist girth (cm), blood pressure (mmHg), triglycerides (mg/dL), HDL-c (mg/dL), and fasting glucose (mg/dL) were measured via standardized procedures and fasting blood samples. National Cholesterol Education Program-Adult Treatment Panel III criteria were used for MetS, and American Diabetes Association criteria were used for diabetes classification. Coronary heart disease (CHD) combined ECG reports of prior MI, self-reported heart attack, angioplasty, stent, and bypass surgery to arteries of the heart. Cerebrovascular disease combined stroke, transient ischemic attack, balloon angioplasty, and surgery to neck arteries. Analyses were adjusted for sampling, clustering and stratification weights, and age (logistic regression adjusted also for body mass index, healthcare access, income, HCHS/SOL site, ancestry, diet, sedentary time, cigarette & alcohol use).

Women with a history of GD were younger (39.1 v. 45.5 years, p<.0001), had more healthcare access (68.5% v. 54.4%, p=.0005), greater waist circumference (101.6 v. 97.3 cm, p=.0001), higher fasting glucose (116.0 v. 99.4 mg/dL, p<.0001), and more likely to have MetS (OR=4.53, CI=2.79-7.36) and diabetes (OR=18.2, CI=10.61-31.44) than women without a history of GD. GD confers metabolic risk later in life and differences in CVD risk and diabetes do not translate into differences in CVD.

## 249) Abstract 1248

**A LATENT PREDICTION MODEL OF TYPE D PERSONALITY, DEPRESSION AND ANXIETY IN 3314 ADULTS WITH DIABETES**

Paul Lodder, MSc, Medical Psychology, Jelte Wicherts, PhD, Wilco Emons, PhD, Methodology and Statistics, Giesje Nefs, PhD, Frans Pouwer, PhD, Johan Denollet, PhD, Medical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands

**Background:** Type D personality has been associated with anxiety and depression in adults with type 1 or 2 diabetes (Nefs et al., 2015). However, conclusions about the presence and magnitude of the associations are conditional on the assumptions that the scores on the
scales measuring anxiety (GAD-7), depression (PHQ-9) and Type D personality (DS14) are normally distributed and measured without error. In our study we aimed to take into account both the measurement error and the extreme skewness of the GAD-7, PHQ-9 and DS14, enabling a minimally biased estimate of the relationship between Type D personality, depression and anxiety.

*Methods:* GAD-7, PHQ-9 and DS14 scores of 3314 Dutch adults with type 1 or 2 diabetes were used in a structural equation model, including both main effects and a latent interaction effect, as Type D personality refers to an interaction between its components negative affect (NA) and social inhibition (SI) (Smith, 2011). The latent interaction term was estimated using a matched pairs indicator multiplication method (Marsh, Wen & Hau, 2004). Skewed polytomous item responses were handled by fitting the model to the polychoric correlation matrix and estimating the parameters with weighted least squares estimation (Flora & Curran, 2004).

*Results:* After taking into account measurement error and skewed item scores, the relationship between Type D and depression and anxiety remained significant and the latent prediction model showed adequate fit, RMSEA 95%CI = [0.038, 0.041]. NA and SI were significantly associated with both anxiety ($\beta_{NA}$=0.82, Wald Z=22.94, *p*<.001; $\beta_{SI}$=-0.10, Wald Z=-4.05, *p*<.001) and depression ($\beta_{NA}$=0.80, Wald Z=20.99, *p*<.001; $\beta_{SI}$=-0.08, Wald Z=-3.05, *p*=0.001). These main effects were qualified by significant NA*SI interaction effects on both anxiety ($\beta_{NA*SI}$=0.16, Wald Z=8.17, *p*<.001) and depression ($\beta_{NA*SI}$=0.17, Wald Z=8.21, *p*<.001).

*Conclusions:* People with both high negative affect and social inhibition tend to be more depressed and anxious than people with either high negative affectivity or high social inhibition. Thus, after correcting for measurement error and skewed item responses, Type D personality was associated with both depression and anxiety. These results are based on more accurate estimates of the association between Type D, depression and anxiety in adults with diabetes.

## 250) Abstract 1211

### TYPE D PERSONALITY, DYADIC ADJUSTMENT, AND PERCEIVED SOCIAL SUPPORT IN ADULTS WITH DIABETES

Viola Spek, PhD, Giesje Nefs, PhD, Paula Mommersteeg, PhD, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, Brabant, The Netherlands, Jane Speight, PhD, Psychology, Deakin University, Melbourne, Victoria, Australia, Frans Pouwer, PhD, Johan Denollet, PhD, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, Brabant, The Netherlands

**Background:** Type D personality is defined as high negative affectivity (NA) and high social inhibition (SI). In cardiovascular patients, it has been shown that Type Ds experience less social support compared to others. However, little is known about Type D personality, social support, and dyadic adjustment in people with diabetes.

**Methods:** 621 Dutch adults with diabetes completed an online survey. Binary logistic regression analyses were used to compare participants scoring (i) low on NA and SI; (ii) low on NA, high on SI; (iii) high on NA, low on SI; (iv) high on NA and SI (Type D). Analyses were adjusted for gender, age, educational level, and diabetes type. To measure quality of adjustment in couples, we used the 32-item Dyadic Adjustment Scale. To determine poor adjustment, we used the official cut-off of 97. We used the Multidimensional Scale of Perceived Social Support to assess social support from a special person, family, and friends.

**Results:** Type D participants experienced poor dyadic adjustment (OR=3.57; 95%CI=1.42-8.96; *p*<.01) and low social support (OR=10.96; 95%CI=6.13-19.60 *p*<.01) more often compared to non-Type Ds. Type Ds had higher odds for low support from special persons (OR=6.45; 95%CI=3.79-11.00; *p*<.01), friends (OR=7.39; 95%CI=4.08-13.37; *p*<.001), and family (OR=4.18; 95%CI=2.51-6.96; *p*<.01), compared to non-Type Ds. We also found that participants with

NA only had higher odds for poor dyadic adjustment (OR=3.31; 95%CI=1.24-8.89; *p*=.02) and low social support (special person OR=3.25; 95%CI= 1.77-5.97; *p*<.001; friends OR=3.88; 95%CI=1.99-7.58; *p*<.01; family OR=3.38; 95%CI=1.91-6.00; *p*<.01), compared to others. Participants with SI only had higher odds for low social support (special person OR=3.38; 95%CI=1.86-6.16; *p*<.01; friends OR=3.70; 95%CI=1.91-7.17; family OR=2.12; 95%CI=1.17-3.85 *p*=.01), compared to others, but not for poor dyadic adjustment.

**Conclusions:** Diabetes patients with Type D had higher odds to experience poor dyadic adjustment and low social support compared to non-Type Ds. People with NA or SI only also had higher odds compared to others, but not as high as people with a Type D personality profile.

<figure><img src="image_31.png" /><figcaption>Figure 1. Social support stratified by personality</figcaption></figure>

subgroups

## 251) Abstract 1623

### DIETARY RESTRICTION MODULATES SALIVARY ALPHA-AMYLASE REACTIVITY TO THE TRIER SOCIAL STRESS TEST

Luke Hanlin, MA, Alex Fiksdal, MA, Catherine Wen, BA Candidate, Sam Leib, BA Candidate, Annie Kim, BA, Psychology, Brandeis University, Waltham, MA, James Mitchell, PhD, Genetics and Complex Diseases, Harvard University, Boston, MA, Nicolas Rohleder, PhD, Department of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bavaria Land, Germany

**Rationale:** Dietary restriction of proteins has been shown to prolong the lifespans of rodents by 30% and also improve survival outcomes of these animals after surgery. It is unclear whether the benefits of dietary restriction are also conferred to humans. If this is the case, decreases in Sympathetic Nervous System (SNS) activation could result in less inflammation. In this study we set out to test whether DR is modifying reactivity of a marker of SNS activation, salivary alpha-amylase (sAA), to acute psychosocial stress.

**Methods:** Sixty adults (M=19.31 years, SD=1.85; 51% male; 42% Caucasian) with a mean BMI of 24.63kg/m² (SD=2.98), were randomly assigned to an 18-hour overnight fast (n=19), 72-hour juice fast (protein restriction; n=20), or control condition (n=20). All participants were exposed to the Trier Social Stress Test (TSST) and sAA was measured at baseline, and +1, 10, 20, 45, 60, and 120 minutes after the stressor.

**Results:** Analysis of baseline samples showed differences between overnight (M=59.63, SD=32.06) and control groups (M=86.18, SD=57.50), but not between those and the juice group
(M=84.92; SD=74.75). An independent T test confirmed the difference between the overnight and control groups (t=1.80, p=0.08) at a trend level, while all other comparisons were insignificant. A repeated-measures ANOVA revealed a significant effect of time (F=15.81, p<0.001) indicating that amylase was reactive to the TSST. Further analysis showed that there were significant differences in reactivity (peak minus baseline; F=5.62, p=0.01) as the overnight (M=103.29 U/mL, SD=66.59) and juice groups (M=120.47 U/mL, SD=103.29) showed higher reactivity as the control (M=64.64 U/mL, SD=82.69).

**Conclusion:** We found that DR modifies sAA reactivity to acute psychosocial stress, which indicates that DR affects ANS stress responses. These findings add to previous findings that DR is impacting stress responses, as differences in cortisol and inflammatory reactivity have already been described. These findings also add evidence that DR is decoupling systems that are typically linked, as increased ANS activation should result in increased inflammation, though the opposite has been found. Future studies should examine what systemic and intercellular mechanisms are responsible for this decoupling.

## 252) Abstract 1019

# INTRAINDIVIDUAL VARIABILITY IN DIURNAL CORTISOL: MEASUREMENT APPROACHES AND RECOMMENDATIONS

Suzanne C. Segerstrom, PhD, Psychology, University of Kentucky, Lexington, KY, Sandra E. Sephton, PhD, Psychological and Brain Sciences, University of Louisville, Louisville, KY, Philip M. Westgate, PhD, Biostatistics, University of Kentucky, Lexington, KY

Most of the variance in diurnal cortisol comes from intraindividual variability (IIV): short-term, reversible changes. Multiple methods for measuring IIV have been proposed, including the individual SD (iSD), rMSSD, and autocorrelation. The measurement of cortisol IIV (cIIV) is complicated by its ability to be decomposed into between-day (e.g., variability in slopes) and within-day (e.g., variability in residuals). IIV measurement approaches were applied to both simulated and real cortisol data to determine the most reliable and valid analytic approaches to cIIV. Simulated data comprised 2000 datasets with IIV at either the level of the slopes or residuals, analyzed using bootstrapping. The iSD of slopes and residuals best captured these differences; the iSD over all data and the rMSSD did poorly. Sampling frames that yielded at least 10 slopes (see Figure) and 50 residuals resulted in reliable and stable estimates of the iSD. In the real data from 119 law students sampled over 15 days, neuroticism was unrelated to mean cortisol levels (r = .06, p = .51) and mean slopes (r = .08, p = .41). However, neuroticism was significantly negatively correlated with the iSD in slopes (r = -.24, p = .008). This result, which was not captured by other measurement levels or approaches, may indicate that people higher in neuroticism had less flexibility in cortisol regulation. New research on cIIV suggests it is an important parameter, and reliable and valid measurement is a prerequisite for further research.

<figure><img src="image_32.png" /><figcaption>Correlation estimates with increasing numbers of days: Slope variance datasets</figcaption></figure>

## 253) Abstract 1294

# PERCEIVED DISCRIMINATION IS ASSOCIATED WITH COGNITIVE FUNCTION IN URBAN-DWELLING AFRICAN AMERICANS

Antione D. Taylor, M.A., Psychology, University of Maryland Baltimore County, Baltimore, Maryland, U.S.A, Danielle L. Beatty Moody, Ph.D., Psychology, University of Maryland Baltimore County, Baltimore, Maryland, Michele K. Evans, M.D., Laboratory of Epidemiology and Population Sciences, National Institutes of Aging, Baltimore, Maryland, Alan B. Zonderman, Ph.D., Laboratory of Epidemiology & Population Sciences, National Institute of Aging, Baltimore, Maryland, Shari R. Waldstein, Ph.D., Psychology, University of Maryland Baltimore County, Baltimore, Maryland

Perceived discrimination (PD), a type of chronic stress that is particularly salient for African Americans (AAs), has been linked to untoward mental and physical health outcomes. However, little is known of its relation to brain health outcomes such as cognitive function. Here, we examined whether the relation of PD to cognitive function among AAs was moderated by poverty status. The sample consisted of 926 AAs, ages 30-64 years (57% women, mean age = 47, SD = 9.2) who had completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Participants rated their day-to-day experiences with PD with the Williams Everyday Discrimination Scale and underwent a neuropsychological evaluation that included measures of attention, learning and memory, and executive function. Analyses examined interactive and independent relations of PD and poverty status to cognitive performance after adjustment for literacy, sex, smoking, alcohol and illicit drug use. Results revealed significant interactions of PD and poverty status for the California Verbal Learning Test total recall (b = .05, t(1, 917) = 2.23, p < .05), short delay (b = .03, t(1, 917) = 2.35, p < .05), and long delay (b = .03, t(1, 917) = 2.31, p < .05). Among those above the 125% poverty line, greater PD was associated with lower verbal recall scores; for those below the poverty line, greater PD was related to higher recall scores. Significant main effects were also noted such that higher levels of PD were associated with lower levels of performance on Trails B (b = .99, t (1, 918) = 2.98, p < .01) and the Brief Test of Attention (b = -.01, t (1, 918) = -2.08, p < .05). It appears relations of PD to verbal learning and memory performance varied by socioeconomic contexts. Interestingly, AAs above the poverty line may experience a "double edged sword" - while being above the poverty line may afford better opportunities, they may be subject to higher levels of PD in both daily life and the work place, which can influence cognition through various stress pathways. However, it is unclear why AAs living in poverty performed better on verbal memory measures in the context of PD. Because stress has been associated with both increases and decreases in hippocampal volumes, future research should identify potential linkages among PD, brain, and cognitive function.

## 254) Abstract 1083

# THE HUMAN BEHAVIOUR CHANGE PROJECT: DEVELOPMENT OF AN AUTOMATED SYSTEM TO SYNTHESISE EVALUATIONS OF BEHAVIOUR CHANGE INTERVENTIONS TO FURTHER THE SCIENCE AND APPLICATION OF BEHAVIOUR CHANGE

Marie Johnston, PhD, Medicine, Dentistry & Nutrition, University of Aberdeen, Aberdeen, Scotland, UK, Susan Michie, PhD, Clinical, Educational and Health Psychology, University College London, London, England, UK, Robert West, PhD, Clinical, Educational and Health Psychology, James Thomas, PhD, Social Science, UCL, London, England, UK, Pol Mac Aonghusa, PhD, Social, Mobile and Decision Science, IBM Research, Dublin, Dublin, Ireland, John Shawe-Taylor, PhD, Computer Science, UCL, London, England, UK, Michael Kelly, PhD, Public Health and Primary Care, University of Cambridge, Cambridge, England, UK
**Background:** Behaviour change is essential if major health problems such as obesity are to be addressed. Evidence is needed by researchers, policy-makers and practitioners about what interventions work, for which behaviours, how well, for whom, in what settings and why. Such evidence is currently being produced on a vaster scale than humans can read and process but without the organisational structure which would allow computers to do this task. This paper describes a major project, the *Human Behaviour Change Project*, funded by the Wellcome Trust addressing this issue.

**Methods:** The project will involve an iterative process involving the following steps:

1. Building a consensus of international experts around a suitable ontology (a formal structure for organising knowledge in terms of defined constructs and their relationships) of behaviour change intervention evaluations that capture key features linking observed effect sizes with the interventions and their comparators, their reach and engagement, the behavioural outcomes being targeted, characteristics of the populations and setting, and mechanisms of action.

2. Building and training a natural language processing system to extract information from published research reports to populate the ontology.

3. Developing, testing and refining machine learning algorithms to integrate information in the populated ontology to generate a knowledge structure that captures principles of behaviour change.

4. Developing, testing and refining a user interface for researchers, policy makers and practitioners to be able to interrogate the knowledge structure and its supporting evidence base.

**Outputs:** The main outputs will be: an ontology of behaviour change interventions; a natural language processing system capable of extracting key information from research reports to populate the ontology, a machine learning system for synthesising evidence in the populated ontology to create knowledge about behaviour change; and an interface allowing users to interrogate and update the knowledge structure and evidence base.

**Conclusions:** This collaboration between behavioural, computer and information scientists has the potential to make a step-change in the accessibility and value of information about behaviour change interventions, and allow important societal behavioural problems to be addressed.

## 255) Abstract 1399

# BIOLOGICAL MARKERS AND HEALTH BEHAVIORS DO NOT MEDIATE THE RELATIONSHIP BETWEEN TRAIT HOSTILITY AND THE METABOLIC SYNDROME

Mark C. Thomas, BA, Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, Thomas W. Kamarck, PhD, Aidan G. Wright, PhD, Karen A. Matthews, PhD, Barbara Anderson, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA, Stephen Manuck, PhD, Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania

Much evidence links trait hostility with the metabolic syndrome (MS), but less is known about which components of hostility are most strongly linked to MS and their potential mechanisms. Here, we investigate the relationship between dimensions of hostility and MS, as well as the role of blood pressure (BP) reactivity, metrics of adrenocortical activity, and health behaviors in accounting for any associations. In a cross-sectional sample of 493 healthy, employed middle-aged adults (mean age=42.7 years, 81% white, 53% female), we measured trait hostility using the Buss Perry Aggression Questionnaire (assessing Physical Aggression, Verbal Aggression, Anger, Hostility) and the Cook-Medley Hostility Inventory (assessing Cynicism, Hostile Affect, Aggressive Responding, Hostile Attribution). We operationalized MS using a continuous measure (zMS) averaging z-scores measuring each component (glucose, triglycerides, HDL, systolic and diastolic BP, and waist circumference). Lifestyle variables include smoking status, alcohol consumption, energy expenditure, caloric intake, and actigraphy-measured sleep duration. Participants

collected biological samples and hourly ecological momentary assessment (EMA) interviews across 4 monitoring days. We measured cortisol area under the curve (AUC) and slope using five samples collected from wake time to bedtime averaged across the 4 days. Epinephrine (EPI) and norepinephrine (NE) collected from two 15-hour overnight urine samples were expressed as a ratio to creatinine excretion. We measured ambulatory mean arterial pressure response (MAPR) to EMA-measured daily life social conflict.

When controlling for demographic variables, Physical Aggression (b=.015, p=.009), Anger (b=.014, p=.016), and Aggressive Responding (b=.032, p=.023) were significantly associated with zMS, but the other Buss-Perry and Cook-Medley scales were not. Of the biomarkers, significant associations with zMS emerged for EPI (b=-.079, p=.038), AUC (b=-.226, p=.006), and MAPR (b=.986, p<.0001), however, only Aggressive Responding was associated with NE (b=.035, p=.016). Neither the five biomarkers nor the five lifestyle behaviors significantly mediated the relationship between hostility scales and zMS. Behavioral and affective components appear to be most strongly linked with MS, but further research on potential mechanisms is needed.

## 256) Abstract 1461

# USING SOCIAL MEDIA AS A SHIELD AGAINST STRESS: FACEBOOK USE MAY BUFFER ACUTE STRESS

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

**Background and Aim:** A conflicting body of research suggests that Facebook use may both enhance and undermine well-being. Despite these associations, to date there have been hardly any objective measurement of the potential impact of Facebook use on well-being in the context of stress. We aimed to examine the impact of Facebook use on stress reactivity.

**Methods:** Forty-eight undergraduate students (mean age 19.8±2.3) were randomly assigned to either the experimental group (Facebook use) or the control group (digital reading materials) during 18 minutes before experiencing the Trier Social Stress Test (TSST). All participants completed measures of mood and well-being. Objective physiological markers (blood pressure, heart rate, and salivary cortisol) were collected at baseline and during recovery.

**Results:** The groups did not differ on any measure at baseline. During the TSST, the experimental group showed a decrease in heart rate, whereas the control group showed a steep increase (p<.05). When considering just the TSST responders (i.e. salivary cortisol levels increasing or flat-lining 20 minutes after the onset of the TSST), participants in the experimental group showed a more blunted response to the TSST in terms of salivary cortisol (p<.05). There were no significant differences in blood pressure or any subjective measures.

**Conclusion:** This pilot study showed that participants who used Facebook before experiencing acute stress showed a more blunted response to the TSST with regard to heart rate and salivary cortisol compared to the control group. Results suggest that Facebook use may act as a buffer against the physiological response to acute stress.

## 257) Abstract 1505

# HEALTHY LIFESTYLE AND CARDIAC VAGAL MODULATION OVER 10 YEARS: WHITEHALL II COHORT STUDY

Vera K. Jandackova, Ph.D., Department of Epidemiology and Public Health, University of Ostrava, Ostrava, Czech Republic, Czech Republic, Shaun Scholes, Ph.D., Annie Britton, Ph.D., Department of Epidemiology and Public Health, University College London, London, United Kingdom, United Kingdom, Marek Malik, Ph.D. MD, National Heart and Lung Institute, Imperial College of Science, Technology and Medicine London, London, United Kingdom, United Kingdom, Andrew Steptoe, D.Phil, Department of Epidemiology and Public Health, University of Ostrava, London, United Kingdom, United Kingdom
**Background:** A healthy lifestyle factors, including regular physical activity, not smoking, moderate alcohol consumption and healthy body mass index (BMI) have been individually and mostly cross-sectionally related to increased vagal modulation of the autonomic nervous system (ANS), an indicator of better cardiac health. But how these 4 important healthy lifestyle factors combine to affect ANS function in the longerterm is not established. We prospectively examined the association between these 4 healthy lifestyle factors and vagal modulation over a 10y follow-up period. **Methods:** Data of the fifth (1997-1999), seventh (2002-2004) and ninth (2007-2009) calls of the UK Whitehall II longitudinal population-based study were analysed. The population size ranged from 2518 to 3479 (55.7ys at baseline). A healthy lifestyle score (HLS) was created wherein participants received 1 point for each healthy criterion met: physically active, healthy BMI, currently not smoking and moderate alcohol consumption. Two heart rate variability (HRV) measures reflecting vagal modulation were used: high-frequency HRV (HF; ms²) and RMSSD(ms). We applied general linear model and a random mixed models analysis. **Results:** Cross-sectionally, a significant positive graded association was observed between a HLS and both HRV measures at baseline ($p_{trend} \le 0.001$). The differences in HRV according to the HLS remained stable over time. Compared with participants who hardly ever adhered to healthy lifestyle practices over the 10ys, those who always had healthy lifestyles displayed higher HF ($\beta$=0.18; 95%CI 0.04-0.31; $p$=0.009) (Figure) and RMSSD ($\beta$=0.12; 95%CI 0.04-0.20; $p$=0.003) at follow-up after adjustment for age, sex, ethnicity, employment grade, cardiometabolic condition and medication use. Compared with participants who reduced their number of healthy lifestyle practices, those who increased the number of healthy lifestyle practices had higher subsequent HF ($\beta$=0.14; 95%CI 0.01-0.26; $p$=0.033) and RMSSD ($\beta$=0.08; 95%CI 0.01-0.15; $p$=0.036) after adjustment for the covariates. **Conclusion:** Findings suggest not only that increased vagal modulation may be a biological mechanism linking healthy lifestyle to better cardiac health, but also that maintaining healthy lifestyle throughout aging has a favourable effect on cardiac vagal functioning and these beneficial adaptations may be lost on cessation.

<figure><img src="image_33.png" /><figcaption>Predicted High-Frequency Heart Rate Variability at Follow-up according to Habitual Healthy Lifestyle* over a 10-year follow-up period (n=3333)</figcaption></figure>

Habitual Healthy Lifestyle practices over 10 years; „hardly ever“, „occasionally“ and „always“ includes those participants who reported 0-4, 5-8 and 9-12 healthy lifestyle factors (not currently smoking, physically active, moderate alcohol consumption and healthy BMI) respectively out of the time points (phases 5, 7 and 9).

**258) Abstract 1346**
A RANDOMIZED CONTROLLED TRIAL EVALUATING THE EFFECT OF WRITTEN DISCLOSURE ON SUBJECTIVE STRESS AND CORTISOL ACTIVITY AMONG PARENTS OF CHILDREN WITH AUTISM

Nikko S. Da Paz, Ph.D., Psychiatry, University of California, San Francisco, San Francisco, CA, Jitske Tiemensma, Ph.D., Jan L. Wallander, Ph.D., Psychology, University of California, Merced, Merced, CA

**Background:** Repeated exposure to stressful events creates sustained activation of the hypothalamic-pituitary-adrenal (HPA) axis which can contribute to poor health. Extensive research reports that parents of children with autism spectrum disorders (ASD) experience chronic caregiver-related stress, triggering increased risk for unfavorable health consequences. With prevalence rates of ASD rapidly increasing, it is imperative to identify effective interventions targeting attenuation of stress-related parent outcomes. Investigations of written disclosure (WD) have shown promising results in stress reduction for the general population but a paucity of research has evaluated WD with parents of children with ASD. Fewer have utilized the stress biomarker of cortisol activity to evaluate WD treatment efficacy.

**Hypothesis:** We hypothesized that parents who wrote about traumatic events (treatment) would display better psychophysiological stress profiles compared to parents who wrote about a neutral topic (control).

**Method:** We conducted a randomized controlled trial with 71 parents of children with ASD (ages 23 to 62 years; M = 38.0, SD = 10.35). We evaluated self-reported stress (perceived stress, parenting stress, and caregiver strain) and collected salivary cortisol to examine the cortisol awakening response (CAR) at baseline and 6-month follow-up.

**Results:** At 6-month follow-up treatment parents displayed more robust cortisol activity, $F(1,52) = 12.08; p = .002$, and reported less perceived stress, $F(1,56) = 9.14; p = .004$. While conditions did not differ at follow-up, parenting stress ($F(1,56) = 7.64; p = .008$) and caregiver strain ($F(1,56) = 6.46; p = .014$) were reported significantly better for all parents over time. Thus, results partially support WD as an effective stress-reduction treatment for parents of children with ASD. Given the small sample size, caution is warranted for generalizability.

**Conclusions:** Overall, the results of this study partially support the efficacy of written disclosure in improving stress-related outcomes at 6-month follow-up for parents of children with ASD. The improvement of health outcomes for parents of children with ASD is both significant and timely. Being able to simply write to evoke positive change to one's health and well-being appears welcomed in a population of uniquely distressed caregivers.

**259) Abstract 1042**

FEASIBILITY OF OUT-PATIENT EXERCISE PROGRAMS TO IMPROVE COGNITION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Elizabeth Kozora, PhD, JoAnn Zell, MD, Andrew Burleson, MS, Medicine, National Jewish Health, Denver, Colorado, Emily C. Duggan, BA, Neuropsychology, University of Victoria, Victoria, BC, Canada, Barry Make, MD, Medicine, National Jewish Health, Denver, Colorado, Jeff Swigris, DO, Medicine, National Jewish Health, Denver, CO

**Background:** Preliminary evidence suggests that limited exercise tolerance is associated with lower cognitive function in patients with SLE. No studies have objectively evaluated the impact of standardized exercise programs on cognitive improvement in this patient group.

**Methods:** Eligible SLE patients were enrolled and randomized to participate in an eight-week medical center-based, standardized, outpatient exercise program (n=3) or usual care without an exercise program (n=3). The average age of the active group was 39.3 years with 13.3 years of education and 69.7 months of disease duration. Outcomes included measures of cognitive, behavioral and cardiopulmonary function. The active subjects participated in an exercise program consisting of three 30 minute exercise sessions per week for eight weeks (total 24 sessions). Subjects began training on a treadmill at 60% of their personal peak oxygen consumption (VO2max). Exercise intensity was gradually increased via increased speed or incline each week. Evaluation of enrollment activities and barriers to patient participation in outpatient exercise were formally
**assessed. Results:** Improvement in aspects of exercise ability (mean peak oxygen consumption increased 9.5%), distance covered during a timed walk test (mean increase of 90 feet), and depression were noted in two of the three subjects. Improvement in resting heart rate (mean decrease of 10.3bpm), and weight loss (mean decrease of BMI by 0.66) were noted in all three subjects who participated in the exercise program. Work, school and family responsibilities, physical concerns (and limitations), and transportation issues were the primary reasons that SLE patients reported they were not interested in participating in outpatient exercise. **Conclusions:** Although some improvement in physical and psychological status was noted in select SLE subjects following an outpatient exercise program, no specific improvement in cognitive function was observed. Protocol-imposed exclusions (i.e. cardiovascular risks) and high frequency of exercise at baseline limited enrollment and overall conclusions. Home- or community-based programs and other methods to overcome barriers to participation should be explored in future studies aimed at improving cognition and health in patients with SLE.

## 260) Abstract 1354

### THE AIM JUSTIFIES THE MEANS - DIFFERENCES AMONG MUSICAL AND NONMUSICAL MEANS OF RELAXATION OR ACTIVATION INDUCTION IN DAILY LIFE

Mattes B. Kappert, Dipl.-Psych., Alexandra Linnemann, Ph.D., Urs M. Nater, Ph.D., Psychology, University of Marburg, Marburg, Hesse, Germany

Music listening has been shown to produce a wide variety of effects on mind and body. Music listening may be used for stress reduction in general, but it may also be used to specifically induce relaxation or activation. However, it is unclear whether these effects are specific to music listening or whether other activities may have similar effects.

We aimed to investigate the specific effect of music listening on relaxation and activation. To this end, we used an app that provided users with three different means of achieving relaxation and/or activation: 1) listening to self-selected music, 2) listening to guided relaxation or activation, accompanied by music, and 3) listening to self-enhancing instructions (no music condition). In 1) and 2), the participants were able to choose whether they wanted to achieve relaxation or activation. 62 subjects (age: M = 40.19 years; 18 women) participated in the study. Each participant was equipped with an iPod and instructed to use the app as often as desired. Assessment duration was individualized and ranged from 3 to 10 consecutive days (M = 7.26 days). Subjective stress, fatigue, relaxation and activation as well as skin resistance were assessed before and after using the app.

The app was used, on average, 10.19 times over the course of the study. The participants felt less stressed and fatigued as well as more relaxed and activated after using the app for all three means. Furthermore, after using the app, skin resistance was lower indicating an increase in autonomic arousal. There were no general differences between the three conditions in any of the outcomes. However, there was a stronger decrease in subjective stress and a stronger increase in relaxation when participants wanted to achieve relaxation.

The results indicate that all three different means had beneficial effects on stress, fatigue, relaxation, and activation. Interestingly, there were no general differences among means containing music and those not containing music. However, the aim for using the app predicted the outcome independent of the chosen means.

## 261) Abstract 1441

### TEMPERAMENT FACTORS AND DIMENSIONAL, LATENT BIFACTOR MODELS OF CHILD PSYCHOPATHOLOGY: TRANSDIAGNOSTIC AND SPECIFIC ASSOCIATIONS IN YOUTH

Benjamin Hankin, PhD, Psychology, University of Illinois, Urbana, IL
Common psychopathology, including internalizing problems of anxiety and depression, and externalizing problems of hyperactivity and

conduct problems, significantly co-occur. Temperament factors, negative affectivity (NA), positive affectivity (PA), and effortful control (EC), predict emotional distress and behavioral problems. Little research has integrated these findings to understand how temperament operates as transdiagnostic risks broadly for psychopathology and specific risks to unique syndromes.

Common diagnoses (mood, anxiety, conduct and aggression) are best structured by a general psychopathology latent factor and unique internalizing and externalizing latent factors. The general psychopathology (the "p factor") captures the co-occurrence across all measured symptoms. After statistically accounting for shared variance across all symptoms via the p factor, unique covariance that remains is independently organized by unique latent internalizing and externalizing dimensions.

Poor effortful control (EC) and higher negative affect (NA) are associated with most forms of psychopathology. Low positive affect (PA) is more specific to internalizing problems.

I examined links between temperament factors and child psychopathology when modeled via p factor and specific internalizing and externalizing latent dimensions. Past work studied temperament-psychopathology without all three temperament dimensions simultaneously and explicit consideration of psychopathology co-occurrence.

Data come from 571 children. They were 13.58 years old (SD=2.37). Child psychopathology included depression, anxiety, aggression, oppositional and conduct problems, ADHD. Temperament was assessed via EATQ and PANAS.

SEM showed the bifactor latent model fit well (CFI = .97, RMSEA=.054). All psychopathology loaded onto the p factor; depression and anxiety loaded onto internalizing specific factor; aggression, oppositional and conduct problems loaded on externalizing specific factor. Regression analyses showed the p factor was negatively predicted by EC, positively with NA. Internalizing-specific factor was positively predicted by NA, and negatively by EC and PA. The externalizing-specific factor was negatively predicted by EC, no effect of NA or PA.

Temperament relates transdiagnostically to general psychopathology and is linked more specifically to unique aspects of child psychopathology.

## 262) Abstract 1600

### PERCEIVING ONESELF AS A GIVER VS. RECEIVER ELICITS UNIQUE EMOTIONAL STATE BLENDS: A WEB-BASED ACTIVATION OF SUPPORT SCHEMAS IN OLDER ADULTS

Diana Wang, B.S., Gerontology, University of Southern California, Los Angeles, CA, Tara L. Gruenewald, PhD, Family and Consumer Sciences, Gerontology, California State University, Long Beach, Long Beach, CA

Epidemiological studies indicate that giving support to others is beneficial for health and well-being, above and beyond receiving support. However, the cognitive-affective and physiological pathways which may underlie the health benefits of support provision or receipt remain to be elucidated. The current study seeks to identify the unique or shared cognitive-affective states linked with perceiving oneself as a giver or receiver of support in older adults.

324 participants age 55+ were recruited for this online study through online survey panels (Qualtrics and mTurk) as well as from the greater Los Angeles area. Subjects were randomly assigned to one of three 10-minute writing conditions: discussing their role as support-givers or receivers, or previous-day activities. Immediately after, participants were asked to report perceived levels of positive and negative affect and feelings of control, social connectedness and ego achievement. ANOVA models were used to compare the mean levels of cognitive-affective states and expressions of positive and negative affect, social connectedness and ego achievement in written narratives as assessed with the Linguistic Inquiry and Word Count (LIWC) program.
There were significant group differences in mean levels of self-reported perceived control (p=.027) and contributions to others (p=.044). Givers report higher levels of control than receivers, and marginally higher levels of contributions to others compared to the neutral group.

Linguistic expression analyses indicated that givers used less positive and negative emotion words (p<.001), and marginally less affiliation words than receivers, but more achievement-related words than those in the giver and neutral conditions. Receivers also used greater levels of positive, negative, and affiliation and achievement-related words compared to the neutral group (p<.001).

Our findings indicate both shared and unique cognitive-emotional states linked with support giving and receiving in older adults, providing clues to the pathways through which the giving and receiving of support may be beneficial for health. We will also share findings from an ongoing investigation that utilizes our support provision paradigm to examine the endocrine and autonomic nervous system sequelae of support-giving and links to the cognitive-affective states examined in the current study.

## 263) Abstract 1003

### LEUKOCYTE TELOMERE LENGTH AND PERSONALITY: ASSOCIATIONS WITH THE BIG FIVE AND TYPE D PERSONALITY TRAITS

Dounya Schoormans, PhD, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, Netherlands, Josine Verhoeven, PhD, Psychiatry and EMGO Institute for Health and Care Research, VU Univeristy Medical Center, Amsterdam, Zuid-Holland, Netherlands, Johan Denollet, Professor, Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, Netherlands, Lonneke van de Poll-Franse, Professor, Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands, Brenda Penninx, Professor, Psychiatry and EMGO Institute for Health and Care Research, VU Univeristy Medical Center, Amsterdam, Noord-Holland, Netherlands

**Background:** Accelerated cellular ageing, which can be examined by telomere length (TL), may be an overarching mechanism underlying the association between personality and adverse health outcomes. This 6-year longitudinal study examined the relation between personality and leukocyte telomere length (LTL) over time among adults with a wide age-range.

**Methods:** Data from the Netherlands Study of Depression and Anxiety were used and included patients with a depression and/or anxiety disorder and healthy controls. Overall, 2936 persons (18-65 years, 66% female) had data on LTL at baseline and 1883 persons had LTL at six year follow-up. The Big Five personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) and Type D personality were assessed.

**Results:** Neuroticism was negatively (B=-2.15, p=0.040) and agreeableness was positively (B=3.98, p=0.030) related to LTL measured over two time points, which became just non-significant after adjusting for somatic health, lifestyle factors, and recent life stress (B=-2.08, p=0.055; and B=3.27, p=0.087). Type D personality was negatively (B=-53.02, p=0.009) related to LTL across two time points, which still remained statistically significant after full adjustment (B=-50.76, p=0.017). Associations did not differ by age, gender, and current psychiatric status.

**Conclusions:** The Big Five traits high neuroticism and low agreeableness and Type D personality were associated with shorter LTL measured over a six year period. Associations with the Big Five traits became non-significant after controlling for somatic health, lifestyle factors, and recent life stress, yet similar trends were observed. Type D personality remained independently associated with shorter LTL after full adjustment.

## 264) Abstract 1165

### PHYSIOLOGICAL CONCORDANCE IN MOTHER-CHILD DYADS IN THE CONTEXT OF MATERNAL EMOTIONAL ABUSE HISTORY AND EMOTION DYSREGULATION

Jacqueline R. O'Brien, B.A., Maureen Zalewski, Ph.D., Psychology, University of Oregon, Eugene, OR

Physiological concordance in the parent-child dyad, conceptualized as similar physiological profiles of parent and child, has been associated with developmental milestones for children, while discordance has been viewed as a risk factor for negative child outcomes. The HPA-axis, a component of the sympathetic nervous system, uses its main hormonal output of cortisol to regulate the body's reaction to stressors. Heart rate variability (HRV), a component of the parasympathetic nervous system, has been indicated as a measure of emotion regulation. Maternal childhood trauma history and emotion dysregulation have both been associated with disrupted diurnal cortisol and HRV. The current study examined concordance rates for both cortisol and HRV in an at risk sample and determined whether maternal trauma history and emotion dysregulation moderates the degree of concordance.

Mother-preschooler dyads were recruited (N=68) in which mothers with borderline personality disorder, a disorder marked by extreme emotion dysregulation and high levels of trauma history were oversampled. Maternal emotion dysregulation (Difficulties in Emotion Regulation Scale) and maternal trauma history (Childhood Trauma Questionnaire, emotional abuse subscale) were measured. Dyads completed a 5-minute baseline measure of HRV and collected cortisol samples at home for three days in the morning and evening.

Results showed that dyads exhibited cortisol concordance at every time point, except for the Day 1 PM sample, which was discordant. Dyads did not exhibit HRV concordance. When controlling for emotion dysregulation, mother cortisol levels predict child levels in the morning, but not in the evening. Neither emotion dysregulation nor mother HRV predict child HRV. When emotional abuse history is taken into account, mother cortisol levels do not predict child levels at any time point. However, emotional abuse history predicts child HRV. No interactions were significant.

While concordance has been viewed as a positive indicator of child development, it may be a risk factor that this sample showed cortisol concordance, as maternal emotion dysregulation and abuse history both lead to disrupted cortisol patterns that are associated with negative health outcomes. Further research will explore long-term effects maternal emotion regulation and trauma history has on dyad concordance and child outcomes.

<table><caption>Table 1. Bivariate Correlations in Salivary Cortisol (Transformed, µ/dL) and HRV</caption><thead><tr><td></td><td>Concordance Rate</td></tr></thead><tbody><tr><td>Day 1 AM</td><td>.362*</td></tr><tr><td>Day 1 PM</td><td>-.047</td></tr><tr><td>Day 2 AM</td><td>.339*</td></tr><tr><td>Day 2 PM</td><td>.346*</td></tr><tr><td>Day 3 AM</td><td>.284†</td></tr><tr><td>Day 3 PM</td><td>.433*</td></tr><tr><td>HRV</td><td>.089</td></tr></tbody></table>

## 265) Abstract 1426

### DOES BREASTFEEDING REALLY ENHANCE MATERNAL SENSITIVITY? AN EXPERIMENTAL TEST

Jennifer Hahn-Holbrook, PhD, Psychology, Chapman University, Orange, CA

It is widely assumed that breastfeeding facilitates maternal sensitivity, in part, because breastfeeding triggers the acute release of oxytocin and
prolactin, hormones important for regulating social behaviors. While there is strong evidence from animal models that lactation and its related hormonal profile promote maternal behavior, no experimental evidence existed in humans. To experimentally test the hypothesis that breastfeeding triggers hormonal changes that enhance maternal sensitivity in humans, 40 breastfeeding mothers were randomly assigned to either breastfeed or bottle feed (with pumped breast milk or formula) in the laboratory. Afterwards, all mothers played with their infant for 12 minutes and provided a blood sample to assess levels of prolactin and oxytocin. Maternal sensitivity was coded by raters blind to participate condition using the National Institutes of Child and Human Development (NICHD) behavioral coding scheme. Mothers randomly assigned to breastfeed were rated as more sensitive to their infant's cues than mothers randomly assigned to bottle feed. Serum prolactin levels were also positively correlated with maternal sensitivity. Together, these finding provide the first experimental evidence in humans that breastfeeding and its associated hormonal changes do indeed help to facilitate maternal sensitivity. These results also suggest that breastfeeding promotion could be a target for interventions designed to enhance maternal sensitivity.

## 266) Abstract 1106

### ASSOCIATIONS BETWEEN CUMULATIVE ADVERSE CHILDHOOD EXPERIENCES AND CARDIOVASCULAR DISEASE AND MORTALITY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Karen P. Jakubowski, MS, Psychology, University of Pittsburgh, Pittsburgh, PA, Jenny M. Cundiff, PhD, Psychological Sciences, Texas Tech University, Lubbock, TX, Karen A. Matthews, PhD, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA

**Methods:** The search returned 2314 articles (Figure 1). Included studies had a measure of cumulative adversity (an index that included at least 2 adverse childhood experiences from age 0 to 18) and at least one CV-related outcome (CV clinical events: hypertension, stroke, coronary heart disease; CV clinical risk scores: Framingham risk; and metabolic outcomes: diabetes, metabolic syndrome), or mortality measured at age 19 or older in a non-psychiatric population. Effect sizes were reported as regression weights, odds ratios (OR), or hazard ratios (HR), and were drawn from fully adjusted models. Given differences in the interpretation of OR versus HR, effects were pooled separately. Regression weights were included with OR. Overall, 27 studies were included: 11 HR studies (18 effects; N=268,960) and 17 OR studies (34 effects; N=464,215).

**Results:** Exposure to cumulative childhood adversity was associated with risk of CV-related outcomes in adulthood (OR [95%CI]=1.36 [1.26-1.47]) and time to event for CV-related outcomes and mortality (HR=1.34 [1.18-1.52]). Combined risk for CV clinical events, CV risk scores, and mortality was elevated relative to risk for metabolic outcomes (ORCV=1.51 [1.35-1.68] vs. ORmetabolic=1.22 [1.08-1.38]; QM=6.3, p<.05); this pattern was not seen in HR studies. Smaller effects were observed in HR, but not OR, studies that measured childhood SES in the cumulative index or adjusted for adult psychosocial factors. There was a threshold effect of 4-6 adversities for both HR and OR studies. Results did not vary by gender, location (U.S. vs. non-U.S.), design (prospective vs. retrospective report of adversity), type of adversities, adjustment for adult health behaviors, number of covariates, or years of follow-up. We were unable to assess moderation by race, given limited data in non-white samples.

**Conclusions:** Based on the current literature, there is a large estimated cumulative effect of childhood adversity on adult CV-related outcomes and mortality. However, greater numbers of adversities does not necessarily mean greater risk. The literature has not achieved consensus on the definition of adversity (i.e., some studies include poverty, others do not). It is time to have a conceptual perspective guided by developmental and life history theory on the types and timing of events that have maximal impact on CV-related disease and mortality.

<figure><img src="image_34.png" /><figcaption>Figure 1. Flow chart showing inclusion/exclusion of studies identified from initial search.</figcaption></figure>

Note. *1 study was included in both odds ratio and hazard ratio analyses.

## 267) Abstract 1601

### THE INSULAR GLUTAMATERGIC SYSTEM IN ALEXITHYMIA: A COMBINED FMRI AND MRS STUDY.

Sophie J. Betka, PhD, Gaby Pfeifer, Research Fellow, Sarah N. Garfinkel, Senior research fellow, Charlotte Rae, Research Fellow, Lisa Harris, engineer, Neuroscience, Brighton and Sussex Medical School, Brighton, east sussex, england, Henrique Sequeira, Professor, Neuroscience, University of Lille 2, lille, hauts-de-france, France, Theodora Duka, Professor, Experimental Psychology, University of Sussex, Brighton, east sussex, england, Hugo Critchley, Professor, MD, Neuroscience, Psychiatry, Brighton and Sussex Medical School, Brighton, east sussex, england

Alexithymia is an emotion dysfunction characterised by the inability to describe and identify one's own emotions. A recent theory suggests that alexithymic features are the outcome of an interoceptive failure. Interoception refers to the sensation of internal bodily signals, which is supported by the insular cortex and guides emotional feeling states. In studies using functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (MRS) separately, alexithymia was found to show aberrant insular activation and enhanced insular glutamatergic levels, respectively.

A preliminary sample of 11 healthy male participants evaluated their empathy for pain in response to emotional pictures during fMRI scanning. To measure glutamate levels, MRS scanning was performed at 1.5T by placing a single voxel in the right mid insula of each participant. Metabolites were quantified with Tarquin using the unsuppressed water signal as reference. Non parametric correlations were calculated between scores of alexithymia (using the total and subscale scores of the TAS questionnaire) and glutamate levels of the insula.

Individuals scoring higher for alexithymia showed enhanced activation in the right insular cortex (IC) during emotional processing. Furthermore, the activation of the IC was positively correlated with scores of the factor 1 subscale of the TAS (difficulties describing emotions) of the TAS. Glutamate levels of the right mid insula were positively correlated with scores of the factor 2 subscale of the TAS (difficulties identifying emotions).

These findings confirm that alexithymia is related to a hyper excitability of the insular cortex, both at functional and physiological levels. This conclusion is in line with the emergent literature supporting alexithymia as the outcome of an interoceptive failure. Furthermore,
interception seems to be disrupted in various clinical and subclinical psychiatric populations, and should be subject of further studies.

Key words: Emotion, Interoception, Alexithymia, fMRI, MRS, Glutamate

## 268) Abstract 1443

# THE RELATIONSHIP BETWEEN THE CORTICAL THICKNESS OF THE PREFRONTAL CORTEX AND BASAL CARDIAC AUTONOMIC NERVOUS SYSTEM ACTIVITY

Denise J. van der Mee, MD, Biological Psychology, VU university Amsterdam, Amsterdam, Noord-Holland, Netherlands, Mandy X. Hu, MD, Laura van Velzen, MD, Department of Psychiatry, VU University Medical Center, Amsterdam, Noord-Holland, Netherlands, Dennis van 't Ent, PHD, Biological Psychology, VU university Amsterdam, Amsterdam, Noord-Holland, Netherlands, Femke Lamers, PHD, Brenda W. Penninx, PHD, Department of Psychiatry, VU University Medical Center, Amsterdam, Noord-Holland, Netherlands, Eco J. de Geus, PHD, Biological Psychology, VU university Amsterdam, Amsterdam, Noord-Holland, Netherlands

Both animal studies and human functional neuroimaging studies have shown a network of brain regions to be involved in the regulation of the autonomic nervous system (ANS). However, limited studies have focused on structural brain correlates of ANS activity in humans. This study investigated the relationship between the cortical thickness of the prefrontal cortex, including the anterior cingulate cortex, and basal cardiac ANS activity (mean heart rate (HR) and heart rate variability (RMSSD)) using adjusted multiple linear regression in 391 participants from two consortiums in the Netherlands (297 from the NESDA and 94 from the NTR, mean age: 35,87 years, 62.7% females). The analysis revealed a significant difference between males in females with regard to the association between the thickness of the dorsolateral prefrontal cortex (DLPFC) and both HR (β= 1.354, p=.001) and HRV (β= -.373, p=.002). Post-hoc analyses revealed a significant positive association between thickness of the DLPFC and HR in females only (β= .228, p=.001). Furthermore an indication of a negative association between thickness of the DLPFC and HRV was present, again in females only (β=-.188, p=.006). Testing for an effect of the presence of a psychiatric disorder revealed that the association was stronger in females suffering from a psychiatric disorder compared to healthy control females. This finding fits well within the already established associations between DLPFC activity, HR and HRV with emotion regulations mechanisms and mood disorders and could be a starting point for further research on the explorations of the observed associations and its significance is emotion regulation and mood disorders.

## 269) Abstract 1442

# OPIOID RECEPTOR GENOTYPE (OPRM1 A118G) PREDICTS TRAIT HARM AVOIDANCE IN MEN AND WOMEN

Kristen H. Sorocco, PhD, Geriatric Medicine, William R. Lovallo, PhD, Andrew J. Cohoon, MPH, Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, Mary-Anne Enoch, MD, Laboratory of Neurogenetics, NIH, NIAAA, Bethesda, MD, Andrea S. Vincent, PhD, Cognitive Science Research Center, University of Oklahoma, Norman, OK, David Goldman, MD, Human Neurogenetics, NIH, NIAAA, Bethesda, MD

**Objective:** The Oklahoma Family Health Patterns project (OFHP) seeks to identify individual characteristics that may affect risk for substance use disorders. In prior work, central opioid receptor density accompanied higher scores on the Tridimensional Personality Questionnaire (TPQ) Harm Avoidance (HA) subscale. Cloninger proposed that variation in TPQ HA may contribute to hedonic experience and drinking behaviors. We examined the potential for TPQ HA to accompany a specific polymorphism of the mu-opioid receptor gene (OPRM1 A118G). Persons carrying the OPRM1 G allele (AG/GG genotypes) have higher receptor binding for the endogenous opioid,

beta-endorphin, compared to AA homozygotes, potentially accounting for differences in TPQ HA scores.

**Methods:** The TPQ was completed by 253 healthy young adults, 23.5 years of age, participating in the OFHP. Genotyping was done using an OmniExpress array. Genotypes with African ancestry markers were excluded due to differences in allele frequencies.

**Results:** TPQ HA (Table 1) was significantly higher among G allele carriers (F = 4.38, p = .0374) and among women (F = 8.52, p = .0038). The Pearson intraclass correlation between TPQ HA scores and the four Sex x AA, AG/GG genotypes was 0.24.

**Conclusion:** The present study is the first to find an association between HA and variations in the OPRM1 genotype associated with mu-opioid receptor binding. Further work is needed to identify potential contributions of the mu-opioid receptor genotype and its impact on the HA trait in relation to hedonic experience and alcohol intake. (Supported by the Department of Veterans Affairs and the NIH, grant AA12207).

<table><caption>Table 1</caption><thead><tr><th rowspan="2">Sex</th><th colspan="2">Male</th><th colspan="2">Female</th></tr><tr><th>OPRM1</th><th>AA</th><th>AG/GG</th><th>AA</th><th>AG/GG</th></tr></thead><tbody><tr><td>N</td><td>74</td><td>30</td><td>110</td><td>39</td></tr><tr><td>HA</td><td>7.65</td><td>9.63</td><td>10.30</td><td>11.69</td></tr></tbody></table>

## 270) Abstract 1043

# TRANSCRANIAL DIRECT CURRENT STIMULATION ENHANCES SOOTHING POSITIVE AFFECT AND VAGALLY-MEDIATED HEART RATE VARIABILITY IN HEALTHY INDIVIDUALS

Nicola Petrocchi, PhD, Political and Social Sciences, John Cabot University, Rome, Italy, Gianfranco Piccirillo, M.D., Claudia Fiorucci, M.D., Cardiovascular, Respiratory, Nephrological, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy, Damiano Magri, M.D., Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy, Cristina Ottaviani, PhD, Neuroimaging, Santa Lucia Foundation, Rome, Italy

Transcranial Direct Current Stimulation (tDCS) is a promising tool for the treatment of depression and the dorsolateral prefrontal cortex (dlPFC) is often targeted when exploring tDCS effects on mood. However, the basic effects of tDCS on momentary emotions are inconsistent. We tested whether a single-session of anodal tDCS over the left temporal lobe (T3) had effects on both vagally-mediated heart rate variability (HRV) and momentary affect in healthy participants. Fifty subjects underwent both sham and active tDCS in a counterbalanced random order. ECG was continuously recorded to derive both time and frequency domain HRV indexes. Before and after the tDCS protocol, participants completed momentary affect assessments. Results showed that HRV (p = .003, ηₚ² = .17) and soothing positive affectivity (p = .029, ηₚ² = .14) were both enhanced after a single-session of tDCS over T3, while negative and activating positive affect were not modulated by the stimulation (all ps > .20). Moreover, increases in soothing positive affect were significantly predicted by concomitant increases in vagally-mediated HRV above and beyond the role of sex, age, and levels of anxiety and depression (β = .44, p = .02). Deficits in soothing positive emotions have consistently been associated with psychopathology and psychotherapeutic approaches aimed to develop this type of emotionality have shown to improve psychological well-being. Thus, present exploratory results may impact future research investigating potential moderators (site of stimulation) and mediators (specificity for a determined type of momentary affect) of the effects of tDCS on psychopathological conditions such as depression.
EMOTIONAL IMAGERY ABILITY IS ASSOCIATED WITH
FUNCTIONAL CONNECTIVITY OF THE AMYGDALA

Sarah E. Williams, PhD, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midland, United Kingdom, Peter J. Gianaros, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA, Jennifer Cumming, PhD, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, UK, Lei K. Sheu, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA, Annie T. Ginty, PhD, Psychology and Neuroscience, Baylor University, Waco, Texas

**Background:** Mental imagery can regulate appraisals and emotions. However, its success depends on an individual's imagery ability, with higher imagery ability eliciting greater benefits. Previous research suggests the amygdala is important for the imagery of emotions. However, brain imaging research has been limited to examining neural activity during the imagery itself. The relationship between imagery ability and the amygdala activity at rest, such as its functional connectivity, may be more informative in understanding the neural correlates of someone's endogenous capacity or propensity to create and control images of emotional content. **Aims and hypothesis:** Examine whether individual differences in the ability to image emotional content (i.e., affect imagery ability) are associated with resting state neural connectivity of the amygdala. The association between functional connectivity of the amygdala and movement imagery ability was also examined to determine whether any affect-amygdala connectivity relationship was specific to emotion based imagery. It was hypothesized that only affect imagery ability would be positively associated with stronger connectivity between the amygdala and other areas associated with emotion processing. **Methods:** 40 females (Mage = 19.05; SD = 0.22) completed a 6-min resting state scan and provided self-report measures of affect and movement imagery ability. An amygdala seed was created and the CONN functional connectivity toolbox was used to generate functional connectivity maps at rest. **Results:** A whole-brain analysis indicated that affect imagery ability varied as a function of the connectivity between the amygdala and a cluster extending through the right caudate and putamen t(39) = 4.80, p uncorrected = < .001, k = 123, (x, y, z) coordinates of peak cluster: 24, 14, 2. As hypothesized, higher affect imagery ability was associated with stronger connectivity between the amygdala and the right caudate and putamen during rest. There was no association between movement imagery ability and connectivity between the amygdala and any other area of the brain during rest. **Conclusions:** Connectivity of the amygdala with other areas of the brain associated with emotional processing and envisioning future emotional events may enable individuals to image feelings and emotions more easily.

INTEROCEPTIVE TRAINING FOR ANXIETY MANAGEMENT
IN AUTISM: ALIGNING DIMENSION OF INTEROCEPTIVE
EXPERIENCE, ADIE®

Sarah N. Garfinkel, PhD, Psychiatry, Neuroscience, Abigail Mclanachan, MSc, Psychology, Hugo D. Critchley, PhD, Psychiatry, Neuroscience, University of Sussex, Brighton, East Sussex, UK

Internal states of physiological arousal contribute, through
interoceptive feedback, to the expression and experience of anxiety. We
developed a battery of objective and subjective measures of
interoception (Garfinkel et al., 2015; HeartRater: ERC PoC grant
693143) to characterise the relationship between interoceptive
dimensions and anxiety symptoms in both normative populations and
in patients accessing secondary mental health services. We further
demonstrated that the expression of anxiety symptoms by adults with
Autism (Garfinkel et al., 2016) is predicted by ‘interoceptive trait
prediction error’. This interoceptive trait prediction error is measured
from the discrepancy between objective behavioural accuracy on tests

of cardiac interoception (heartbeat detection task) relative to the self-
reported belief in, and ratings of, interoceptive aptitude.

Here we provide evidence to demonstrate that interoceptive training (N=15) can reduce this interoceptive error signal by elevating interoceptive accuracy on a heartbeat detection task [t(14)=-3.89, 0.002], associated with corresponding reductions in both trait anxiety [t(14)=2.67, 0.02] and depressive symptomatology [t(14)=2.94, 0.01]. With support from a PsyImpact grant from MQ: transforming mental health (https://www.mqmentalhealth.org/articles/psyimpact), we are currently undertaking a clinical trial of ‘ADIE’ therapy (Aligning Dimension of Interoceptive Experience) in people with Autism to mitigate the development and worsening of anxiety symptoms. ADIE therapy will be compared to an active ‘exteroceptive’ control intervention; training ASC individuals on recognition of emotional prosody. In support of this clinical trial and to facilitate the translation into routine clinical practice, MQ are also funding the development of our research software protocols for interoceptive assessment and training, as a robust technology platform for wider clinical implementation.

Thus, ADIE is a novel therapy that builds on mechanistic research into
anxiety at the interface between body and mind. Harnessing technology
to target this mechanism adds translational value to our basic science
and creates the platform for this therapeutic practice to be widely
available for patients and health care professionals to access using
personal devices such as tablet computers, maximising potential
benefits.

GLUCOCORTICOID SENSITIVITY OF THE INNATE
IMMUNE SYSTEM IN DEPRESSION SUBTYPES

Silja Bellingrath, PhD, Marijke Bisping, MSc Psychology, Psychology, University Duisburg-Essen, Essen, NRW, Germany, Oliver Ambrée, PhD, Biology, University Osnabrück, Osnabrück, Lower Saxony, Germany, Volker Arolt, PhD, Psychiatry, University of Münster, Münster, NRW, Germany

Differences in respect to hypothalamus-pituitary-adrenal axis
regulation and immune functioning between patients with different
subtypes of depression have been repeatedly described. In order to
further contribute to the understanding of these differences, the present
study investigated the efficiency of glucocorticoid signaling with
respect to the innate immune system in different subtypes of depression
(atypical and melancholic subtype based on DSM-IV criteria)
compared to healthy control subjects. Lipopolysaccharide (LPS)-
induced interleukin (IL)-6 production and inhibition of IL-6 production
by dexamethasone were assessed in N= 21 depressed patients of the
melancholic subtype, N= 14 patients of the atypical subtype and in 21
healthy controls (20-63 yrs.; mean 43 ±12). Depression severity was
measured with the Inventory for Depressive Symptomatology (IDS).
No group differences in mitogen-induced IL-6 production and
glucocorticoid sensitivity in terms of the general capacity of
dexamethasone to suppress monocyte IL-6 production over all
measurement time points could be observed, controlling for total
monocyte count, sex, age and depression severity. However,
glucocorticoid sensitivity was significantly affected by medication
status. Patients without medication (N= 15), that were also
characterized by a milder depressive symptomatology in terms of
significantly lower IDS-scores (p=0.002), showed a lower sensitivity
towards anti-inflammatory signals (p=0.03) compared to patients
receiving anti-depressive pharmacotherapy. To conclude, the present
findings do not point towards differences in GC signaling in depression
subtypes. However, a potentially beneficial effect of anti-depressive
medication was observed, that might protect patients against the
adverse effects of a sustained expression of inflammatory mediators
associated with low GC sensitivity, such as increased cardiovascular
disease risk.
## 274) Abstract 1468

# A NEW PARADIGM FOR PSYCHOANALYSIS AS PSYCHOTHERAPY

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

We propose that nowadays psychoanalysis has as its object the study and transformation of intimate human relationships, implicit and explicit, based on the new methodology observation of intentionality and psychotherapeutic intervention of the new relationship.

The epistemological break with classical psychoanalysis results of scientific inadequacy of the mythic-philosophical-scientific meta-psychological model, including the theories of ghosts, infantile sexuality, interpretation of dreams, Oedipus complex and transference-countertransference interpretation.

What characterizes human relations is not the language or behavior but the social capacity of travelling in the mind of another and in time, that is, to understand the implicit and explicit intentions present in the actions of others, developed by experienced contexts, as protentions. The discovery of the mutual intentions raises automatically intuitive responses, emphatic enactions, body metaphors, humor, effective gestures for the implementation of projects. Now, the interpretative analysis is no longer made in the transfer, but it is the interpretation of transference to remove and settle her, in order to enable the development of a new relationship in which the therapist and the patient establish a real lived relationship, with focused spontaneous affection for the future. As a lighthouse, like the a mother with positive bonding, the psychotherapist is interactive and responsive and the patient makes his self-analysis. They create a complementary relationship in freedom, which is the prototype for the daily relationships of the patient, transforms the relational style and expands the identity of them both.

### CONCLUSION

This new transversal post-multidisciplinary paradigm of psychoanalysis as a science of intimate relationships, integrates the findings of neuroscience and psychosociology in psychoanalysis, and resumes the development of psychoanalysis as a current science. It applies to the study of healthy interpersonal relationships, in ecosystems, and the transformation of pathological relations, with the goal of attainable happiness, evaluated by the enthusiasm, curiosity and creativity, present in thoughts, decisions and actions facing reality, resolve conflicts, create relationships and life projects.

## 275) Abstract 1223

# HIGH NEUROTICISM AND LOW CONSCIENTIOUSNESS ARE ASSOCIATED WITH INTERLEUKIN-6

En-Young N. Wagner, MD, Psychosomatic Medicine, Bern University Hospital, Bern, Switzerland, Vladeta Ajdacic-Gross, PhD, Psychiatry, Zurich University Hospital, Zurich, Zurich, Switzerland, Jennifer Glaus, PhD, Caroline Vandeleur, PhD, Enrique Castelao, MSc, Marie-Pierre F. Strippoli, MSc, Martin Preisig, MD, MPH, Psychiatry, Peter Vollenweider, MD, Internal Medicine, Lausanne University Hospital, Lausanne, Waadt, Switzerland, Roland von Känel, MD, Psychosomatic Medicine, Clinic Barmelweid, Aargau, and Neurology, Bern University Hospital, Bern, Switzerland

**Background:** Among the five major dimensions of personality (NEO-FFI) high Neuroticism and low Conscientiousness have frequently been linked to worse health-risk behaviours and health outcomes. However, studies on the association between NEO-FFI and biomarkers of chronic inflammation as physiological markers of morbidity and mortality are sparse, therefore the aim of this research was to examine this association.

**Methods:** In a random Swiss population sample of 1529 persons (40-72 years, 43% men), we assessed the five personality traits using a validated semi-structured psychiatric interview, socioeconomic status, traditional cardiovascular risk factors (i.e., body mass index, hypertension, blood glucose levels, total cholesterol/high-density

lipoprotein-cholesterol ratio, smoking), and other major psychiatric diseases (other anxiety disorders, major depressive disorder, drug dependence) which were treated as covariates in linear regression models. Circulating levels of inflammatory markers were also determined.

**Results:** High Neuroticism was significantly associated with high interleukin-6 levels, and for the lowest 10% Conscientiousness was an association the lower conscientiousness the higher interleukin-6 was. Agreeableness showed a significant inverse association with adiponectin.

**Conclusions:** Certain personality traits like high Neuroticism and low Conscientiousness show a relevant impact on chronic low-grade inflammation. Further research is needed to understand this observed link and may help improve prevention.

## 276) Abstract 1339

# KETAMINE USE FOR SUICIDAL IDEATION IN GENERAL HOSPITAL: A CASE REPORT

Hélène Vulser, M.D. Ph.D, Marion Rieutord, Resident, Consultation-Liaison Psychiatry, Claire Vulser, M.D., Assessment and treatment of pain, Amélie Passeron, M.D., Internal Medicine, Didier Lefebvre, M.D., Assessment and treatment of pain, Cédric Lemogne, M.D. Ph.D, Consultation-Liaison Psychiatry, European Hospital Georges Pompidou; Western Paris University Hospital Group, APHP, Paris, France

The incidence of suicide in patients of general hospital is estimated to be three to four times higher than in general population. This risk is particularly high in patients admitted in medical settings owing to surgical lesions or medical complications secondary to a suicide attempt. In such patients, preventing measures, notably means restriction, are required and help to decrease risk for suicide. However, securization of the environment can generally not be as high as in a psychiatric setting. Thus, treatments that may contribute to decrease suicide thoughts are of particular interest for consultation-liaison psychiatrists. Recent evidence indicates that ketamine, a glutamate N-methyl-D-aspartate (NMDA) receptor antagonist, may have a rapid anti-suicidal effect.

We report the case of a 47-year-old woman successfully treated with ketamine for suicidal ideation in the context of medical care. The patient was admitted in general hospital following a suicide attempt by poisoning. Although there was a clear indication for a psychiatric hospitalization, she needed medical care in general hospital because of a high suspicion of endocarditis. The patient reported clear suicidal plans and was absolutely determined to kill herself. Initial Beck Scale for Suicidal Ideation (BSSI) score was at 35 on 38. Her suicidal ideation persisted at the same level during the first ten days, requiring continuous physical restraint to prevent suicide. Due to high suicidal risk and the need for further medical care, we decided to treat the patient with ketamine: two infusions of 0.5 mg per kg at day 0 and day 2. This treatment was well tolerated. BSSI scale decreased following ketamine treatment, reaching a score of 16/38 at day 3, 11/38 at day 5 and 0/38 at day 7. Her medical state was then compatible with her transfer in psychiatry ward where she was treated with mirtazapine 30mg a day. The patient did not report any suicidal thoughts anymore. Although further studies are required to support anti-suicidal effects of ketamine, the safety of this product, routinely used in general hospital for anesthesiology or in painful patients, seems to be in favor of ketamine use in medical inpatients at high risk for suicide.

## 277) Abstract 1025

# DOOR-TO-DOOR TO DRIVE PRESCRIBING CHANGE: IMPROVING PTSD CARE FOR RURAL VETERANS THROUGH ACADEMIC DETAILING

Nancy C. Bernardy, Ph.D., Psychiatry, Geisel School of Medicine at Dartmouth, White River Junction, Vermont, Macgregor A. Montano, PharmD, BCPP, National Center for PTSD, Department of Veterans
*Affairs, White River Jct., VT, Kathleen Sherrieb, DrPH, Sociology, Dartmouth College, White River Jct., VT*

**Background:** Medications such as benzodiazepines and atypical antipsychotics are not recommended by practice guidelines for the treatment of posttraumatic stress disorder. Prazosin is recommended to reduce the occurrence of trauma-related nightmares. Current prescribing patterns do not appear to be aligned with evidence-based guideline recommendations.

**Methods:** Education and training outreach to help clinicians improve quality of care delivered to Veterans with PTSD at White River Junction, VT VA Medical Center and 7 community-based outpatient clinics. Academic Detailing consists of individualized educational outreach visits to prescribing clinicians at their practice site to promote evidence-based care. The Department of Veterans Affairs Pharmacy Benefits Management Office and the Academic Detailing Program offer a desktop dashboard that identified provider and patient-level prescribing data. Changes in prescribing of pharmacotherapies for PTSD were examined over time as well as referrals to evidence-based psychotherapies for PTSD.

**Key Clinical Messages:** Encourage referral for trauma-focused psychotherapies which are more effective than pharmacological treatment. Increase the use of antidepressants with proven benefit in PTSD: sertraline, paroxetine, fluoxetine, and venlafaxine. Increase the use of prazosin for trauma-related nightmares and titrate to effective dose. Avoid the use of benzodiazepines in PTSD because of lack of efficacy and risk of harm.

**Lessons Learned:** Academic Detailing was associated with positive findings of decreased benzodiazepine use and increased prazosin use in Veterans with PTSD. There was no change in atypical antipsychotic use, however, this clinical topic was not addressed during detailing visits.

**Future Work:** Continue work to reduce benzodiazepine use in PTSD and promote use of prazosin for trauma-related nightmares. Focus on most at-risk Veterans: 65 years and older, taking strong pain medication (Opioids), history of Traumatic Brain Injury (TBI), or history/current diagnosis of Substance Use Disorder (SUD). Deliver new key clinical messages: Increase use of first-line Cognitive Behavioral Therapy (CBT) for Insomnia for PTSD-related sleep disturbances, decrease use of atypical antipsychotics because of metabolic risk and lack of PTSD efficacy, and promote safe prescribing in women of reproductive age.

## 278) Abstract 1581

# THE ASSOCIATION BETWEEN PHYSICIAN BURNOUT AND SATISFACTION ON HEALTH OUTCOMES IN HIV-INFECTED OUTPATIENTS

Andrew J. Wawrzyniak, PhD, Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, Allan E. Rodriguez, MD, Medicine, University of Miami Miller School of Medicine, Miami, FL

### Background

Patients' health outcomes have been extensively examined in the context of patient factors, and despite research examining the effect of structural-level factors on patients' health and physician burnout on care quality, the existing literature has not reported on how physician burnout impacts objectively-measured patient health outcomes, particularly in the arena of chronic disease typically accompanied by repeated visits with the same healthcare provider. The present study assessed the effect physician burnout and satisfaction in HIV primary care physicians on virological suppression at an inner city clinic.

### Methods

Physician burnout (Depersonalization, Emotional Exhaustion) and satisfaction (Personal Accomplishment, Satisfaction with Medicine) from the Abbreviated Maslach Burnout Inventory was assessed in 9 HIV primary care physicians; virological suppression (+ 11.6 years; 39.7% female; 63.7% Black; 36.3% Hispanic/Latino).

### Results

After adjusting for years of experience as an HIV care provider, patient caseload, patients' age, patients' gender, and the lowest CD4 count to control for disease severity, patients were more likely to be virologically suppressed when their provider had lower ratings of depersonalization (OR = 1.30, 95% CI = 1.12-1.50) and emotional exhaustion (OR = 1.08, 95% CI = 1.03-1.13); physicians with higher personal accomplishment (OR = 1.24, 95% CI = 1.05-1.47) and satisfaction with medicine ratings were more likely to have undetectable patients (OR = 1.14, 95% CI = 1.05-1.23).

### Conclusions

Taken together, these findings implicate physician-related factors as an integral component of health outcomes in HIV-infected patients. Although patient-related factors on both an individual and structural level affect patients' health, the psychosocial characteristics of the physician should not be ignored, particularly in chronic diseases such as HIV that require recurring visits with the same healthcare provider. Further research is needed to assess the strength of patient and provider factors relative to each other on health outcomes in chronic diseases.

## 279) Abstract 1532

# SLEEP HEALTH AND HIV: DAY-LEVEL ASSOCIATIONS WITH NEGATIVE AFFECT, EMOTION DYSREGULATION, AND CORTISOL IN HIV-POSITIVE GAY AND BISEXUAL MEN

Brett M. Millar, M.A., Psychology, Graduate Center CUNY, New York, NY, Jeffrey T. Parsons, PhD, H. Jonathan Rendina, PhD MPH, Psychology, Hunter College, CUNY, New York, NY

**Background:** Poor sleep quality has been shown to influence subsequent affect, mood, and emotion dysregulation across numerous populations. Daily diary studies have also observed the influence of negative affect, stress, and medication adherence in a variety of chronic conditions. We aimed to explore links between sleep quality and subsequent day affect, emotion regulation, and stress response amongst HIV-positive gay and bisexual men (GBM) using event-level data from an online daily diary study.

**Method:** Daily diary reports over a 21-day online study from 53 HIV-positive gay and bisexual men generated 798 data points. Multilevel logistic modeling tested whether sleep quality (both one's average sleep quality, and one's daily fluctuations around that average) predicted next-day affect and emotion dysregulation. Global links to medication non-adherence were tested at the bivariate level. A subsample of 10 men also completed cortisol testing on a total of 67 days, allowing for additional analyses of sleep quality on cortisol outcomes.

**Results:** The racially diverse sample (75% men of color) had a mean age of 38 years. Overall poor sleep quality and daily sleep disruptions were both significantly associated with negative affect and emotion dysregulation—predicting higher levels of depressive (B = -0.08, *p* < 0.001), anxious (B = -0.04, *p* = 0.02), and angry (B = -0.05, *p* < 0.01) affect, fatigue (B = -0.11, *p* < 0.001), and emotion dysregulation (B = -0.04, *p* < 0.01). A trend (B = 0.06, *p* = 0.20) among the subsample of 10 men suggested that worse sleep was associated with decreased cortisol levels upon waking.

**Conclusions:** Poor sleep quality is associated with increased negative emotionality and emotion dysregulation, among this sample of HIV-positive gay and bisexual men. Indication of sleep's influence on reduced cortisol was also suggested among a subsample of our participants, but requires further investigation.

**Implications:** Interventions targeting sleep hygiene and health could help to improve mood, daily coping, and health outcomes in HIV-positive gay and bisexual men.

## 280) Abstract 1552

# PSYCHOSOCIAL WELLBEING AND IMMUNE HEALTH AMONG HIV-POSITIVE OLDER ADULTS: THE CRITICAL ROLE OF HIV STIGMA
H. Jonathon Rendina, PhD, MPH, Psychology, Hunter College of the City University of New York, New York, NY, Brett M. Millar, MA, Psychology, The Graduate Center of the City University of New York, New York, NY, Sitaji Gurung, MD, MPH, Community Health and Social Sciences, The City University of New York Graduate School of Public Health and Health Policy, New York, NY, Tyrel J. Starks, PhD, Jeffrey T. Parsons, PhD, Psychology, Hunter College of the City University of New York, New York, NY

**Background:** Available evidence suggests a link between psychosocial wellbeing and immune function. For example, depression has been strongly linked to inflammatory processes and this has been shown among individuals with chronic illnesses such as HIV. We sought to explore how a range of psychosocial issues might influence immune health among older adults with HIV.

**Method:** We enrolled 120 substance-using older adults, and utilized a multivariable linear regression predicting log CD4 cell count with depression, loneliness, social support, HIV stigma, alcohol use problems, and drug use problems, adjusting for potential confounders (gender, race, income, age, years since HIV diagnosis, and undetectable HIV viral load).

**Results:** The sample was two-thirds male (n = 81, 67.5%) and the majority were people of color (n = 111, 92.5%). The average age was 54.6 (SD = 4.1) and participants had been living with HIV for an average of 17.1 years (SD = 6.9). In the adjusted multivariable model, we found that the only significant predictor of log CD4 cell count was HIV stigma (B = -0.46, β = -0.26, p = 0.03) showing higher levels of stigma associated with lower CD4 levels—depression, loneliness, social support, alcohol use problems, and drug use problems were all unassociated with CD4.

**Conclusions:** In adjusted models, HIV stigma was the only psychosocial condition to show a statistically significant association with CD4 count, such that increased levels of stigma were associated with decreased CD4 count (i.e., poorer immune health). HIV-related stigma appears to be a critical psychosocial factor in considering the immune health of HIV-positive older adults and interventions with this population should focus on reducing stigma and improving coping. Future research is needed to examine the interrelation among these psychosocial conditions and how they may interact in their association with health.

## 281) Abstract 1627

### STIGMA, MEANING-MAKING, AND PUBLIC HEALTH POLICY

Michael V. Stanton, Ph.D., Health Sciences, California State University, East Bay, Hayward, California, Matthew D. Moore, J.D., M.P.H., Health Sciences, California State University, East Bay, Hayward, CA, Jason A. Smith, M.T.S., J.D., Health Sciences, California State University, East Bay, Hayward, California

In research on public health concerns, stigma has been described both as an agent of positive health behaviors and as an agent of marginalization and poorer health. Past scholarship has described instances where stigma has positively motivated public health changes, such as among tobacco users. However, in the case of obesity or HIV, stigma has also been associated with shame and discrimination of vulnerable individuals and increasingly poorer health behaviors.

Using the examples of obesity and HIV, we explain how the identity of the communicators of stigma, either within or outside of the target community, might alter the nature of the message communicated. We also discuss how stigma reduction efforts in the areas of obesity and HIV may have provided the foundation for additional stigma within communities. Next, we offer a broader perspective on how public health policy makers can conceptualize the positive and negative functions of stigma in motivating health behaviors by incorporating discussions of meaning and illness. Finally, we describe how future policymakers might leverage support within the target community to selectively motivate positive health behaviors while simultaneously avoiding harming vulnerable populations.

## 282) Abstract 1123

### EPIGENETIC RISK FACTORS FOR OBESITY IN TRAUMA-EXPOSED REFUGEES

Bengt B. Arnetz, MD, PhD, MPH, MScEPi, Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, Hikmet J. Jamil, MD, PhD, Family Medicine, Michigan State University, West Bloomfield, MI, Abir Dhalimi, PhD, Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, Susan J. Land, PhD, OB/GYN, Wayne State University, Detroit, MI, Arko Sen, PhD, Biological Studies, Salk Institute for Biological Studies, La Jolla, CA, Douglas Ruden, PhD, OB/GYN, Wayne State University, Detroit, MI

Refugees are at increased risk to develop overweight and obesity once they settle in their new Western host country. Furthermore, trauma exposure increases the likelihood of developing obesity. We have earlier reported of an increase in body mass index (BMI) as well as obesity in a randomly selected group of newly-arrived Iraqi refugees, as compared to immigrant controls, during the first two years in the United States. While increase in weight was not related to prior trauma exposure, it is of note that obesity is a function of gene x environment interactions. Thus, in order to further delineate reasons underlying mechanisms for obesity and non-communicable disorders (NCD) in refugees, DNA methylation was utilized to investigate differential methylation of PPARG (peroxisome proliferator-activated receptor gamma) in Iraqi refugees with varying degree of trauma exposure and subsequent development of posttraumatic symptoms. This gene is the regulator of adipogenesis and its molecular function is associated with modulation of insulin sensitivity, control of blood pressure, as well as glucose homeostasis.

Self-reported questionnaires and blood samples were collected from refugees in the U.S. Refugees were divided into two groups: those who reported high levels of trauma exposure and high PTSD symptoms scores (HL) (n=24) and those reporting low trauma, and low PTSD symptom scores (LH; n=10). Genome-wide analysis identified 31,353 CpG sites that were hypermethylated and 48,324 CpG sites that were hypomethylated in the HH group at a significant FDR-corrected p-value (≤ 0.05. At an effect size cut-off of 20% and FDR cut-off of 0.05, we found 583 CpG sites that were hypermethylated and 109 CpG sites that were hypomethylated. This indicates that trauma is a stronger predictor of changes in DNA methylation than PTSD. Gene ontology (GO) analyses of the genes with differential methylation showed that the GO category that had the most differential methylation between the HH vs HL groups was "diabetes mellitus" (FDR-corrected P-value < 0.01). An increase in expression of PPARγ due to decreased DNA methylation of this gene, could be one mechanism that explains the higher obesity rate in trauma-exposed refugees.

## 283) Abstract 1491

### PSYCHOLOGICAL FACTORS, HEALTH BEHAVIORS, AND OBESITY: FINDINGS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINO YOUTH (SOL YOUTH)

Alan M. Delamater, PhD, Pediatrics, University of Miami, Miami, FL, Ashley Marchante, MS, Psychology, University of Miami, Coral Gables, Florida, Elizabeth R. Pulgaron, PhD, Pediatrics, University of Miami, Miami, FL, Krista Perreira, PhD, Public Policy, University of North Carolina-Chapel Hill, Chapel Hill, NC, Carmen R. Isasi, MD, Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, Mercedes R. Carnethon, PhD, Preventive Medicine, Northwestern University, Chicago, IL, Guadalupe Ayala, PhD, Institute for Behavioral and Community Health, Linda Gallo, PhD, Psychology, San Diego State University, San Diego, CA, Linda Van Horn, PhD, Preventive Medicine, Northwestern University, Chicago, IL, Shrikant Bangdiwala, PhD, Biostatistics, University of North Carolina-Chapel Hill, Chapel Hill, NC

**Objective:** Psychological factors such as depression, anxiety, disordered eating (DE), and body image discrepancies (ideal vs. actual) have been associated with insufficient physical activity, unhealthy diet
quality, and obesity, but few studies have evaluated these associations
in a national sample of Latino youth.

**Methods:** HCHS/SOL Youth enrolled 1,466 Hispanic/Latino youth (728 boys and 738 girls, 8-16 years) from four cities (Miami, San Diego, Chicago, Bronx). Standardized self-report scales measured depression, anxiety, disordered eating (DE), and body image discrepancy, as well as social desirability; interviewer-administered 24-hour dietary recalls were quantified and scored to provide daily servings of fruits and vegetables (F&V) and sweetened beverages (SB); 7-day accelerometry measured moderate-to-vigorous physical activity (MVPA); height and weight was measured to obtain BMI %iles. Correlational and regression analyses determined relationships of psychological factors to MVPA, F&V and SB intake, and BMI. Analyses used sample and survey-weighting procedures.

**Results:** 52% of youth were overweight or obese, and 11.7% and 13.8% of youth reported elevated depression and anxiety, respectively. Depression was positively associated with BMI (β=.094, p<.001). Controlling for social desirability and gender and, there was an interaction of age and depression in association with BMI (β=.07, p<.035), with the effect of depression on BMI stronger for older youth. Depression and anxiety were unrelated with MVPA, F&V, and SB; anxiety was unrelated to BMI. DE was common: 50.9% reported dieting; 20.1% reported out of control eating; 15.4% reported being afraid they could not stop eating; and 5.1% purged. DE was associated with higher BMI (r=.386, p<.001), depression (r=.147, p<.001), anxiety (r=.06, p<.03), and body image discrepancy (r=.175, p<.001), but not with MVPA, F&V and SB intake. Greater body image discrepancy was reported by girls (r=.085, p<.001) than boys and was associated with higher BMI (r=.271, p<.001).

**Conclusions:** Overweight and obesity are highly prevalent among Latino youth and depression, DE, and body image discrepancy are associated with higher BMI. These psychological factors may be important targets to address in obesity interventions for this population.

## 284) Abstract 1268

### ASSOCIATIONS AMONG NEIGHBORHOOD FACTORS, PSYCHOSOCIAL DISTRESS, AND OBESITY IN AN ETHNICALLY DIVERSE SAMPLE

Diana A. Chirinos, Ph.D., Luz M. Garcini, Ph.D., M.Ph., Annina Seiler, Ph.D., Kyle W. Murdock, Ph.D., Psychology, Rice University, Houston, TX, Kristen Peek, Ph.D., Preventive Medicine and Community Health, University of Texas, Medical Branch, Galverston, TX, Raymond P. Stowe, Ph.D., n/a, Microgen Laboratories, La Marque, TX, Christopher Fagundes, Ph.D., Psychology, Rice University, Houston, TX

Neighborhood characteristics are important determinants of obesity. While most studies have focused on the built environment, few have examined perceptions of neighborhood safety and community factors. Further, the pathways by which neighborhood characteristics impact obesity remain unknown, particularly among ethnic minorities. In this study, we aimed to (1) examine associations among neighborhood characteristics, psychological distress and obesity, (2) establish whether neighborhood has an indirect impact on obesity through psychological distress, and (3) determine whether these associations vary by ethnicity. Participants included 2,686 adults (53.50% Hispanic, 34.4% Non-Hispanic [NH] White and 12.1% NH Black) enrolled in the Texas City Stress and Health Study. Neighborhood characteristics were measured using subscales of the Perceived Neighborhood Scale (Sense of Community, Satisfaction with Neighborhood, Perception of Crime, and Social Embeddedness). Psychological distress was measured with the Center for Epidemiological Studies Depression Scale (CES-D), the Perceived Stress Scale (PSS) and the mental composite of the Short Form Health Survey-36 (SF-36). Structural equation modeling was used to examine associations among variables. The model depicted in Figure 1 had good fit with the data (CFI=0.964, RMSEA=0.059, SRMR=0.049). Results indicated that less favorable neighborhood characteristics were associated with greater psychological distress (β=0.224, 95% Confidence Intervals [CI]: -0.261 to -0.187) and BMI (β=-0.067, 95% CI: -0.104 to -0.031). Psychological distress was also significantly associated with greater BMI (β=0.059, 95% CI: 0.024 to 0.095). The indirect path specified from the neighborhood characteristics to BMI was also significant (β=-0.013, 95% CI: -0.022 to -0.005), indicating that in addition its direct effect, neighborhood characteristics impact BMI through its effect on psychological distress. Associations were independent of age, gender, and education. In multiple group analysis, a model with parameters constrained equal across ethnicities showed adequate fit to the data (CFI= 0.954, RMSEA=0.055, SRMR=0.058) suggesting associations were similar across ethnicity. Our study extends the literature by demonstrating the importance of neighborhood perceptions in predicting obesity via psychological distress across all ethnicities.

<figure><img src="image_35.png" /><figcaption>Figure 1. Structural equation model linking neighborhood characteristics, psychological distress and obesity.</figcaption></figure>

## 285) Abstract 1377

### EXPLORING THE RELATIONSHIP BETWEEN CHURCH LEVEL PREDICTORS OF STATUS AND OBESITY RISK IN AFRICAN AMERICAN WOMEN OF FAITH

Kinjal Pandya, MA, Psychology, University of South Carolina, West Columbia, SC, Cheryl Armstead, PhD, Psychology, University of South Carolina, Columbia, SC

**Background & Significance:** African American (AA) women residing in the Southern region of the United States are more likely to be classified as obese as compared to all other gender, racial, and geographical groups. Given the high church attendance among AAs in the South, scholars have targeted AA churches to implement dietary and physical activity interventions to combat obesity disparities. Despite the numerous interventions that take place in churches, very little is known about the socioeconomic status parameters of church affiliation regarding organizational power, prestige, and hierarchy. Substantial research demonstrates that both objective and subjective markers of status impact health outcomes, but no studies to date have examined the role of church social status (CSS) on obesity outcomes. This study's aim is to examine how markers of CSS relate to total and central measures of adiposity in a sample of Southern, religious, AA females. **Methodology:** Data for the current study comes from a large dietary and physical activity intervention conducted in churches in South Carolina from 2010 to 2014, and data from a 2016 survey measuring church prestige. Participants were 790 AA females, ages 25 to 86 (M=57.28, SD=11.92). All anthropometric measurements were obtained via bioelectrical impedance assessment. CSS was measured via single item demographic questions. An additional variable, church prestige, was measured in a separate survey conducted in 2016. **Results:** An exploratory factor analysis containing the CSS variables yielded a three-factor solution. These factors were named church prestige (CP), church hierarchy (CH), and church socioeconomic status (CSES). Hierarchical regressions between CSS and obesity measures indicated that CP was negatively related to fat percentage (FP) (B=-1.01 SE=.39, p=.006), and BMI (B=-.899, SE=.299, p=.003), and that CH was positively related to waist
circumference(WC) (B=1.6 SE=.74, p=.035). **Discussion:** This correlational study showed that components of CSS impact obesity measures such as BMI, FP, and WC. These results are consistent with literature that suggests that the higher one's status, the better one's health. These results suggest that church components play a role in the health and well-being of its congregations.

## 286) Abstract 1373

### ASSOCIATIONS BETWEEN DEPRESSIVE SYMPTOMS AND EATING EXPECTANCIES IN SEVERE OBESITY

Misty Hawkins, PhD, Zachary Helms, BS, anticipated, Natalie Keirns, BS, Caitlin Smith, BS, Psychology, Oklahoma State University, Stillwater, OK, Jennifer Duncan, PsyD, Summa Bariatric Center, Summa Health, Akron, OH

**Background:** Depression is both an obesity risk factor and consequence; yet, the relationships between depressive symptoms and maladaptive eating expectancies are not clear, especially in severe obesity. **Method:** Participants were 308 patients seeking bariatric surgery for severe obesity. Depressive symptoms were measured with the Beck Depression Inventory-II (BDI-II); both the total score and subscale scores (Somatic and Non-somatic) were computed. Eating expectancies were assessed with the Eating Expectancies Inventory (EEI) which has five subscales regarding perceived properties of eating that are unrelated to hunger: To Manage Negative Affect, As Pleasurable Reward, To Lose of Control, To Enhance Cognition, and To Alleviate Boredom. Both measures were administered as part of a pre-surgical evaluation. Regressions were used to examine the relationships between the BDI and EEI scores after adjusting for age, gender, and baseline body mass index. **Results:** Results revealed that a higher total BDI-II score was associated with higher scores on all of the EEI subscales ($\beta$s = .13-.51, ps $\le$ .021) in separate models. This effect was driven by the Non-somatic subscale (all ps $\le$ .037); the Somatic subscale was unrelated to all EEI scores (all ps $\ge$ .343) in simultaneous models. When predicting each BDI-II score with the EEI subscales simultaneously, the Loss of Control subscale was the only unique predictor of the total score and both subscales (BDI-II Total $\beta$=.28, p=.001; Somatic $\beta$=.33, p<.001; Non-somatic $\beta$=.36, p<.001). The total and Non-somatic scores were also predicted by the Manage Negative Affect subscale (Total $\beta$=.28, p=.001 and Non-somatic $\beta$=.33, p<.001) and the Pleasurable Reward subscale (Total $\beta$=-.17, p=.009 and Non-somatic $\beta$=-.18, p=.005). **Conclusions:** Among those with severe obesity, greater depressive symptoms, particularly the non-somatic symptom cluster (e.g., anhedonia, sadness), were associated with expectations about eating that were not related to hunger and may promote obesity. Certain eating expectancies were uniquely related: As depression increased, eating was seen as a way to cope with negative emotions. However, the reward value of eating was blunted and feelings of losing control were augmented. Such findings suggest that impaired reward and inhibitory control pathways may be mechanisms between depression and obesity.

## 287) Abstract 1096

### HEARTRATER: TOOLS FOR THE EVALUATION OF INTEROCEPTIVE DIMENSIONS OF EXPERIENCE

Cassandra D. Gould van Praag, PhD, Department of Neuroscience, Brighton and Sussex Medical School, Brighton, East Sussex, United Kingdom, Donna L. Ewing, PhD, Applied Social Science, University of Brighton, Brighton, East Sussex, United Kingdom, Clare E. Brown, MSc, Neuroscience, Brighton and Sussex Medical School, Brighton, East Sussex, United Kingdom, Frances Meeten, PhD, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, London, United Kingdom, Sarah N. Garfinkel, PhD, Hugo D. Critchley, PhD, Department of Neuroscience, Brighton and Sussex Medical School, Brighton, East Sussex, United Kingdom

Interoception is the body-to-brain axis of sensation concerning internal physiological state and the functioning of visceral organs, including the

heart. There is increasing interest in quantifying interoception to determine its impact on conscious and unconscious experience, with particular reference to emotion and psychopathological symptoms including anxiety. There is consequently a need to standardise measures of interoceptive ability. We present here the *HeartRater* toolbox: a suite of established methods to assess and characterise sensitivity to states of emotional bodily arousal through measures of interoception.

*HeartRater* encompasses: 1) quantified assessment of objective interoceptive accuracy (using heartbeat detection tests derived from Schandry, Katkin/Whitehead), subjective interoceptive sensitivity, and metacognitive interoceptive awareness (Garfinkel et al., 2015); 2) standardised questionnaires probing autonomic symptoms; 3) quantified evaluation of cardiac afferent (individual heartbeat) influences on emotional processing (Garfinkel et al., 2014).

Following laboratory experiments, the *HeartRater* toolbox was implemented (field-tested) in normative and selected groups of healthy individuals, and validated across a clinical population (patients accessing secondary mental health services; n = 306). This growing database reveals distinct interoceptive profiles related to patient diagnostic group. One example is how 'interoceptive trait prediction error' manifests in patients with a primary diagnosis of anxiety. This measure is also strongly associated with the expression of anxiety in adults with autism (Garfinkel et al 2015) and is now the basis for a targeted biobehavioural intervention. Our interoceptive data also link to psychopharmacological studies in our laboratory that suggest approaches to personalise medicinal treatments. Continued development of *HeartRater* as stand-alone and cross-platform software applications permits dissemination and use of these measures in research, health, occupational and personal settings. Ultimately, the availability of this technology for rapid, accurate and standardised tests of interoceptive abilities will advance understanding of body-to-brain interactions in biobehavioural science and health.

## 288) Abstract 1496

### MINDFULNESS INTERVENTION IN PULMONARY ARTERIAL HYPERTENSION (PAH) PATIENTS: OUTCOMES, ISSUES, LESSONS LEARNED

Julie M. Turner-Cobb, PhD, Psychology, Bournemouth University, Bournemouth, Dorset, United Kingdom, Vanessa Garratt, DClinPsy, Psychology, Jenny Tagney, PhD, Cardiology, University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, United Kingdom, Elsa Marques, PhD, School of Social & Community Medicine, University of Bristol, Bristol, Avon, United Kingdom, Rosemary Greenwood, PhD, Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, United Kingdom, Andrew Barton, MSc, Research Design Service South West, National Institute for Health Research, Plymouth, Devon, United Kingdom, Paul Ewings, MSc, Research Design Service South West, National Institute for Health Research, Taunton, Somerset, United Kingdom, Pippa Craggs, MSc, Cardiology, University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, United Kingdom, William Hollingworth, PhD, School of Social & Community Medicine, University of Bristol, Bristol, Avon, United Kingdom, Robert M. Tulloh, DM, Cardiology, University Hospitals Bristol NHS Foundation Trust, Bristol, Avon, United Kingdom

**Objective:** To examine the feasibility of conducting a full scale randomised controlled trial (RCT) using a mindfulness based stress reduction (MBSR) programme in pulmonary arterial hypertension (PAH) patients.

**Methods:** A pilot, non-medicinal clinician/analyst blinded RCT randomly allocated PAH patients to an 8-week customised MBSR group programme in addition to treatment as usual (TAU), or solely to TAU. Outcome measures assessed at baseline, 6, and 15 months post-randomisation included the Beck Anxiety and Depression Inventories (BAI/BDI), quality of life (SF-36), the Mindfulness Attention Awareness Scale (MAAS), patient use of NHS services; physical health assessment via an echocardiogram, electrocardiogram (ECG), the New