# Alexithymia was not associated with the risk of incident cardiovascular diseases in the supplementation en vitamines et mineraux antioxydants (su.vi.max) cohort

Emmanuel Wiernik, Cedric Lemogne, Léopold Fezeu Kamedjie, Nathalie Arnault, Serge Hercberg, Emmanuelle Kesse-Guyot, Maria del Pilar Galan Hercberg

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## To cite this version:

Emmanuel Wiernik, Cedric Lemogne, Léopold Fezeu Kamedjie, Nathalie Arnault, Serge Hercberg, et al.. Alexithymia was not associated with the risk of incident cardiovascular diseases in the supplementation en vitamines et mineraux antioxydants (su.vi.max) cohort. 75th Annual Scientific Meeting on Mobilizing Technology to Advance, Mar 2017, Seville, Spain. pp.2. hal-01605962

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75th Annual Scientific Meeting

*Mobilizing Technology to Advance Biobehavioral*
*Science and Health*

March 15-18, 2017

Sevilla, Spain

Abstracts

Abstracts are listed by presentation type: first posters, then paper and symposia presentations. Citation posters are presented first and represent the highest rated posters.
## 1) Abstract 1170

# IMPACT OF BRIEF COGNITIVE BEHAVIORAL AND RELAXATION TRAINING INTERVENTIONS ON CANCER-RELATED DISTRESS IN BREAST CANCER PATIENTS OVER 12-MONTHS

Chloe J. Taub, M.A., Chelsea R. Amiel, B.A., Hannah M. Fisher, B.S., Devika R. Jutagir, M.S., Laura C. Bouchard, M.S., Psychology, Suzanne R. Lechner, Ph.D., Psychiatry and Behavioral Sciences, Charles C. Carver, Ph.D., Michael H. Antoni, Ph.D., Psychology, University of Miami, Coral Gables, FL

**INTRODUCTION.** We have demonstrated that a 10-week cognitive behavioral stress management (CBSM) program mitigates distress in breast cancer patients undergoing primary treatment. These prior investigations, however, did not identify the active components of CBSM. We recently completed a randomized controlled dismantling study that partitioned CBSM into two separate group-based 5-week interventions, cognitive behavioral training (CBT: cognitive restructuring, coping and interpersonal skills training) and relaxation training (RT: muscle relaxation, deep breathing, imagery), and compared these interventions to a 5-week attention-time matched health education (HE) control group. **METHODS.** We recruited 183 women (age M = 54.28) in the weeks after surgery and before initiating adjuvant therapies, randomized them to CBT, RT or HE, and assessed intrusion of cancer-related thoughts at four time points (baseline, post-intervention, 6-month follow-up, 12-month follow-up) using the Intrusions subscale of the Impact of Event Scale – Revised (IES-I). Treatment groups did not differ on age, education, marital status, race/ethnicity, disease stage, time since surgery, surgical procedure type, or type of adjuvant treatment received but HE reported higher income. Prior analyses revealed that women assigned to CBT showed greater IES-I reductions vs RT and HE controls at 2-month (post-intervention) follow-up. We hypothesized that IES-I effects would also be more likely to persist in the CBT condition over a longer period. Here we tested whether there would be a significant group x time interaction over a 12 month follow-up period, such that women in the CBT group show the greatest reductions over time. **RESULTS.** A 3 (condition) by 4 (Time: baseline, 2 months, 6 months, 12 months) general linear model repeated measures analysis revealed that compared to both the HE and RT groups, women in the CBT group had the greatest decreases in cancer-related intrusive thoughts over the 12-month period, F(6, 200) = 2.5, p = .02. **CONCLUSION.** These findings suggest that a brief group-based program teaching cognitive behavioral methods in the post-surgical period shows the greatest reductions in cancer-related stress for breast cancer patients over the initial one-year period of primary treatment. The brevity of this intervention increases the likelihood of uptake in clinical oncology settings.

## 2) Abstract 1185

# IS YOUR SMARTPHONE A DIGITAL SECURITY BLANKET? HOW PHONE USE AND AVAILABILITY INFLUENCES SALIVARY ALPHA AMYLASE AND EXCLUSION REPORTS DURING SOCIAL STRESS

John F. Hunter, BA, Emily Hooker, MA, Amanda M. Acevedo, MA, Marie P. Cross, MA, Emily Wong, BA, Sarah D. Pressman, PhD, Psychology & Social Behavior, University of California, Irvine, Irvine, CA

**Objectives:** Cell phones are increasingly becoming a part of the social environment and play a significant role in the nature of social interactions. In this modern age, when an individual feels rejected or isolated during a socially stressful situation, they may retreat to the comfort of their phone to feel better. This study examined whether smartphones alter psychological and physiological responses to social stress by exposing individuals to rejection and experimentally manipulating smartphone use and availability. **Method:** Participants (N=147) completed questionnaires and were subjected to a modified

version of the Yale Interpersonal Stressor, where two confederates ignored the participant during a brief interaction. Prior to exclusion, participants were randomized to one of three conditions: (1) phone present with use encouraged, (2) phone present with use restricted/not permitted or (3) no phone access. Saliva samples were collected at five points across the study to assess salivary alpha amylase, a marker of sympathetic activity. Self-reported exclusion was also reported following the stressor. **Results:** Participants in the phone-present conditions reported lower feelings of exclusion as compared to individuals who had no access to their phone, p=.004. Reported exclusion was not significantly different across phone-present groups. Multi-level modeling of salivary alpha amylase responses revealed that the individuals in the restricted phone condition had a significantly different trajectory following the stressor in comparison to individuals in the phone use condition (p=.014) and no phone condition (p=.009). Those in the no phone and phone use conditions show a gradual increase over the course of the study, whereas those in the restricted phone condition show a decrease following the stressor. **Conclusions:** Taken together, these results suggest that the presence of a phone (not necessarily phone use) may reduce feelings of exclusion and buffer the negative physiological stress response associated with social exclusion. In this way, a phone may symbolically serve as a “digital security blanket” in stressful social environments. These findings also lay a foundation for future studies to explore the intricacies of how phones may influence our psychological, physiological, and social well-being.

## 3) Abstract 1194

# PREGNANCY ANXIETY AND LENGTH OF GESTATION: HOW DO RACE AND ETHNICITY FIT IN?

Isabel F. Ramos, M.A., Christine Dunkel Schetter, Ph.D., Christine M. Guardino, Ph.D., Psychology, University of California, Los Angeles, Los Angeles, CA, Community Child Health Network, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD

**Pregnancy anxiety** (also called pregnancy-specific anxiety) is a distinct form of anxiety related to fears and worries reported about a current pregnancy, and may include anxiety about being pregnant, about one's own health and that of the developing child, fear about labor and childbirth, and worries about parenting ability (Dunkel Schetter, 2011). Pregnancy-specific anxiety is a risk factor for early delivery, infant complications, and less than optimal development after birth. In fact, pregnancy anxiety is a more powerful predictor of early delivery than general anxiety, depression, or various forms of stress. Despite the well-documented disparities in birth outcomes, few studies have examined whether levels of pregnancy anxiety differs by race/ethnicity or if prediction of birth outcomes is modified by a woman's ethnicity or race. To address this gap, the current study examined levels of pregnancy anxiety in a sample of 180 predominantly low-income African American, Latina, and Non-Latina White pregnant women. Analyses aimed to: (1) test differences between the three groups, (2) replicate the finding that pregnancy anxiety is related to shorter length of gestation and (3) test whether or not the relationship between pregnancy anxiety and length of gestation differed by race/ethnicity. Pregnant women participated in structured interviews that were conducted at two intervals during pregnancy (14-27 weeks, 28-37 weeks) in this prospective study about preconception and prenatal stress.

We found statistically significant differences in mean levels of pregnancy anxiety across groups at both time points (p's < .001). Post-hoc analyses revealed statistically significant differences in mean levels of pregnancy anxiety at 14-27 and 28-37 weeks between African American and White women (p < .01) and African American and Latina women (p < .01). In the full sample, pregnancy anxiety at 28-37 weeks predicted length of gestation (β = -.22, p < .05). Although length of gestation did not differ between ethnic groups, separate analyses by ethnic group revealed that pregnancy anxiety at 28-37
weeks predicted length of gestation for African American women (β = -.33, *p* < .05) only. These findings add to growing evidence that associations of pregnancy anxiety with birth outcomes may differ depending on race/ethnicity.

## 4) Abstract 1201

### CHILDHOOD BEREAVEMENT AND REDUCED STRESS RESILIENCE IN LATE ADOLESCENCE

Beatrice Kennedy, MD, Clinical Epidemiology and Biostatistic, Örebro University, Örebro, Örebro, Sweden, Ruoqing Chen, MMEd, Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Stockholm, Sweden, Unnur Valdimarsdóttir, PhD, Public Health Sciences, University of Iceland, Reykjavík, Reykjavík, Iceland, Fang Fang, MD, PhD, Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Stockholm, Sweden, Katja Fall, MD, PhD, Clinical Epidemiology and Biostatistic, Örebro University, Örebro, Örebro, Sweden

**Methods:** In this national register-based study, we identified 492 152 Swedish young men born 1973-1983, who underwent compulsory military enlistment examinations including measures of psychological stress resilience. We further identified biological first-degree relatives of conscripts as well as of their mothers through the Multi-Generation Register, and ascertained antenatal, childhood and adolescence familial deaths in the Cause of Death Register. Relative risk ratios (RRR) with 95% confidence intervals (CI) adjusted for parental socioeconomic circumstances and conscript's birth characteristics were calculated using multinomial logistic regression.

**Results:** Bereavement in childhood or adolescence conferred a 49 % increased risk of low stress resilience in late adolescence (RRR, 1.49, 95 % CI, 1.41-1.57). The association was present regardless of the familial relationship to the deceased, age at loss or cause of the relative's death. Strong associations were noted for loss of father (RRR, 1.71; 95% CI, 1.57-1.85), loss after the age of 12 (RRR: 1.60, 95 % CI: 1.50-1.72) and for deaths not due to illness (RRR, 1.68; 95 % CI, 1.52-1.86). The seemingly highest risk was observed for suicide (RRR, 1.75; 95 % CI, 1.49-2.05). In contrast, exposure to antenatal maternal bereavement was not associated with stress resilience in late adolescence.

**Conclusion:** These data suggest that childhood bereavement may be an important determinant of stress resilience in late adolescence. Interventions aimed at relieving long-term emotional and social consequences of bereavement may thus help reduce the risk of stress-related health outcomes later in life.

## 5) Abstract 1309

### INTERACTIVE RELATIONS OF BLOOD PRESSURE AND SOCIODEMOGRAPHIC FACTORS ON GLOBAL BRAIN VOLUMES IN URBAN DWELLING AFRICAN-AMERICAN AND WHITE ADULTS

Eduardo A. Alsina, B.A., Daniel K. Leibel, B.A., Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, Leslie I. Katzel, M.D., PhD., Medicine, University of Maryland School of Medicine, Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, Stephen L. Seliger, M.D., M.S., Medicine, Rao Gullapalli, Ph.D., M.B.A., Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, Christos Davatzikos, Ph.D., Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, Theresa Kouo, M.D., Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, Guray Erus, Ph.D., Radiology, University of Pennsylvania, Baltimore, Maryland, Michele K. Evans, M.D., Alan B. Zonderman, Ph.D., Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland, Shari R. Waldstein, Ph.D., Psychology, Medicine, University of Maryland, Baltimore County, University of Maryland School of Medicine, Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland

**Objective:** Examine interactive relations of systolic and diastolic blood pressure (SBP, DBP) with age, sex, race, and/or SES on global brain volumes.

**Participants and Methods:** Participants were 193 African-American (AA) and White, urban dwelling adults (mean age = 51.79, 53% female, 36% AA, 48% below the poverty line) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study. Seated SBP (M = 118.59, SD = 15.91) and DBP (M = 72.75, SD = 9.47) were measured by standard brachial artery auscultation following a 5 min rest. Approximately five years later, cranial magnetic resonance imaging determined total brain, gray matter (GM), white matter (WM), and white matter lesion (WML) volumes. Education and poverty status were used to compute a dichotomous composite of SES. Exclusion criteria were history of stroke, dementia, neurological disease, HIV+ status, and known cardiovascular disease. Multiple linear regression was used to examine up to three-way interactive relations of SBP (and DBP) with sex, age, SES, and/or race and their main effects with global brain outcomes. Body mass index (BMI) and the use of antihypertensive medications were covariates.

**Results:** A significant three-way interaction of SBP, sex, and SES was found for total brain (β = 1.86, *p* = .006), WM (β = 2.00, *p* = .005), and GM (β = 1.62, *p* = .014) volumes. For high-SES men only, greater SBP was inversely associated with total brain (β = -3030.99, *p* < .001), WM (β = -1623.21, *p* < .001), and GM (β = -1407.78, *p* = .002) volumes. A significant three-way interaction of SBP, race, and SES with WML volume (β = 3.06, *p* = .002) was also noted. Greater SBP was associated with significantly greater WML volume, but only for high-SES Whites (β = 55.68, *p* = .005) and low-SES African-Americans (β = 83.82, *p* < .001). No significant associations were found with DBP.

**Conclusions:** This study suggests that men of high SES with greater SBP may be vulnerable to lower total brain, WM, and GM volumes; while high-SES Whites and low-SES African Americans with greater SBP may be vulnerable to WML. Future studies should identify relevant vulnerability and protective factors within these sociodemographic subgroups.

## 6) Abstract 1311

### KEEP CALM AND CARRY ON: LOW AROUSAL POSITIVE AFFECT IS ASSOCIATED WITH HIGHER PARASYMPATHETIC FUNCTION BUT NO SYMPATHETIC ACTIVATION DURING EXPERIMENTALLY INDUCED PAIN

Amanda M. Acevedo, B.A., Kate A. Leger, M.A., Psychology and Social Behavior, University of California, Irvine, Irvine, CA, Jacquelyn L. Shader, B.A., Rosemead School of Psychology, Biola University, La Mirada, CA, John Hunter, B.A., Marie P. Cross, M.A., Sarah D. Pressman, PhD, Psychology and Social Behavior, University of California, Irvine, Irvine, CA

Experimental studies have shown positive affect impacts health by attenuating responses to stress. However, little has been done to understand the *type* of positive affect that is beneficial, what kind of stressful *context* positive affect is beneficial for, and *how* positive affect attenuates responses to stress. Thus, the current study explored the effect of different types of positive affect on both parasympathetic and sympathetic responses to two kinds of stressors: a passive-coping stressor (i.e., cold pressor task) and an active-coping stressor (i.e., star tracing task). Participants (N=279, 75.6% female, Mage=20.6) completed a resting baseline, then were randomized to one of three positive mood writing inductions (calm, happy, or excited) or a neutral morning routine writing period. This was followed by a manipulation check, a 2-minute painful, cold pressor task, a 5-minute recovery, a brief repeat of their initial writing manipulation, a 2-minute star tracing task, and a final 5-minute recovery. Root mean square of the successive differences (RMSSD; a time-domain measure of parasympathetic function) and pre-ejection period (PEP; a time-domain measure of sympathetic function) were recorded continuously throughout the study via BioLab 3.0.13. Results revealed that individuals who were induced to feel calm had greater rates of change in RMSSD from stress to
recovery during the cold pressor task compared to both the neutral control and excited conditions (ps<.05), but there were no differences between conditions during the star tracer task. Additionally, the calm condition had smaller rates of change in PEP compared to both the neutral control and happy conditions (ps<.05) but there were no differences between conditions during the star tracer task. These results suggest that feelings of calm promote greater autonomic flexibility (i.e. more adaptive functioning) during responses to passive stressors via parasympathetic nervous system activation (i.e., vagus nerve). These results support past research on the stress buffering effects of positive emotion and point to an underlying parasympathetic mechanism of these effects. Furthermore, these results suggest that low arousal positive affect (calm) may be physiologically adaptive during acute pain.

### 7) Abstract 1325

#### PREDICTORS OF INCIDENT DEPRESSIVE SYMPTOMS IN ADULTS WITH DIABETES: PROSPECTIVE RESULTS FROM A COMMUNITY COHORT STUDY IN MONTREAL

Sonya S. Deschênes, Ph.D., Rachel J. Burns, Ph.D., Psychiatry, McGill University, Montreal, Quebec, Canada, Frans Pouwer, Ph.D., Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands, Norbert Schmitz, Ph.D., Psychiatry, McGill University, Montreal, Quebec, Canada

**Background:** Depression is more common in adults with diabetes than in adults without diabetes, and comorbid depression is associated with adverse diabetes health outcomes. Prospective studies examining risk factors for incident depressive symptoms in people with diabetes, however, are limited. This study examined associations between three classes of predictors (sociodemographic, lifestyle, and medical characteristics) and the risk of incident depressive symptoms over 5 years in a cohort of adults with diabetes.

**Methods:** Data were from a prospective community survey of adults with diabetes from Montreal (N = 1,261) who reported no/low depressive symptoms at baseline. Sociodemographic (age, sex, education, marital status, ethnicity, material neighbourhood deprivation), lifestyle (smoking, body mass index, alcohol use, exercise), and medical (number of comorbid chronic conditions, insulin use, diabetes duration, self-reported diabetes control, disability) characteristics were assessed at baseline. Self-reported depressive symptoms were assessed annually for 5 years. Modified Poisson regression analyses estimated the relative risk of depressive symptoms during over 5 years. Models were first estimated for each class of predictors and a final model was estimated for all predictors entered together.

**Results:** Of the sociodemographic factors, non-white ethnicity (risk ratio [RR]=2.14, 95% confidence interval [CI]=1.45, 3.16) and being single (RR=1.34, CI=1.00, 1.80) predicted incident depressive symptoms. Of the lifestyle factors, only obesity vs. normal weight (RR=1.55, CI=1.02, 2.37) predicted incident depressive symptoms. Of the medical factors, more comorbid chronic conditions (RR=1.13, CI=1.02, 1.25), poor vs. excellent diabetes control (RR=1.64, CI=1.14, 2.37), and increased disability (RR=1.03, CI=1.02, 1.04) predicted incident depressive symptoms. When all predictors were simultaneously entered into one model, non-white ethnicity, comorbid chronic conditions, and increased disability remained significant predictors of incident depressive symptoms.

**Conclusions:** Results suggest that adults with diabetes who are of non-white ethnicity, have comorbid chronic conditions, or have disability have the greatest risk of developing depressive symptoms. Identifying who is at greatest risk of depression can help inform prevention strategies for people with diabetes.

### 8) Abstract 1331

#### INTRA-INDIVIDUAL VARIABILITY IN MOMENTARY CORTISOL IN A SAMPLE OF WORKING ADULTS: RELATIONSHIPS TO PERCEIVED STRESS AND AFFECTIVE VALENCE AND AROUSAL

Jillian A. Johnson, Ph.D., Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, Matthew J. Zawadzki, Ph.D., Department of Psychological Sciences, University of California Merced, Merced, CA, Joshua M. Smyth, Ph.D., Departments of Biobehavioral Health and Medicine, The Pennsylvania State University and Hershey Medical Center, University Park, PA

**BACKGROUND:** Research employing ecological momentary assessment (EMA) methodology to assess cortisol levels during daily life is still sparse, as is careful testing of the dynamic within-person associations between stress, affect, and cortisol levels. Such analyses are essential to understanding potential processes linking stress and affect to health. In this study we examined the within-person covariation of momentary cortisol with momentary stress and affect.

**METHODS:** A community sample of 115 working adults (mean age=41.2; 75.7% women; 76.1% white) completed 3 days of EMA surveys (6 per day; 2 work days and 1 weekend day) to assess perceived stress and momentary affect (valence and arousal indicators, derived from a circumplex approach), and provided salivary cortisol samples. Multi-level models were used to examine the contemporaneous association between (person-mean centered) momentary stress or affect and (log-transformed) momentary cortisol, controlling for time of day.

**RESULTS:** Moments characterized by greater perceived stress were associated with higher cortisol (p=.036). Similarly, momentary affective valence covaried with cortisol (p=.003), wherein states of more positive affective valence were associated with lower cortisol and more negative valence with higher cortisol. Momentary affective arousal was not related to cortisol (p=.131). The interaction between momentary affective arousal and valence did not predict cortisol (p=.085). When momentary perceived stress, affective valence, and affective arousal were tested in the same model, only valence remained a significant predictor of cortisol (p=.047).

**CONCLUSION:** The results conceptually replicate and extend previous research by demonstrating that momentary perceived stress and affective valence, but not arousal, predicted within-person fluctuations of cortisol in the natural environment. Also, although preliminary, the results suggest that within-person variability in cortisol may be more strongly influenced by affective valence than by perceived stress. These findings contribute to our understanding of how moments of stress and dynamic changes in the degree of positive or negative valence of mood states could 'get under the skin' in daily life. When repeated over time, these micro-processes may represent one mechanism underlying the long-term associations of stress and mood to health outcomes.

### 9) Abstract 1332

#### SEXUAL MINORITY IDENTITY DISCLOSURE PREDICTS PSYCHIATRIC SYMPTOMS AND DIURNAL CORTISOL IN SEXUAL MINORITY YOUNG ADULTS

Cari Hollenbeck, BA, Wilson S. Figueroa, MS, Andrew Manigault, MS, Psychology, Ohio University, Athens, Ohio, Anna Mendlein, BSW, College of Social Work, The Ohio State University, columbus, Ohio, Alex Woody, MS, Psychology, Katrina Hamilton, BA, Heritage College of Osteopathic Medicine, Matt Scanlin, MS, Ryan C. Johnson, PhD, Peggy M. Zoccola, PhD, Psychology, Ohio University, Athens, Ohio Previous research indicates that the degree to which sexual minority young adults (SMYA) disclose their sexual identity (outness) predicts better mental and physical health outcomes (e.g., reduced depressive symptoms, anxiety, and total cortisol output). In order to further investigate these associations, the current study sought to extend previous findings by using a more nuanced degree of disclosure scale (assessing different dimensions of outness), and assessing diurnal cortisol more robustly. We expected more disclosed SMYA to report
less depressive symptoms and anxiety, and to have lower total cortisol output across the week. We also examined whether particular dimensions of disclosure (3 subscales: outness towards family members, outness towards the world, outness towards religious figures) underlie its relationship to diurnal cortisol.

One hundred and twenty-one SMYA (aged 18-35, 54.5% female, free of major psychiatric/endocrine disorders) completed an initial survey and daily evening questionnaires for one week. A randomly selected subset (n = 58) also provided salivary cortisol samples at wake, 45 minute post-, 12 hours post-wake, and at bedtime over 7 days. Outness was measured using the Outness Inventory at baseline.

Overall outness was associated with less depressed mood (baseline) but was unrelated to trait anxiety. Mixed linear models revealed that overall outness predicted lower AUCg cortisol across the week, $F(1,231) = 6.08, p = .01$. The effect of outness on cortisol AUCg was driven by disclosure to family members, $F(1,230) = 10.18, p = .001$) but not disclosure to world or religious groups, $F(1,231) = 1.78, p = .18$ and $F(1,81) = .91, p = .34$, respectively. This effect was independent of sexual orientation, sex, or time since disclosure, and was not moderated by sex or orientation. Follow up analyses revealed that disclosure to family did not predict diurnal slopes, $F(1,634) = .003, p = .95$, but was associated with lower cortisol levels at wake, 45 minute post-wake, 12 hours post-wake, and at bedtime, $F(1,634) = 11.37, p < .001$, $F(1,634) = 12.66, p < .001$, $F(1,633) = 7.44, p = .006$, and $F(1,634) = 4.56, p = .03$, respectively.

These results extend previous work by suggesting that, for SMYA, regardless of sexual orientation, sex, or age of disclosure, disclosing one's sexual identity to family members may have the most benefit for health.

<figure><img src="image_4.png" /><figcaption>Fig. 1 Outness to family members (median split) and diurnal cortisol in SMYA</figcaption></figure>

## 10) Abstract 1333

YEARNING PREDICTS SUBGENUAL ANTERIOR CINGULATEACTIVITY IN COMPLICATED GRIEF

Mairead H. McConnell, B.A., Mary-Frances O'Connor, PhD, Psychology, University of Arizona, Tucson, Arizona

Research has demonstrated that experiencing the death of a loved one has medical repercussions in addition to the psychological burden of the loss. The widowhood effect refers to a person's increased risk of morbidity or mortality after the death of a long-time partner or spouse. Neural mechanisms may differentiate those who are adjusting well, compared to those with complicated grief. Individuals with complicated grief experience symptoms of debilitating, recurring emotions and yearning for the deceased for years after the death. The present study

included bereaved individuals with both complicated and non-complicated grief in order to better understand the neurobiological processes involved in different grief trajectories.

Sixteen widow(er)s (mean age = 71.94, SD = 4.06) completed the Inventory of Complicated Grief (ICG), a 19-item self-report questionnaire designed to assess grief severity. Of the sixteen participants, 9 met criteria for complicated grief. Because yearning is a “hallmark” symptom of complicated grief, and has prior evidence of neural correlates, the yearning item was extracted from the scale. This item asks participants to rate the extent to which they yearn for the deceased on a scale from 1 to 4. All participants completed a photo-viewing task in the fMRI scanner. This task consisted of an “anticipation” period in which participants were shown a countdown of the numbers 4 through 1 on the screen, followed by a photograph of either the deceased spouse or a stranger.

Results of a regression analysis in SPM12 revealed that greater self-reported yearning scores significantly predicted greater neural activation in the subgenual anterior cingulate cortex (sgACC, x = -4, y = -28, z = -6) during the anticipation phase compared to viewing a photo of one's spouse (Z= 3.11, p < .005). Activity in the sgACC has been previously linked to depressive symptoms and sadness and is generally related to emotion regulation. This finding may suggest that yearning for the deceased taxes the individual's emotion regulation system and prevents abatement of the grief experience. Future research should investigate potential interventions that reduce yearning as a mechanism for improving psychological as well as physical health outcomes associated with bereavement.

<figure><img src="image_5.png" /></figure>

## 11) Abstract 1344

GREATER EMERGENCY DEPARTMENT CROWDING IS ASSOCIATED WITH ELEVATED POSTTRAUMATIC STRESS SYMPTOMS IN THE ACUTE AFTERMATH OF EVALUATION FOR SUSPECTED ACUTE CORONARY SYNDROME

Anusorn Thanataveerat, MPH, Center for Behavioral Cardiovascular Health, Bernard P. Chang, MD, PhD, Emergency Medicine, Faith E. Parsons, BS, Kevin J. Sundquist, BS, Center for Behavioral Cardiovascular Health, Edward Suh, MD, Emergency Medicine, Jennifer A. Sumner, PhD, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY

**Background:** One in 8 patients evaluated for acute coronary syndrome (ACS) in the emergency department (ED) develops posttraumatic stress disorder (PTSD). In one study, high ED patient census during ACS evaluation was associated with PTSD symptoms 1 month later, but the sample was small and ED census is a crude crowding metric. No study has accounted for ED staffing, triage level of patients, or patient-to-bed ratio when considering the association of crowding with PTSD
symptoms, nor tested potential mechanisms. We examined the association between a standard ED crowding metric and early PTSD symptoms in patients evaluated for ACS, and assessed whether threat perceptions in the ED explained this association.

**Methods:** The REACH study is an observational study of patients recruited during ED evaluation for ACS. Perceived threat was assessed in the ED, and early PTSD symptoms were measured with the Acute Stress Disorder Scale (ASDS) upon inpatient transfer or discharge. ED crowding when patients first entered the ED was measured using the Emergency Department Work Index (EDWIN). The sample comprised 1000 participants (age 61±13yrs; 46% female; 56% Hispanic; 21% Black). Multivariable linear regression was used to determine the association between EDWIN and ASDS score, and between EDWIN and threat perceptions. The indirect effect of EDWIN on ASDS score through threat perceptions was evaluated using the bootstrap resampling procedure for more robust confidence intervals. Covariates included the Charlson Comorbidity Index, GRACE index, race, gender, age, and ACS diagnosis.

**Results:** Higher EDWIN score was significantly associated with higher ASDS score in unadjusted; b=1.67, p=0.01, and adjusted models; b=1.51, p=0.03. EDWIN was not significantly associated with ED threat perceptions in the adjusted model, b=0.31, p=0.26. When ED threat perceptions were entered in the model, the association of EDWIN with ASDS score was attenuated by 26% to b=1.10, p=0.08, but the bootstrap test of the indirect effect (0.39) was not significant, p=0.16.

**Conclusions:** We found that an objective ED crowding measure was associated with the development of early PTSD symptoms after ACS evaluation. Crowding may influence early PTSD symptoms in part through elevated threat perceptions in the ED, although other mechanisms are also likely at play. Findings have implications for ED management.

## 12) Abstract 1353

### PATTERNS OF CIRCADIAN RHYTHMS OF VAGAL ACTIVITY VARY BY TRAIT MEASURES OF EUTHYMIA AND DYSTHYMIA

Marc N. Jarczok, Dr., Marco Warth, M.A., Christine Gäbel, M.A., Institute of Medical Psychology, Julian Koenig, Dr., Department of Child and Adolescent Psychiatry, Corina Aguilar-Raab, Dr., Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, BW, Germany, Claudia Traunmüller, Mag.rer.nat., Institute of Psychology, University of Graz, Graz, ST, Austria, Julian F. Thayer, PhD, Department of Psychology, The Ohio State University, Columbus, Ohio, Beate Ditzen, Dr., Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, BW, Germany, Andreas Schwerdtfeger, Dr., School of Human and Social Sciences, University of Wuppertal, Wuppertal, NRW, Germany

**Introduction:** Vagal activity fluctuates in a pattern of diurnal variation, with a peak during nighttime. We previously demonstrated an association of circadian variation patterns (CVP) and depressive symptoms in predominantly healthy employees. The present analysis aimed to replicate and extend our previous finding by investigating associations between both positive and negative affective trait measures with CVP.

**Methods:** We analyzed root mean square of successive differences (RMSSD) as an indicator of vagally-mediated heart rate variability (HRV) from 24-h HR-recordings of 81 male subjects (mean age 41±7). Each participant had two measurements with one day in between. Positive and negative affect were measured by subscales of the state trait depression scale (STSD; Trait Euthymia, Trait Dysthymia).

Three individual-level cosine function parameters were estimated to quantify the CVP: MESOR (*M*, the 24h mean), amplitude (*A*, the distance between *M* and the highest maximum value of the cosine curve, and acrophase (*θ*, the phase shift of *A*). The MESOR is thought to index overall vagal activity. Two multivariate linear regression models were estimated, assessing the association of affective traits

with *M*, *A*, and *θ* simultaneously using measures of positive and negative affect respectively. Covariates were age, habitual exercise, smoking and working hours.

**Results:** Figure 1 shows the predicted diurnal variation of RMSSD by a median split of the negative (upper panel) or positive (lower panel) affect scale respectively and their according MESOR lines and θ around 1:30 a.m.. Dysthymia was a significant negative predictor of MESOR, but not of *A* or *θ*. Euthymia was a significant positive predictor of MESOR, but not of *A* or *θ*.

None of the other covariates were significantly associated. Explained variance in the euthymia models were 11% (*M*), 7% (*A*) and 1% (*θ*), and 11% (*M*), 5% (*A*) and 0% (*θ*) in the dysthymia models respectively. Zero influence of selected explanatory variables on *θ*, mean that there is no systematic phase shift difference observed as a function of the respective variable.

**Conclusions:** This is the first study investigating circadian rhythm patterns by measures of euthymia and dysthymia in a healthy male sample. In the present study trait measures of positive and negative affect were associated with the rhythm adjusted 24h mean (MESOR).

<figure><img src="image_6.png" /></figure>

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

## 13) Abstract 1422

### THE EFFECTS OF A STRESS MANAGEMENT INTERVENTION ON REDUCING BIRTH COMPLICATIONS AND THE MEDIATING ROLE OF PRENATAL MATERNAL CORTISOL

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

A growing body of evidence has associated elevated maternal stress levels with heightened risk for birth complications, particularly among low-income women. Recent studies have found cognitive behavioral stress management (CBSM) interventions to be effective in reducing stress among pregnant women, yet few studies have examined the impact of these interventions on reducing the risk of birth complications. The current study evaluated whether participation in a prenatal CBSM intervention was associated with reduced birth complications, and whether this association was due to lower maternal cortisol levels during the third trimester. Our sample consisted of 69 mothers and their infants (67% Latina, 80% with annual combined household incomes under $20,000). During their first trimester of pregnancy (<17 weeks pregnant), participants were randomly assigned to either a CBSM intervention (n = 34) or control group (n = 35). Women in the CBSM intervention completed an eight-week, group-based course which covered topics such as thought modification and relaxation techniques. The control group received print-based prenatal
information throughout the eight-week period. Maternal salivary
cortisol was assessed seven times on one collection day during the
participant's third trimester to calculate Area Under the Curve (AUC).
At postpartum, a medical record review was conducted to assess the
prevalence of nine birth complication outcomes (e.g., premature birth,
labor duration). A mediation analysis revealed that group assignment
was a significant predictor of birth complication outcomes, with
women in the CBSM intervention experiencing fewer birth
complications compared to women in the control group, $\beta$ = -.77, t(66) = -2.68, p < .01. However, these CBSM intervention effects
on birth complications were not driven by maternal cortisol levels
during the third trimester, $\beta$ = .005. These results highlight the
importance of stress management interventions for low-income
pregnant women and support their implementation as an effective
method for reducing the risk of birth complications in this population.
Additional studies are needed to examine potential mediators of this
relationship.

14) Abstract 1451

MONITORING AND MODELING FAMILY EATING DYNAMICS (M2FED): A SYSTEM THAT DETECTS FAMILY EATING BEHAVIORS AND MOODS IN THE HOME ENVIRONMENT

Jessica Rayo, BA, Psychology, California State University, Long Beach, Long Beach, CA, Brooke Bell, BA, Preventive Medicine, University of Southern California, Los Angeles, CA, Mohsin Y. Ahmed, MS, Computer Science, University of Virginia, Charlottesville, VA, Kayla de la Haye, Ph.D., Preventive Medicine, University of Southern California, Los Angeles, CA, John Lach, Ph.D., Electrical and Computer Engineering, John A. Stankovic, Ph.D., Computer Science, University of Virginia, Charlottesville, VA, Donna Spruijt-Metz, Ph.D., Preventive Medicine, University of Southern California, Los Angeles, CA

BACKGROUND

Diet monitoring historically relies on self-reporting tools, which have
significant accuracy limitations that make dietary behavior modeling
difficult. Furthermore, these tools fail to account for parenting style,
home environment, interpersonal influence, and stress reactions, which
play a significant role in obesogenic eating behaviors. Monitoring
eating behaviors, mood, and social interactions in real-time can provide
unique insights into obesity-related eating patterns. M2FED is an
mHealth approach that uses sensors, and Ecological Momentary
Assessment to understand and intervene on family eating dynamics
(FED) contextually in real-time. One of the primary components of this
system is detection of conversation, stress, and mood. Accurately
assessing mood is challenging, but our project aims to refine and
improve this process.

METHODS

Our group has developed a cyber-physical system controlled by
computer algorithms that will detect and model eating events, mood,
and interpersonal interactions in home environments. It includes
sensors that capture acoustic signals and analyze the audio data for
mood and stress. In order to develop accurate algorithms for detecting
moods related to eating events, machine learning techniques were used
on 535 short coded utterances (2-5 seconds each) from 5 male and 5
female participants. Six moods currently identified in the literature as
related to eating behavior were chosen as a focus: anger, anxiety,
boredom, annoyance, happiness, and sadness.

RESULTS

The accuracy of the algorithms for each mood, respectively, was: anger (94.5%), anxiety (95.7%), boredom (97.5%), annoyance (97.8%), happiness (88.7%), and sadness (88.9%).

CONCLUSIONS

M2FED will deploy new methods for in-home mood detection that will
contribute to accurately monitoring and modeling FED. In addition to
mood, M2FED will refine sensors that detect eating behavior, social
interactions, participant co-location, and other signals. It will allow for

the generation of theory-based system models of family social
dynamics and eating events that learn and react to personal, social, and
environmental cues in real-time and in context to inform and refine
behavior models. This will enable the identification of temporally-
specific processes and events within the family system that can be
targeted for personalized, context-specific, and real-time feedback.

**15) Abstract 1493**

EFFECTS OF A MINDFULNESS INTERVENTION FOR STUDENT TEACHERS ON DEPRESSIVE SYMPTOMS, AFFECT AND EMOTION REGULATION.

Silja Bellingrath, PhD, Psychology, University Duisburg-Essen, Essen, NRW, Germany, Lena Wimmer, PhD, Psychology, Bangor University, Bangor, Wales, Great Britain, Lisa von Stockhausen, PhD, Psychology, University Duisburg-Essen, Essen, NRW, Germany

Educator stress and teacher burnout are not only the cause for negative health consequences, they also impact negatively on educational performance and diminish students' learning behavior. Therefore, it should be an important element in teacher education, to increase self-regulatory capacities to manage job-related stress. The present study investigated effects of a mindfulness intervention for student teachers on affect and emotion regulation. The intervention was based on the Mindfulness Based Stress Reduction approach by Kabat-Zinn (2005), which was adapted to fit the context of a university seminar, including e-learning elements. N= 96 student teachers received 8 group sessions, each 14 days apart and were instructed to practice essential exercises (sitting meditation, bodyscan) for 25 min daily. To identify effects specific to mindfulness training, the pre-post study design included a passive (N= 31) and an active control group (N= 42). The active control group received a phenomenologically oriented training of awareness, which consisted of a theoretical input during class and homework assignments collected from Blackmore (2010), during which participants reflected on their own consciousness by asking themselves questions such as “Am I conscious now?”. Linear mixed-effect models were computed using R. Significant group x time interactions were found in the following domains: With respect to depressive symptomatology (Hospital Anxiety and Depression Scale) and negative affect (Positive and Negative Affect Schedule, PANAS), the mindfulness group showed decreased scores after the training whereas the passive control group showed increased scores (p < .01 and p = .05). Furthermore, the passive controls showed a significant decrease in positive mood (PANAS) compared to the mindfulness group at post measurement (p=0.05). Finally, effects on emotion regulation (Emotion Regulation Questionnaire) were observed. Students trained in mindfulness increased the use of cognitive reappraisal after the intervention, whereas the active as well as the passive control group exhibited lower reappraisal scores at the end of the term (p's .04). To conclude, positive effects of mindfulness training in the university context on affect and emotion regulation were observed, which might be beneficial during the transition into school placements.

**16) Abstract 1501**

INVESTIGATING SOCIAL EVALUATIVE THREAT (SET)
USING A ROBOTIC STRESS TESTING PANEL

Julie M. Turner-Cobb, PhD, Psychology, Bournemouth University, Poole, Dorset, United Kingdom, Mashal Asif, MSc, Chris Bevan, PhD, Danae Stanton Fraser, PhD, Psychology, James E. Turner, PhD, Department for Health, University of Bath, Bath, Somerset, United Kingdom

Objective: A variety of social stress testing paradigms manipulate the panel or participant environment focusing on the characteristic of social evaluative threat (SET) to elicit a response. This pilot study assessed whether a non-human (robot) panel could elicit a stress response in human participants.
Methods: Nineteen healthy adult participants (female=16) aged 21-57 years (mean=29.7) underwent a 90-minute experimental testing session based on the Trier Social Stress Test (TSST). A pre-recorded robotic panel was used, presented as a live on-screen simulation with mannerisms parallel to those typically used in TSST paradigms. Instructions for the stress task were delivered by a confederate who was not part of the panel. Following a 20-minute preparation stage, a 5-minute mock interview and 5-minute maths task were undertaken in front of the robot panel. Forty minutes after the stress task participants were interviewed about their experience. Cortisol was assessed via saliva at five points; baseline, anticipation and three points post-test. Underlying perceived stress and coping responses were assessed pre-test. Simple numerical coding of subjectively reported experiences was applied to the post-test interview data.

Results: The stress test induced a significant effect on cortisol response over time (p=.037). Using the subjective stress experience from interview, participants reported either: a) not finding the test stressful; b) finding the performance stressful but not the presence of the robots; or c) finding the test and the robots stressful. Analysis of cortisol based on these three groupings revealed a borderline effect for the task only group (p=.044) and a stronger significant effect for the task and robot group (p=.018). Perceived stress and coping scores did not distinguish between these groupings.

Conclusions: Using a non-human (robot) panel within a social stress testing paradigm produced overall significant effects with cortisol responses distinguishable by subjective stress experience. In a proportion of the group for whom the robot panel elicited SET, cortisol responses were the strongest. This is the first time that a robotic panel has been utilised in testing responses to the TSST and offers an innovative application with potential for further in-depth study.

## 17) Abstract 1515

# THE ASSOCIATION OF RESTING HEART RATE VARIABILITY AND FALSE MEMORY: A PRELIMINARY STUDY FOCUSED ON MEMORY VALENCE

Havovi Desai, B.A., DeWayne P. Williams, M.A., Nicole R. Feeling, M.A., Nicolas Joseph, M.A., Lassiter F. Speller, M.A., Psychology, The Ohio State University, Columbus, OH, Julian Koenig, M.A. Dr. sc. hum., Section for Translational Psychobiology in Child and Adolescent Psychiatry and the Department of Child and Adolescent Psychiatry in the Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany., Heidelberg, Heidelberg, Germany, Derek Spangler, PhD, Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, OH

Research suggests that higher resting high frequency heart rate variability (HF-HRV) is associated with both better health and cognitive control, including the domain of memory control. Previously we found greater resting HF-HRV was associated with fewer false memories. However, lower HF-HRV is associated with a greater negativity bias, and research has yet to understand how the valence of the memories (positive, negative, or neutral) may influence these results. The current preliminary analysis attempts to investigate this in a sample of 32 students at a large Midwestern university (14 women, mean age = 22.37, SD = 5.37). Baseline-resting HF-HRV was collected for 5 minutes using an electrocardiogram in accordance with Task Force (1996) guidelines. Participants then completed a false memory paradigm. During the task, participants first completed a presentation phase, in which participants were shown a total of 6 word lists with each list containing 12 words (2 word lists per valence). Immediately following the presentation phase, participants completed the recognition phase, in which they were to indicate if they previously saw a word. Outcome variables include: hits rates (defined as the proportion of true words correctly identified as true, with higher values reflecting better identification of true memories), and false alarm rates (defined as the proportion of lure or false words incorrectly identified as true words with lower proportions reflecting better rejection of false memories). Controlling for age, gender, and respiration, preliminary results showed

lower resting HF-HRV to be associated with a higher tendency to incorrectly identify both neutral (r = -.349, p = .034) and negative (r = -.362, p = .029) false memories; however a similar pattern was not observed for positive false memories (r = .152, p = .220). These results are in line with our lab's previous work, suggesting that those with lower resting HF-HRV have difficulties with correctly identifying false memory-words. Importantly, this pattern was found in negative and neutral, but not positive, memory-words. These preliminary data support the novel idea that individual differences in resting HF-HRV may not predict control over positive memories, and may best predict control over negative and neutral memories.

## 18) Abstract 1523

# THE ASSOCIATIONS BETWEEN HEART RATE, PERCEIVED HEART RATE AND ANXIETY DURING ACUTE PSYCHOLOGICAL STRESS.

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

**Introduction:** Acute psychological stress typically induces feelings of anxiety and increases in heart rate (HR). However, some research suggests that the level of anxiety is not always associated with the amount an individual's HR increases. Instead, feelings of cognitive and somatic anxiety, and the interpretation of these symptoms may be more closely associated with an individual's perceived HR response (i.e., how much an individual feels their HR is changing in response to the task). However, research has yet to investigate whether actual or perceived HR changes in response to stress are more strongly associated with anxiety experienced during stress. **Aim:** Examine whether perceived or actual HR changes are more strongly associated with cognitive and somatic anxiety during two different stress tasks. **Method:** 71 healthy males (M (SD) age = 20.1 (1.1) years) completed baseline rest, mental arithmetic task (PASAT) and impossible puzzle task (order counterbalanced), during which HR was measured continuously. Immediately after the tasks, cognitive and somatic anxiety intensity and interpretation of these symptoms were measured with the Immediate Anxiety Measure Scale, and perceived change in heart rate was measured on a 7-point scale (0 = no change, 6 = large increase). **Results:** Compared to the puzzle task, the PASAT elicited a faster HR, greater perceived HR change, and higher and more debilitative anxiety (p's <.05). Regression models, entering both perceived and actual HR changes as independent variables, revealed that only perceived HR significantly predicted PASAT cognitive and somatic anxiety (positively for anxiety intensities and negatively for interpretation of symptoms; p's <.05). The findings were replicated for anxiety intensity during the puzzle task (p's < .05), but the overall models did not significantly predict perceptions of puzzle task anxiety symptoms (p's > .05). In all models, actual heart rate was unrelated to anxiety intensity or perceptions of symptoms (p's > .26). **Conclusion:** Individual ratings of anxiety intensity and interpretation of these symptoms appears to be closely associated with perceptions of HR change in response to stress rather than actual HR changes. Future research should investigate whether training individuals to lower their perceptions of HR can reduce the anxiety experienced during stress.

## 19) Abstract 1531

# HIGHER TRAIT PERSEVERATIVE COGNITION IS ASSOCIATED WITH DECREASED HEART RATE VARIABILITY DURING A NEGATIVE EMOTION INDUCTION IN WOMEN

Alexa D. Barton, BS, Psychology, The Ohio State University, Columbus, OH, DeWayne P. Williams, M.A., Catalin Dragomirescu, Mr., Nicole R.
Feeling, MA, Psychology, The Ohio State University, Columbus, OH,
Julian Koenig, Dr. sc. Hum, Psychology, Section for Translational
Psychobiology in Child and Adolescent Psychiatry and the Department of
Child and Adolescent Psychiatry, The Ohio State University, Centre for
Psychosocial Medicine at University of Heidelberg, Heidelberg, Baden-
Württemberg, Germany, Derek Spangler, PhD, Julian F. Thayer, PhD,
Psychology, The Ohio State University, Columbus, OH

Perseverative Cognition (PC) is defined as excessive worry and rumination, and is associated with lower high frequency heart rate variability (HF-HRV). However, little work has demonstrated how trait PC relates to changes in HF-HRV from rest to a negative emotional state. Decreased HF-HRV when processing negative emotions suggests decreased inhibitory control and is conceptualized as a maladaptive psychophysiological response. As such, we expected that those with greater trait PC would show decreased HF-HRV in response to negative emotions. The current study investigated this relationship in 56 women (mean age of 20, standard deviation of 4). HF-HRV was collected using an electrocardiogram (ECG) as participants first completed a 5-minute resting-baseline period, followed by a 5-minute negative emotion induction (NEI). During this NEI, participants were instructed to think about someone with whom they were currently frustrated. Participants then completed a number of self-report questionnaires, including the 16-item Penn State Worry Questionnaire and the 22-item Ruminative Responses Scale as indices of trait perseveration. HF-HRV was analyzed in accordance with Task Force (1996) guidelines, and change scores were calculated as NEI HF-HRV minus baseline-resting HF-HRV, with higher scores reflecting an increase in HF-HRV from baseline to the NEI. Results showed greater trait PC, both worry (r = -.330, p = .006) and rumination (r = -.230 p = .044), to be significantly associated with decreases in HF-HRV from rest to the NEI. These results are consistent with prior research suggesting that state changes in HF-HRV from baseline to an emotion inducing task may reflect emotion regulation. Our data further support the idea that trait PC can lead to decreases in HF-HRV reactivity, which may be maladaptive for overall health and well-being. Directions for future research will be discussed.

## 20) Abstract 1534

# NEIGHBORHOODS AND HEALTH: DEVELOPMENT AND VALIDATION OF AN EXPERIMENTAL MANIPULATION OF NEIGHBORHOOD CHARACTERISTICS IN A VIRTUAL REALITY ENVIRONMENT

Daniel A. Hackman, Ph.D., USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, Stephanie A. Robert, Ph.D., School of Social Work, University of Wisconsin-Madison, Madison, WI, Jascha Grübel, MSc, Raphael Weibel, B.Sc., Christoph Hölscher, Ph.D., Victor R. Schinazi, Ph.D., Chair of Cognitive Science, ETH Zurich, Zurich, Zurich, Switzerland

**Background:** Neighborhood disadvantage is an independent predictor of health that is thought to operate, in part, through acute impacts on emotion and stress reactivity. Nevertheless, no studies have measured the acute effect of neighborhood contexts on emotion and stress reactivity. To address these issues, we used virtual reality (VR) to develop an experimental model of neighborhood disadvantage and affluence. This study (1) assesses the validity of the VR neighborhoods by examining participant observations and (2) tests the hypothesis that neighborhood disadvantage elicits greater stress reactivity and emotion.

**Methods:** In a preliminary analysis of an ongoing study, 26 participants were randomly assigned to complete a simple navigation task in the virtual affluent (VR-A) (n = 11) or disadvantaged (VR-D) (n = 15) neighborhood. Participants were young adults (M = 22.8 years, SD = 3.1), 53.8% female, and undergraduate or graduate (88.5%) students. Participants completed a systematic social observation of the virtual neighborhood, and ratings of emotion and arousal, after the task. Blood pressure (BP) was measured three times during a baseline condition and at 3-minute intervals during the task.

**Results:** The VR-D condition was rated as lower in a measure of overall socioeconomic position (t = 10.2, p < .001). It was also rated as less safe to live in, less desirable, in worse condition, and having more garbage and fewer trees (all p < .001). The VR-D condition also elicited more negative affect (t = 2.5, p = .02) but not arousal (t = -.48, p = .64), and higher ratings of anger, disgust, and sadness (all p ≤ .02). Systolic and diastolic BP were significantly higher than baseline across both VR conditions (all p < .001). No significant differences in BP were found in preliminary analyses between VR-D and VR-A (all p > .55). **Conclusions:** The validity of the VR-based models was supported by participants' differentiated perception of the neighborhood environments. In addition, the disadvantaged condition elicited more negative affect, consistent with hypotheses. Physiological and psychological responses to the virtual environments indicate the feasibility and utility of this approach for studying acute effects of neighborhood conditions on stress reactivity and other pathways to health. The final presentation will include complete data from this ongoing study.

## 21) Abstract 1541

# AGGRESSION AND CHRONIC PHYSIOLOGICAL STRESS: EXTERNALIZING BEHAVIORS BUFFERS THE EFFECT OF EARLY LIFE ADVERSITY ON ALLOSTATIC LOAD.

Stacey N. Doan, PhD, Psychology, Claremont McKenna College, Claremont, Ca, Nadya Dich, PhD, Public Health, University of Copenhagen, Copenhagen, Denmark, Denmark, Gary W. Evans, PhD, Human Development and Design and Environmental Analysis, Cornell University, Ithaca, NY

Early life adversity is associated with increases in behavioral problems including the class of externalizing behaviors which include disruptiveness, aggression and bullying (Yoshikawa, Aber & Beardslee, 2012). Traditional developmental pathology models have operated under the assumption that early adversity lead to these maladaptive behaviors (Campbell, 1995; Hinshaw, 1992; Qi & Kaiser, 2003). Externalizing behaviors are associated with a variety of negative outcomes such as underachievement (Hinshaw, 1992), peer rejection (Ladd, 2006) and substance use (Kruerger, Markon, Patrick, Benning and Kramer, 2007). However, recent theoretical perspectives have argued that the assumption that these behaviors are pathological is problematic and limit our understanding of effective interventions (Ellis et al., 2012). Instead, they posit the idea that externalizing behaviors are in fact adaptive responses to stressful/disadvantageous environments, and thus for interventions to be effective they must consider the possibility that these behaviors serve important functions. In the proposed study, we test the counterintuitive hypothesis that in the context of adversity, externalizing behaviors are adaptive for physical health. The sample for the study included 239 children (110 girls). Participants' ages were 9.2 (SD = 1.1) at Wave 1, snf 13.4 (SD =1.0), 17.3 (SD = 1.0) at Wave 2 and 3. Early life adversity was a measure of confluence of nine risk factors from three domains: demographic, psychosocial, and environmental, all of which have been previously shown relevant in the development of psychopathology. Externalizing behaviors were assessed via parent and child report. Allostatic load, a measure of chronic physiological stress consisted of six parameters capturing HPA axis (cortisol), SAM system (epinephrine and norepinephrine), cardiovascular (systolic and diastolic blood pressure), and metabolic (body mass index) activity. Linear mixed effect models were used to analyze the prospective associations between externalizing behaviors, cumulative risk and allostatic load. Results were consistent with our hypothesis - higher levels of externalizing behaviors moderated the effects of cumulative risk on allostatic load for males.
<figure><img src="image_7.png" /></figure>

## 22) Abstract 1548

### SOCIAL INTEGRATION AMONG DISTRESSED MOTHERS OF CHILDREN DIAGNOSED WITH CANCER ASSOCIATES WITH ELEVATED INFLAMMATION ONE YEAR AFTER CHILDREN INITIAL DIAGNOSIS

Catherine P. Walsh, MS, Psychology, University of Pittsburgh, Pittsburgh, PA, Linda J. Ewing, PhD, RN, Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, Berhane Messay, PhD, Psychology, University of Pittsburgh, Pittsburgh, PA, Jennifer L. Cleary, BS, Alina D. Vaisleib, MA, Chelsea H. Farrell, MA, LPC, Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, Katarina Gray, BS, Anna L. Marsland, PhD, RN, Psychology, University of Pittsburgh, Pittsburgh, PA

Chronic distress associates with upregulation of innate inflammation known to predict risk for inflammatory diseases. Social network integration may buffer the effects of stress on health risk. Caring for a child newly diagnosed with cancer is a provocative psychological stressor. While most parents cope well, 25-30% of caregivers show prolonged distress that may contribute to elevated levels of inflammation over time. Here, we followed 120 mothers (age 18-56, 86% Caucasian) from just after their child's cancer diagnosis through one year. Assessments of stress (Perceived Stress Scale; PSS), social integration (Social Network Index), BMI, and circulating levels of interleukin (IL)-6 were conducted on 3 occasions: T1 (mean = 1 mo. post dx), T2 (mean = 6.8 mo. post dx), and T3 (mean = 12.7 mo. post dx). Hierarchical linear modeling showed that change in social network diversity positively associated with change in plasma IL-6 over time (B = .93, *p* = .03), but change in PSS and social network size did not (B = 0.02, *p* = .30, B = 2.46, *p* = .36). These findings were independent of mother's age, education, race, change in BMI over time, and the child's treatment intensity. Interestingly, the interaction between change in PSS and change in social network size over time positively associated with change in plasma IL-6 over the study period after adjusting for mother's age, education, race and child's treatment intensity (B = 1.38, *p* = .042). When change in BMI was included in the model, a similar trend was observed (B = 1.19, *p* = .085). This interaction reveals

greater increases in IL-6 over time among mothers endorsing increasing perceived stress and social integration when compared with those remaining low on both measures. This effect was more pronounced further in time from the child's initial diagnosis. These results are contrary to the stress-buffering hypothesis and suggest that in this population increasing social integration may not be health protective and may combine with increasing distress to predict systemic inflammation. Further research is warranted to understand the direction of these effects. It may be that mothers reporting prolonged distress increase social integration in an effort to cope. It is possible that reducing social network diversity may associate with better emotional and physical health in this population. American Cancer Society RSG118367

## 23) Abstract 1576

### SIX-MONTH STABILITY OF HEART RATE AND BLOOD PRESSURE RESPONSES TO MOMENTARY AFFECT

Laura Meli, MS, Joseph E. Schwartz, PhD, Jacob Julian, BS, Othanya Garcia, BS, Donald Edmondson, PhD, MPH, Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY

Much of behavioral medicine is concerned with physiological responses to cognitive affective states. Those responses are often treated as though they are individual traits or features of a psychiatric disorder. Little is known, however, about how stable these responses are in the world and in specific populations. We estimated blood pressure (BP) and heart rate (HR) responses to a series of momentary affective states in the Masked Hypertension Study at two time points over the course of six months in 160 participants. Participants were recruited through workplace BP screenings at two universities and affiliated medical centers, and a financial investment firm. Participants were outfitted with a SpaceLabs 90207 Ambulatory Blood Pressure monitor, programmed to take BP and HR readings every 30 minutes, and were provided with a smartphone on which they were asked to answer questions about their thoughts, emotions, and activities immediately after each reading. To estimate the 6-month stability of BP and HR response to different cognitive affective states, we calculated the correlation between the mean within-person BP (HR) response to each cognitive affective state at Time 1 with the mean within-person BP (HR) 6-months later. Participants were 160 individuals (age 52.1 ± 9.9; 38% male; 6% black race; 14% Hispanic). Six-month stabilities for the 9 cognitive affective states are listed in Table 1. For Systolic BP the most stable cognitive affective variable was excited (*r*=0.69; *p*<.0032). For HR, angry/hostile (*r*=0.99; *p*=.005) and frustrated (*r*=0.64; *p*=0.002) were most stable. For Diastolic BP, no cognitive affective variables were more stable than anxious/tense (*r*=0.48; *p*=0.52). In this study we found that the stability of physiological responses to cognitive affective states vary by the physiological parameter assessed. HR responses, overall, to cognitive affective variables are more stable that BP responses and physiological responses to emotions higher on the arousal dimension are more stable than those lower on the arousal dimension. These findings should inform future research on health consequences of physiological reactivity to cognitive affective states.

<table><thead><tr><th rowspan="2"></th><th colspan="2">Systolic Pressure (BP)</th><th colspan="2">Blood Diastolic Pressure (BP)</th><th colspan="2">Blood Heart Rate (HR)</th></tr><tr><th>r</th><th>p-value</th><th>r</th><th>p-value</th><th>r</th><th>p-value</th></tr></thead><tbody><tr><td>Excited</td><td>0.69</td><td>0.0032</td><td>0.40</td><td>0.28</td><td>0.45</td><td>0.029</td></tr><tr><td>Tired</td><td>0.10</td><td>0.68</td><td>0.11</td><td>0.65</td><td>0.28</td><td>0.11</td></tr><tr><td>Frustrated</td><td>-0.30</td><td>0.40</td><td>--</td><td>--</td><td>0.64</td><td>0.002</td></tr><tr><td>Anxious/Tense</td><td>0.58</td><td>0.047</td><td>--</td><td>--</td><td>0.45</td><td>0.024</td></tr><tr><td>Angry/Hostile</td><td>0.02</td><td>0.96</td><td>-0.79</td><td>0.55</td><td>0.99</td><td>0.005</td></tr><tr><td>Relaxed</td><td>0.18</td><td>0.43</td><td>0.09</td><td>0.72</td><td>0.53</td><td>0.0009</td></tr></tbody></table>
## 24) Abstract 1591

# NOCTURNAL BLOOD PRESSURE DIPPING AND CARDIOVASCULAR RESPONSES TO ACUTE STRESS IN YOUNG ADULTS: EVALUATING CONCORDANCE USING AMBULATORY AND LABORATORY-BASED METHODS

Ann-Marie Creaven, PhD, Department of Psychology, University of Limerick, Limerick, Ireland, Ireland, Siobhan Howard, PhD, Psychology, Mary Immaculate College, University of Limerick, Limerick, Ireland, Eanna D. O'Leary, PhD, Institute of Psychiatry, Kings College London, London, United Kingdom, Brian M. Hughes, PhD, Psychology, National University of Ireland, Ireland, Jack E. James, PhD, Department of Psychology, Reykjavik University, Reykjavik, Iceland

Despite a large literature on the topic, the utility of nocturnal blood pressure dipping as a predictor of cardiovascular disease (CVD) risk has recently been described as "far from practical" (Bloomfield & Park, 2015). For example, studies rarely facilitate comparisons between dipping and other CVD markers. This study combines laboratory and ambulatory methods to compare dipping profiles with cardiovascular reactivity to, and recovery from, acute stress. Given mixed literature on blunted/exaggerated stress reactivity, we had no a priori hypotheses regarding reactivity/ We hypothesized that blunted dipping would be associated with reduced cardiovascular recovery.

Participants were 120 young adults (M = 18.50 years, SD = 1.08) recruited as part of a larger study on stress and health. Participants underwent a laboratory-based stress-testing session during which cardiovascular reactivity to an acute stressor was monitored using a Finometer hemodynamic monitor. Participants also underwent a 24-hour ambulatory cardiovascular monitoring protocol with the Oscar 2 monitor. Measures were recorded once every 20 minutes over the daytime (plus or minus 5 minutes to ensure participants could not predict the next blood pressure measurement), and every 45 minutes during sleep time, with times determined based on a sleep diary completed for 7 days prior to ambulatory monitoring. Following screening for artefacts and outliers, nocturnal BP dipping values were calculated according to the standard formula as: (average daytime BP - average night-time BP)/average daytime BP) x 100.

The mean percentage dipping was 12.34 (SD = 8.51) for SBP and 19.64 (SD = 7.67) for DBP; scores were positively correlated (r = +.42, p <.001). Contrary to our hypotheses, regression models adjusted for age, sex, and BMI revealed that percentage SBP dipping predicted SBP recovery (i.e., an adaptive dipping profile was associated with poorer recovery, b = .24, t = 2.66, p = .009, R2 change = .06), but not reactivity. No associations between DBP measures were observed.

These unexpected findings suggest that the relationship between dipping and other prognostic factors for CVD is far from straightforward. This presentation will discuss the methodological and analytical issues in evaluating dipping and cardiovascular recovery to enhance our understanding of the predictive value of these markers for CVD.

## 25) Abstract 1612

# DIFFERENCES IN PAIN-RELATED SYMPTOMS AMONG ADULT OUTPATIENTS CONSIDERED FOR CHRONIC OPIOID MANAGEMENT AND SPINAL CORD STIMULATOR IMPLANTATION.

Miriam H. Feliu, Psy.D., Labarron K. Hill, Ph.D., Amy Kupper, Ph.D., Risa Long, MA, Psychiatry, Duke University Medical Center, Durham, North Carolina, Erica Brooks, MA, David Gray, BA, Psychology, Fielding Graduate University, Santa Barbara, California, Christopher L. Edwards, Ph.D., Psychiatry, Duke University Medical Center, Durham, North Carolina

Chronic pain is a growing public health crisis worldwide that poses significant challenges for both providers and patients. The use of opioids to treat chronic pain has a controversial history given its known effectiveness and the risks of overdose, developing dependence and

addiction. Neuromodulation with the use of implantable devices such as spinal cord stimulator (SCS) and targeted drug delivery systems (TDDS) are alternatives to opioids in some cases. Patient selection is paramount in determining success in both interventions. Suitability for chronic opioid management (COM) and implantable devices may be further complicated by psychiatric co-morbidities which are common in patients with chronic pain. Psychological, biological and social factors have been shown to predict outcomes. IN the present study, we examined differences in pain-related symptoms in a cohort of chronic pain patients being considered for COM and/or SCS with co-morbid Axis I psychopathology. The sample consisted of N=246 (191 females, 70% Caucasian) outpatients evaluated at a multidisciplinary comprehensive pain center in the southeast US. Diagnostic and pain-related symptom data were obtained from an archival database including information from clinical interview and psychological testing. A total of 176 patients met DSM-IV TR criteria for an Axis I diagnosis including 69% for depression (i.e. unipolar, bipolar and unspecified) and 14% for Anxiety (i.e. generalized, obsessive compulsive and post-traumatic stress disorder). Relative to patients with a primary Axis I diagnosis of Anxiety, patients with Depression reported significantly greater pain severity prior to treatment (p<.05). In contrast, patients with Anxiety endorsed significantly less pain-related functional impairment (p<.05), compared to patients with Depression. These results suggest that patients with chronic pain and with co-morbid Depression may present with greater pain-related distress and impairment compared to those with Anxiety. Such differences must be considered during evaluation and determination of treatment recommendations, especially in patients assessed for long-term opioid management and/or implantable devices.

## 26) Abstract 1634

# PILOT STUDY TO ASSESS THE EFFECT OF LIFE-SKILLS TRAINING ON PREVENTION OF INTERPERSONAL VIOLENCE AMONG SCHOOL ADOLESCENTS IN NEW DELHI, INDIA.

Drishti Sharma, MD, Community Medicine- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India, Jugal Kishore, MD, PhD, Community Medicine, Vardhman Mahavir Medical College, New Delhi, New Delhi, India, Nandini Sharma, MD, MBA, Community Medicine, Maulana Azad Medical College, New Delhi, New Delhi, India

**Background:** Region bound cross-sectional studies suggest that acts of interpersonal violence are prevalent (from 10 to 66%) among adolescents across India. World over, there is strong evidence that universal school-based programs that provide information about violence and its prevention, or help children learn positive social skills, decrease rates of violence and aggressive behaviour. Information regarding the same is scarce in developing regions. **Methods:** Quasi-experimental study among middle school students (8th grade) of public schools, located in Central Delhi, was conducted. Two classes (95 participants) in intervention school and three classes (108 participants) in comparison school were selected. The intervention, comprising knowledge regarding violence and a culturally apt Life Skills Training, was administered weekly over one month (total 4 sessions). The comparison group, on the other hand, did not receive any intervention; standard school protocols were functional at both the schools. Self-reported violence behaviour (physical and emotional perpetration of violence and victimization) was measured at baseline and at one month and six months after intervention in both the schools. Intention to treat analysis was used. The difference in violent behaviour was compared using Chi-square test and Odds ratio was calculated. **Findings:** The differences observed in prevalence of violence parameters were: a fall of 15.8 percent points (OR=0.32, p=0.008) for victimization and a decrease of 19.9 percent points (OR=0.13, p=0.0002) for perpetration of physical violence in the intervention group compared to the comparison group. However, no significant difference was observed in the prevalence of emotional violence (OR=0.42, p=0.099). The effect
of intervention was uniform across gender. **Implications for Research:** Compared to the comparison group, the intervention group showed significant improvements in mean scores for physical perpetration of violence and victimization. The results of this study suggest that Life Skills Training is effective in reducing violence among adolescents even in the Indian setting. The intervention under study requires further testing on larger samples and for longer durations (>12 months) to determine its effectiveness.

<figure><img src="image_8.png" /></figure>

## 27) Abstract 1023
### CYTOKINE PATTERNS IN OLDER U.S. ADULTS: MIXED-METHODS CLUSTERING OF INDIVIDUALS BASED ON 22 ANALYTES

Kristina L. Pagel, MA, PhD Candidate, Institute for Mind and Biology, Department of Comparative Human Development, Center on Demography and Aging, L. Philip Schumm, MA, Kristen E. Wroblewski, MS, Department of Public Health Sciences, Joscelyn N. Hoffmann, BA, Hannah M. You, BA, Institute for Mind and Biology, Elbert S. Huang, MD, MPH, FACP, Center for Translational and Policy Research of Chronic Diseases, Section of General Internal Medicine, Louise C. Hawkley, PhD, NORC, Martha K. McClintock, PhD, Institute for Mind and Biology, Department of Comparative Human Development, Center on Demography and Aging, The University of Chicago, Chicago, IL

Cytokines are protein molecules with interactive and cascade effects that regulate immune processes underlying physical and mental health. The sheer number of cytokines and their multiple possible interactions makes studying their roles in health necessarily complex. Further, little is known about the distribution of individual cytokines or cytokine profiles among healthy older adults. The National Social Life, Health, and Aging Project (NSHAP, 2010-11) introduced an innovative protocol for obtaining plasma samples in the home and used them to measure 22 cytokines: IFN-γ, IL-10, IL-1b, IL-6, MCP-1, TGF-α, TNF-α, GM-CSF, IL-12, IL-13, IL-1ra, IL-2, sIL-2ra, IL-3, IL-4, IL-5, TNF-β, VEGF, NGAL, fibrinogen, adiponectin, and apo-B. Our goals were to 1) describe the univariate and joint distributions of cytokines among U.S. older adults, 2) develop multivariate methods for analyzing multiple analytes within individuals that address both challenging measurement issues and possibly non-linear and discrete relationships, and 3) use these methods to study the association between inflammatory profiles and health conditions related to immune function. Plasma from a representative U.S. sample of 2,745 home-dwelling older adults (62-91 yrs; 55% women) were assayed at the University of Chicago Flow Cytometry Core Facility, using a Bio-Plex system and Luminex xMAP technology. We used a hierarchical cluster analysis to identify groups of individuals with similar cytokine profiles. Analyte values were coded as high or not, using cutoffs based on the observed percentiles of each distribution. Similarity was then measured using the Jaccard coefficient, thereby emphasizing the co-occurrence of cytokines with high values. A K-means cluster analysis was then used to identify and visualize distinct cytokine profiles. While both gender and race/ethnicity were associated with specific cytokine profiles, age

was surprisingly not. Health outcomes that were strongly associated with specific cytokine profiles included body mass index (BMI), cognitive function, cardiovascular disease, and diabetes. Several distinct cytokine profiles are identifiable among the general population of U.S. older adults, and are associated with demographic characteristics and health outcomes. Cluster analysis is an effective method for analyzing data from multiplex cytokine panels in a population-based study.

## 28) Abstract 1054
### LOW SELF-RATED HEALTH AND BLOOD HYPERCOAGULABILITY IN PATIENTS WITH AN ACUTE CORONARY SYNDROME

Roland von Känel, MD, Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Aargau, Switzerland, Rebecca E. Meister, PhD, Psychiatry, Clienia Schlössli AG, Oetwil am See, Zürich, Switzerland, Mary Princip, PhD, Preventive Cardiology & Sports Medicine, Jean-Paul Schmid, MD, Cardiology, University of Bern, Bern, Switzerland, Jürgen Barth, PhD, Complementary & Integrative Medicine, University of Zürich, Zürich, Switzerland, Hansjörg Znoj, PhD, Psychology, University of Bern, Bern, Switzerland, Ulrich Schnyder, MD, Psychiatry & Psychotherapy, University of Zürich, Zürich, Switzerland

**Background:** Self-rated health (SRH) is associated with cardiovascular mortality in patients with coronary heart disease. The increased cardiovascular risk with low SRH shows a dose-response relationship and is poorly explained by demographic factors, comorbidities, health behaviors and patients' psychosocial status. We examined whether SRH relates to hemostatic factors of a hypercoagulable state in patients admitted with acute myocardial infarction (MI) to a university hospital. **Methods:** We assessed 190 patients (median age 59 yrs, range 18-88; 83% men) within 48 h of an acute coronary intervention in terms of demographic factors (age, sex, education), comorbidity (Charlson comorbidity index, history of hypertension, hypercholesterolemia, depression and anxiety disorders), health behaviors (body mass index, smoking status, drinking status, physical activity), cardiac-related variables (previous MI, number of diseased coronary vessels, the prognostic Global Registry of Acute Coronary Events (GRACE) Score at admission), and psychosocial characteristics (distress during MI, social support, depressive symptoms). Patients rated their health state before MI retrospectively with the EuroQol Visual Analogue Scale ranging from 0 ("worst imaginable health state") to 100 ("best imaginable health state"). Levels of fibrinogen, fibrin D-dimer and von Willebrand factor (VWF) antigen were measured in plasma on the morning after hospital referral. **Results:** The median score of SRH was 75 (range 20-100) and inversely associated with fibrinogen (r=-0.25, p<0.001) and D-dimer (r=-0.17, p=0.020) levels in the bivariate analysis. Similar associations emerged for fibrinogen (r=-0.32, p<0.001), D-dimer (r=-0.20, p=0.010), and also VWF (r=-0.17, p=0.027) levels in fully adjusted linear regression models. Regarding covariates, independent associations with hemostatic factors were strongest for the GRACE score (fibrinogen: r=0.29, D-dimer: r=0.28, VWF: r=0.33; all p-values<0.001). **Conclusions:** Lower SRH was associated with greater blood coagulability in patients with acute MI, independent of covariates. The strength of the association was comparable to the one observed for the prognostic GRACE score. The findings provide a novel psychobiological mechanism that may potentially link SRH with cardiovascular outcome in patients with an acute coronary syndrome.

## 29) Abstract 1071
### THE TRAJECTORY OF SCREEN TIME FROM ADOLESCENCE TO EMERGING ADULTHOOD

Marissa D. Alert, M.S., Psychiatry, Alpert Medical School, Brown University, Providence, RI, Roger C. McIntosh, PhD, Maria M. Llabre, PhD, Patrice G. Saab, PhD, Psychology, University of Miami, Coral Gables, FL
**Objective:** US adolescents spend up to 8 hours daily in screen time. Efforts to reduce sedentary time have often focused on identifying its correlates. However, little is known about the trajectory of adolescents' screen time or factors that predict it. This study examined change in screen time from age 13 to 23 and its predictors in a representative US sample. **Method:** Adolescents (N=3,705; 46.3% boys) from the National Longitudinal Study of Adolescent to Adult Health's public-use data self-reported their screen time (hours/week watching TV and videos, and playing video/computer games) in 1994, 1996, 2001, and 2008. Piecewise latent growth models within a cohort-sequential design modelled screen time from ages 13-18 and 19-23 years. Predictors of change for each piece were gender, parental education and limits on screen time, household income, perception of neighborhood safety, race/ethnicity, body mass index, physical activity (PA), and employment status.

**Results:** Adolescents spent an average of 24.99 hours/week in screen time at age 13 and more than 14 hours/week until age 23. Screen time decreased 1.27 hours per week per year from age 13 to 18, then increased .39 hours per week per year from age 19 to 23 (ps<.001). From 13 to 18, decrease in screen time was associated with feeling safe in one's neighborhood (b=2.70, p=.01), having parental limits on screen time (b=1.22, p=.02), and being Asian American (vs. white; b=2.27, p=.02). From 19 to 23, African Americans (b=-1.13, p<.001) and Asian Americans (b=.67, p=.04) had a lower increase compared to whites. More bouts of PA were also associated with lower increase in screen time (b=-.04, p=.03) during emerging adulthood. Participants who were only in school (b=.43, p=.01) or neither in school nor working (b=.91, p<.001) had a greater increase in screen time than those who were only working.

**Conclusion:** Interestingly, screen time increased after the age of 18, a point when many transitions, such as the entry into college, often occur. However, given the high levels of screen time maintained from age 13 to 23, effective means of curbing screen time during these developmental periods are needed. Furthermore, since the factors associated with change in screen time from ages 13-18 and 19-23 differed, this may be important to consider when developing sedentary behavior interventions.

## 30) Abstract 1074

### RESILIENCE TRAINING FOR WORK-RELATED STRESS AMONG HEALTHCARE WORKERS: RESULTS OF A RANDOMIZED CLINICAL TRIAL COMPARING IN-PERSON AND SMARTPHONE DELIVERED INTERVENTIONS

Erin G. Mistretta, B.S., Psychology, The Catholic University of America, Washington, DC, Mary C. Davis, Ph.D., Psychology, Arizona State University, Tempe, AZ, M'hamed Temkit, Ph.D., Biostatistics, Mayo Clinic, Scottsdale, AZ, Christopher Lorenz, M.A., Data Analysis, SOMA Analytics, London, England, United Kingdom, Cynthia M. Stonnington, MD, Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ

Mindfulness interventions hold promise as a strategy to improve employee well-being and mitigate burnout, but most studies measure only distress-based outcomes and lack comparison against an active treatment condition. Despite growing interest in smartphone applications, there is little research on the use of smartphones to decrease work-related burnout. This study assessed the effectiveness of an in-person mindfulness-based resilience training (MBRT) program and a smartphone-delivered resiliency-based intervention against a control condition on distress and well-being in employees at a major tertiary healthcare institution.

Participants (n = 60, 86.7% female; M age = 46) were randomized to a MBRT program (n = 22), a resiliency-based smartphone intervention in which participants selected well-being goals with exercises regarding selected topics (n = 23), or a control group (n = 15) for six weeks. Measures of distress including the Depression, Anxiety, and Stress Scales (DASS-21), Visual Analog Scale-Fatigue, Maslach Burnout

Inventory (MBI), and well-being measures including the WHO5 Well-Being Index, Connor-Davidson Resilience Scale, Self-Compassion Scale, and Compassion for Others Scale were taken at baseline, 6 weeks, and 3-months post-intervention. All participants tracked their sleep via smartphone from baseline to six weeks.

Groups were similar on demographic and baseline outcome measures except that the control group had more meditation experience at baseline than the other groups (p = .028). Compared to changes over time in controls, improvements on well-being as measured by the WHO5, and reductions in stress as measured by the DASS-21, were greater for the MBRT (p < .0001 and .001 respectively) and smartphone group (p = .001 and .049 respectively). The MBRT group also showed significant improvements in the Depersonalization subscale of the MBI (p < .0001). In the MBRT and smartphone groups, number of sessions attended correlated with improvements in WHO5 (p < .001) and Compassion for Others (p = .005) scores at 3-month post-intervention. Results suggest that both a smartphone intervention and a MBRT program reduced stress and increased well-being in employees. However, the employees who did MBRT, an in-person intervention, were most likely to improve in measures of work-related burnout.

<caption>Table 1</caption>

Mindfulness-Based Resilience Training (MBRT) Course Outline

<table><thead><tr><th></th><th></th></tr></thead><tbody><tr><td>Session 1</td><td>Resilience – Core Concepts and Research<br>Mindful Movement<br>Attentional Training – Awareness of Breath<br>Informal Practice</td></tr><tr><td>Session 2</td><td>Awareness of Breath – 10 minutes<br>Mindfulness – Core Concepts and Research<br>Mindful Movement<br>Compassionate Body Scan</td></tr><tr><td>Session 3</td><td>Coping with Difficult Physical Sensations – Core Concepts<br>Mindful Movement<br>Awareness of Bodily Pain/Discomfort<br>Compassion Meditation</td></tr><tr><td>Session 4</td><td>Coping with Difficult Emotions – Core Concepts<br>ABC's of MBRT<br>Mindful Movement<br>Naming Emotions Meditation</td></tr><tr><td>Session 5</td><td>Coping with Unwanted Thoughts/Narratives – Core Concepts<br>Fusion and Diffusion<br>Mindful Movement<br>Practicing with Difficult Thoughts/Narratives<br>Meditation</td></tr><tr><td>Session 6</td><td>Self-Criticism and Self-Compassion<br>Personalized Resilience Plan Incorporating Intentions, Mindfulness Skills and Resilience Skills</td></tr></tbody></table>
### 31) Abstract 1075

#### PREGNANCY INDUCED HYPERTENSION MODERATES THE ASSOCIATION BETWEEN PSYCHOSOCIAL STRESS IN EARLY PREGNANCY AND GESTATIONAL AGE AT BIRTH.

Kristin J. Horsley, B.A. (Hons), Psychology, McGill University, Montreal, Quebec, Canada, Lianne Tomfohr, Ph.D., Psychology, University of Calgary, Calgary, Alberta, Canada, Blaine J. Ditto, Ph.D., Psychology, McGill University, Montreal, Quebec, Canada, Suzanne Tough, Ph.D., Community Health Sciences (Medicine), University of Calgary, Calgary, Alberta, Canada

**Background:** Maternal prenatal psychosocial stress and pregnancy induced hypertension are risk factors for adverse birth outcomes. Research has shown that psychosocial stress and pregnancy induced hypertension are associated with younger gestational age at birth, but whether psychosocial stress influences gestational age differently among women with and without pregnancy induced hypertension has not been determined.

**Objective:** To investigate whether the association between prenatal maternal psychosocial stress and gestational age at birth is moderated by pregnancy induced hypertension.

**Methods:** A secondary data analysis was conducted using the All Our Babies prospective pregnancy cohort (N = 2858). Sociodemographic information (e.g., maternal age, parity, pre-pregnancy body mass index) and measures of psychosocial stress (e.g., perceived stress, and symptoms of anxiety and depression) were obtained at <24 weeks' gestation using self-report questionnaires. Information regarding prenatal and birth record data that included pregnancy complications was retrieved from participants' electronic medical record.

**Results:** In line with previous research, three hierarchical multiple regression analyses revealed significant negative associations between depressive symptoms, anxious symptoms, and perceived stress and gestational age after adjusting for sociodemographic variables. Moderation analyses showed that depressive symptoms significantly predicted younger gestational age at birth among women with and without pregnancy induced hypertension, but among those with hypertension the association was stronger such that a one-unit increase in total score on the Edinburgh Postnatal Depression Scale was associated with a one-day decrease in gestational age ($b = -.14, SE = .03, p < .001$). Anxious symptoms ($b = -.05, SE = .01, p < .001$) and perceived stress ($b = -.06, SE = .02, p < .05$) significantly predicted younger gestational age among women with pregnancy induced hypertension, but not among those without. These results remained significant after adjusting for sociodemographic variables.

**Conclusions:** The association between psychosocial stress and gestational age at birth is moderated by pregnancy induced hypertension. Future research should investigate psychophysiological mechanisms that may link psychosocial stress, pregnancy induced hypertension, and birth outcomes.

### 32) Abstract 1084

#### HAIR CORTISOL AND THE METABOLIC SYNDROME IN A MULTIRACIAL SAMPLE

Henry M. Lehrer, MS, Susan K. Dubois, MD, Mary A. Steinhardt, EdD, LPC, Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas

**Background:** Although hair cortisol is associated with metabolic syndrome prevalence in White adults, this relationship has not been examined in other racial groups. Racial differences in both long-term cortisol concentration and cardiometabolic risk may influence how hair cortisol levels vary with metabolic syndrome status and severity.

**Design:** We used the analysis of cortisol in hair (CORT) to examine associations of long-term cortisol levels with two different metabolic syndrome calculations - standard metabolic syndrome (SMetS) and race-specific metabolic syndrome severity score (MSSS) – and with cardiometabolic components, in a multiracial sample.

**Participants:** Participants included 232 community-dwelling adults (73 White, 89 Hispanic, 70 Black; mean age 45.4 years; 67% females).

**Main Outcome Measures:** The first 3 cm of scalp-near hair were analyzed for cortisol concentration using enzyme-linked immunoassay analysis (ELISA). Relevant cardiometabolic risk factors were assessed and a metabolic syndrome continuous score and diagnosis were determined using 1) standard 2009 international task force SMetS criteria and 2) 2014 MSSS calculations weighting individual metabolic syndrome components for their race-specific contribution to cardiometabolic risk.

**Results:** In bivariate analyses, CORT showed positive associations with systolic and diastolic blood pressure, glucose, glycated hemoglobin, body mass index, and waist-to-hip ratio, and a negative association with HDL cholesterol. These correlations were largely driven by associations among Whites. In fully-adjusted analyses, CORT was associated with MSSS score ($b = .22, p < .01$) and prevalence (odds ratio 2.18, 95% confidence interval 1.24-3.84). Associations of CORT with SMetS score and prevalence were not significant.

**Conclusion:** In a multiracial sample, hair cortisol is associated with the metabolic syndrome when race-specific calculations are used. Clinicians and researchers should consider racial variation in relevant parameters when interpreting and designing studies investigating cortisol and cardiometabolic disease.

### 33) Abstract 1087

#### INTERPERSONAL VIOLENCE, POST-TRAUMATIC STRESS DISORDER, AND SYMPTOMS RELATED TO MENOPAUSE AND AGING AMONG COMMUNITY-DWELLING OLDER WOMEN

Carolyn J. Gibson, PhD, MPH, Medical Service, San Francisco VAMC, San Francisco, CA, Alison J. Huang, MD, MS, Medicine, UCSF, San Francisco, CA, Brigid McCaw, MD, MS, MPH, Family Violence Prevention Program, Kaiser Permanente Northern California, Oakland, CA, Jun Shan, PhD, Division of Research, Kaiser Permanente, Oakland, CA, Leslee Subak, MD, Obstetrics and Gynecology, David Thom, MD, PhD, MPH, Family Community Medicine, UCSF, San Francisco, CA, Stephen K. Van Den Eeden, PhD, Division of Research, Kaiser Permanente, Oakland, CA

**Background:** Because prior research on interpersonal violence and post-traumatic stress disorder (PTSD) has largely focused on younger women, little is known about the impact of these experiences on the health of midlife and older women.

**Methods:** Associations between lifetime interpersonal violence exposures (physical or emotional intimate partner violence, sexual violence), PTSD, and symptoms related to menopause and aging (hot flashes, night sweats, sleep difficulty, urinary incontinence, and vaginal pain with intercourse) were examined in a multi-ethnic sample of community-dwelling midlife and older women (mean age 60.5) using multivariable logistic regression. Interpersonal violence and PTSD were measured with well-validated standardized assessments. Models were adjusted for age, race/ethnicity, and body mass index. Data were drawn from the Reproductive Risk of Incontinence Study in Kaiser (RRISK), an observational cohort study (n=2,106) of long-term enrollees in the Kaiser Permanente Northern California health care system.

**Results:** In this multi-ethnic sample (40% non-Latina White, 20% Latina White, 20% Black, and 20% Asian), 24% of participants reported current or past intimate partner violence, 19% reported having experienced sexual violence, and 22% had clinically significant PTSD symptoms. Intimate partner violence was associated with night sweats (OR 1.42, p<.01), sleep difficulty (OR 1.45, p<.001), vaginal pain with intercourse (OR 1.43, p=.04), and urinary incontinence (OR 1.42, p<.01). Sexual violence was associated with vaginal pain with intercourse (OR 1.46, p=.04). Women with clinically significant PTSD symptoms were more likely to report hot flashes (OR 1.76, p<.001), night sweats (OR 1.78, p<.001), sleep difficulty (OR 3.10, p<.001), and vaginal pain with intercourse (OR 2.12, p<.001).
**Conclusions:** Interpersonal violence and PTSD were prevalent in this sample, and contributed to risk for disruptive menopause- and aging-related symptoms. These findings highlight the importance of systematic screening and early intervention among midlife and older women, and the need to determine best approaches for trauma-informed care of these common symptoms.

## 34) Abstract 1154

### INFLAMMATION AND CIRCULATING ENDOTOXIN ARE INDEPENDENT PREDICTORS OF DEPRESSIVE SYMPTOMS AND FATIGUE IN STABLE KIDNEY TRANSPLANT RECIPIENTS

Jos A. Bosch, PhD, Psychology, University of Amsterdam, Amsterdam, ZH, The Netherlands, Winnie Chan, PhD, Renal Medicine, University Hospital centre Birmingham, Birmingham, West Midlands, United Kingdom, David Jones, PhD, Dept of Sport and Exercise Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom, Pierce G. McTernan, PhD, Medicine, University of Warwick, Warwick, West Midlands, United Kingdom, Richard Borrows, MD, Renal Medicine, University Hospital centre Birmingham, Birmingham, West Midlands, UK

Over 40% of kidney transplant recipients (KTRs) report severe fatigue and approximately 25% are clinically depressed. Persistent inflammation may greatly enhance vulnerability to these syndromes. A recent discovery is that inflammation may, in part, be driven by the translocation of gut bacteria ('leaky gut'), which increases circulating inflammatory bacterial products, such as the endotoxin lipopolysaccharide (LPS). The present study investigated if plasma LPS predicted systemic inflammation in KTRs and symptoms of depression and fatigue.

This study enrolled 128 stable KTRs who were >24 months post-transplantation [Mean age = 50 SD±15; 56% male]. Symptoms of depression and fatigue were assessed using the Hospital Anxiety and Depression scale and the Multidimensional Fatigue Inventory. Fasting blood was analyzed for LPS, and inflammation was assessed as C-reactive protein (hsCRP). Analyses were adjusted for clinical and demographic markers, including age, ethnicity, gender, BMI, comorbidity, and kidney function (eGFR).

As expected, LPS levels predicted hsCRP (β=.39, p<.001). In turn, both LPS and hsCRP predicted depressive symptoms (β=.31 and beta=.24, respectively, p<.01), as well as several dimensions of fatigue (βs >.17 and <.31, p<.01). After adjustment for inflammation, LPS remained an independent predictor of depressive symptoms (β =.28, p<.01) as well as various dimensions of fatigue (βs >.19 and <29, p .001).

This study is the first to identified circulating LPS as an independent predictor of depressive symptoms and fatigue. Control of circulating LPS, e.g., through dietary manipulation of gut permeability, may help to improve mood and fatigue in patients.

## 35) Abstract 1159

### NEIGHBORHOOD ADVERSITY AND CORTISOL SECRETION ACROSS THE LIFE SPAN

Samuele Zilioli, PhD, Psychology; School of Medicine, Richard B. Slatcher, PhD, Psychology, Heather Fritz, PhD, Health Care Sciences, Jason C. Booza, PhD, School of Medicine, Malcolm P. Cutchin, PhD, Health Care Sciences, Wayne State University, Detroit, MI

Previous studies have shown that living in poor neighborhoods is associated with increased morbidity and mortality. However, researchers are now investigating the biological pathways responsible for the deleterious effects of neighborhood disadvantage on health. Here, we investigated whether objective neighborhood adversity was associated with cortisol measured in two sampling matrices, saliva and hair, and whether this link would be mediated by subjective perceptions of neighborhood adversity. In Study 1, one hundred older African Americans were recruited from 39 Detroit census tracts across five strata of census tract adversity. Participants were interviewed face-to-

face to collect psychosocial measures. Next, participants collected four saliva samples a day for seven consecutive days. Our analyses revealed that higher subjective neighborhood adversity mediated the link between higher objective neighborhood disadvantage and steeper diurnal cortisol slopes. In Study 2, the same finding was replicated in a sample of seventy-eight African American children affected by asthma and living in Detroit. In Study 3, we found that subjective neighborhood disadvantage predicted flatter cortisol slopes in a nationally representative sample of adults. Lastly, in Study 1 a subsample provided a hair sample for analysis of cortisol. When the same analyses were run using hair cortisol as the main outcome, we found that higher objective neighborhood adversity was associated with higher levels of hair cortisol levels and than subjective neighborhood disadvantage partially explained this association. In sum, these results demonstrate a link between objective and subjective neighborhood adversity and daily cortisol as well as hair cortisol — a retrospective indicator of long-term hypothalamic pituitary adrenal (HPA) axis activation—across the lifespan.
## 36) Abstract 1277

# TRACKING DAILY ACTIVITY IN FATIGUED BREAST CANCER SURVIVORS. AN EXPLORATORY STUDY

Annina J. Seiler, Ph.D., Department of Psychology, Rice University, Houston, Texas, Vanessa C. Klaas, Dipl.-Inf., Gerhard Troester, Prof. Dr., Wearable Computing Laboratory, Department of Information Technology and Electrical Engineering, ETH Zurich, Zurich, Zurich, Switzerland, Diana A. Chirinos, Ph.D., Luz M. Garcini, Ph.D., Kyle W. Murdock, Ph.D., Christopher P. Fagundes, Ph.D., Department of Psychology, Rice University, Houston, Texas

**Background:** Cancer-related fatigue (CRF) is the most prevalent and distressing problem in cancer survivors that can persist many years beyond successful cancer treatment. Given steadily increasing rates of mobile phone ownership, mobile phone interventions may have the potential to reduce CRF via improved self-efficacy, management of physical symptoms and physical activity.

**Objective:** 1) to learn more about daily activity in fatigued breast cancer survivors; 2) to test whether a smart phone application can maintain and/or increase daily physical activity in fatigued breast cancer survivors over a supervised period of time; 3) to assess whether changes in physical activity will be reflected in self-report and physiological measures.

**Methods:** A total of 30 fatigued breast cancer survivors (FACIT-F score ≤ 34) will be randomly assigned to either the intervention (n = 15) or cancer control group (n = 15). Healthy participants without a history of cancer will also be randomly assigned to an intervention (n = 15) or control group (n = 15). While the intervention groups will receive a smartphone application with feedback regarding their daily activity, the control groups will receive the application without feedback (Figure 1). Behavioral data will be collected by means of GPS and Wi-Fi for localization, and accelerometer, barometer, magnetometer and gyroscope for activity recognition. Primary outcomes will be fatigue (FACIT-F) and physical activity. Secondary outcomes include pain, depression, psychological distress, quality of life, heart rate, and cortisol level. Outcome measures will be completed at baseline (T1), 4 weeks (T2) and 12 weeks (T3). Group differences will be tested by one-way analysis of variance (ANOVA). Intervention effects will be analyzed using mixed models with repeated measurements: fixed factors will include group and time; dependent variables will be the primary and secondary outcomes described above.

**Hypotheses:** The cancer survivor intervention group will demonstrate higher levels of physical activity, lower levels of fatigue, pain, psychological distress and normalization of cortisol levels at 12 week follow-up in comparison to the cancer survivor control group.

## Conclusion

The aim of this exploratory study is to evaluate a theoretically guided smartphone application for fatigued breast cancer survivors.

<figure><img src="image_9.png" /></figure>

## 37) Abstract 1642

# TO RCT OR NOT TO RCT? A REAL WORLD PREFERENCE-BASED COMPARATIVE EFFECTIVENESS TRIAL OF MINDFULNESS BASED CANCER RECOVERY AND TAI CHI/QIGONG IN CANCER SURVIVORS (THE MATCH STUDY)

Erin L. Zelinski, PhD, Oncology, University of Calgary, Calgary, AB, Canada, Michael L. Speca, PsyD, Psychosocial Oncology, Alberta Health Services, Calgary, AB, Canada, Lynda Balneaves, PhD, Nursing, University of Manitoba, Winnipeg, MB, Canada, Jennifer M. Jones, PhD, Psychiatry, Daniel M. Santa-Mina, PhD, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada, Peter M. Wayne, PhD, Medicine, Harvard Medical School, Boston, MA, Tavis S. Campbell, PhD, Psychology, University of Calgary, Calgary, AB, Canada, Janine L. Giese-Davis, PhD, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, AB, Canada, Peter L. Faris, PhD, Community Health Sciences, Alberta Health Services, Calgary, AB, Canada, Jennifer S. Zwicker, PhD, Public Policy, Kamala Patel, PhD, Tara L. Beattie, PhD, Biochemistry & Molecular Biology, University of Calgary, Calgary, AB, Canada, Steve Cole, PhD, Hematology-Oncology, UCLA, Los Angeles, CA, Kristi Toivonen, BA(hon), Psychology, Jill G. Nation, MD, Obstetrics & Gynaecology, University of Calgary, Calgary, AB, Canada, Philip Peng, MD, Anesthesia, University of Toronto, Toronto, ON, Canada, Bruce Thong, MSc, Athletic & Recreation, Raimond Wong, MD, Oncology, McMaster University, Hamilton, ON, Canada, Sunita Vohra, MD, Pediatrics, University of Alberta, Edmonton, AB, Canada, Linda E. Carlson, PhD, Oncology, University of Calgary, Calgary, AB, Canada

Although randomized controlled trials (RCTs) have long been the gold standard in behavioural research, it may be time to move beyond this approach and instead design behaviour trials according to a more pragmatic, real world approach. Research has documented that successful treatment of cancer does not necessarily mean total recovery of function. A growing number of cancer survivors suffer lingering high levels of distress, depression, and stress along with sleep disturbances, pain, and fatigue. Two mind-body interventions with evidence for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been directly compared nor have they been examined under real world, pragmatic conditions where factors such as preference or availability are taken into account. Toward this goal, we have designed an innovative study comparing MBCR and TCQ to treat distressed cancer survivors according to their preferences, while still maintaining the rigor of a traditional RCT. Participants (N = 600) with a preference will receive their preferred intervention; while those without a preference will be randomized into either intervention. All participants will also be randomized into immediate intervention groups or wait-list control, providing randomized usual care comparisons for each condition.
Groups will be compared pre- and post-intervention and at a 6-month follow up. The Profile of Mood States (POMS) Total Mood Disturbance is the primary outcome. Quality of life, psychological measures, cancer-related symptoms and physical functioning will also be assessed. We will also explore the effects of these interventions on biomarkers (e.g., cortisol slopes, cytokines, blood pressure/heart rate variability, telomere length, gene expression), which may uncover important effects on key biological regulatory and antineoplastic functions. Lastly, health economic measures will be assessed to determine potential savings to the health care system associated with adopting these complementary therapies for cancer survivors. This approach will allow us to examine the real world benefits of MBCR and TCQ for cancer patients, including analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and patient demographics.

**38) Abstract 1352**

## APP INTERVENTION BASED ON MIND BODY MEDICINE FOR CANCER PATIENTS (AIM-C)

Jürgen Barth, PhD, Michael Mikolasek, MA, Claudia M. Witt, Professor, Institute for Complementary and Integrative Med, University Hospital Zurich, Zurich, ZH, Switzerland

**Background:** Standard cancer treatment often neglects distress in cancer patients and Mind Body Medicine (MBM) interventions are effective to reduce cancer related distress if they are delivered in a face to face setting. This study will evaluate the benefits for patients and the feasibility of a mind-body medicine mobile app with mindfulness meditation, guided imagery and progressive muscle relaxation in cancer patients (registered at DRKS00010481). The intervention is delivered via a mobile app and enables a simultaneous assessment of patient's distress and the satisfaction with the intervention. **Methods:** We conduct a prospective observational study with a mixed methods approach in 160 adult cancer patients. Patients can use the App for twenty weeks in addition to face to face MBM treatment or in addition to usual cancer care. Quantitative data include clinical data, self-reported health outcomes (i.e. PROMIS 29, HADS, FACT-G, Distress Thermometer and mindfulness) and treatment satisfaction by questionnaires and via a continuous assessment in the app. Interviews with patients and healthcare professionals about the feasibility and satisfaction with the App will be done after the App use. The study is guided by the RE-AIM evaluation framework (Reach the target population; Effectiveness, Adoption by target staff, setting, or institutions; Implementation consistency, costs and adoptions made during delivery; Maintenance of intervention effects in individuals and settings over time). **Results and Discussion:** The development of the MBM App was finished in April 2016 and the recruitment of patients started in July 2016. First data on use and feasibility will be available by March 2017. The study will allow insights, if new technologies are able to deliver MBM interventions in a feasible and effective way for patients with chronic illnesses and will allow conclusions about the acceptance of MBM apps in patients as well as healthcare professionals.

**39) Abstract 1554**

## PRESURGICAL SLEEP QUALITY, INDIVIDUAL RESILIENCE, AND POSTSURGICAL INFLAMMATION AMONG WOMEN WITH SUSPECTED GYNECOLOGIC CANCER

Elizabeth L. Kacel, MS, Chantel M. Ulfig, MS, Janae Kirsch, BA, Adaixa Padron, BS, Diego Esparza-Duran, MS, Shan Wong, MS, Stephanie G. Smith, PhD, Clinical and Health Psychology, Gregory S. Schultz, PhD, Department of Obstetrics and Gynecology, Deidre B. Pereira, PhD, Clinical and Health Psychology, University of Florida, Gainesville, Florida

**Background:** Sleep disturbance is the most common behavioral health issue in cancer patients. It is associated with high inflammation, which may have deleterious effects on outcomes. In contrast, resilience (i.e.,

adaptability to stress) is associated with less inflammation. Few studies have examined relations among resilience, sleep, and inflammation in cancer patients, especially during cancer treatment. Therefore, the current study examined whether resilience moderated the relationship between presurgical sleep quality and postsurgical serum IL-6.

**Methods:** Participants were 21 women (M age=57.71 yrs; SD=11.22) with clinically significant sleep disturbance that were enrolled in an RCT examining cognitive-behavioral effects on sleep, pain, and cytokines in gynecologic cancer. Preoperative sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989). Personal resilience was captured via the Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003). Postoperative inflammation was measured via serum concentrations of IL-6 using standardized ELISA assays at a postsurgical clinical visit.

**Results:** Using linear regression analyses, resilience significantly moderated the relationship between presurgical daytime dysfunction due to sleepiness and postsurgical IL-6 ($\beta$=-0.470, $p=.041$), such that high resilience buffered the relationship between high presurgical daytime dysfunction and high postsurgical IL-6. The overall model accounted for 27% of the variance in postsurgical IL-6. Resilience did not moderate the relationship between Global PSQI score and IL-6 or other PSQI component scores and IL-6.

**Conclusions:** These findings contribute to existing literature on biobehavioral relationships between psychosocial well-being and immunity in gynecology oncology. High personal resilience may attenuate the deleterious effects of daytime dysfunction due to sleepiness on systemic inflammation among women undergoing surgical resection for gynecologic cancers. High daytime dysfunction was endorsed among women with the most severe overall sleep disturbance and may represent a phenotype that confers especially high risk for inflammation and other clinical outcomes. Future research should examine whether interventions that improve resilience and reduce daytime dysfunction can optimize immunity and clinical outcomes in women with cancer.

**40) Abstract 1409**

## HEART-TO-HEART: A DYADIC PSYCHOSOCIAL INTERVENTION FOR COUPLES COPING WITH METASTATIC LUNG CANCER

Kathrin Milbury, PHD, Palliative, Rehabilitative and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, Rosalinda Engle, MA, Palliative, Rehabilitative and Integrative Medicine, Zhongxing Liao, MD, Radiation Oncology, Anne Tsao, MD, Head and Neck/Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, Cindy Carmack, PHD, Palliative, Rehabilitative and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, Alejandro Chaoul, PHD, Lorenzo Cohen, PHD, Palliative, Rehabilitative and Integrative Medicine, The University of Texas MD Anderson Cancer Center, HOUSTON, TX

Over half of new lung cancer (LC) cases are diagnosed with already distant metastases. Given the incurable nature, short survival and high symptom burden of metastatic LC, patients and their families are at risk of experiencing psychological and existential/spiritual distress. To address these concerns, we developed a dyadic intervention integrating meditation training with emotional disclosure exercises to facilitate intra- and interpersonal adjustment. The intervention is based on the Broaden-and-Built Theory of Positive Emotions and involves 4 weekly, 60 min sessions along with homework. Each session focuses on skills to cultivate mindfulness, compassion, gratitude and purpose. The goal of this initial study was to examine intervention acceptability. We conducted focus groups involving 7 patients with metastatic LC (μ age=64.5 yrs; μ time since dx=4.2 mo.; female: n=3) and their partners (μ age=55.3 yrs; female: n=4). Each focus group consisted of 1 couple, the interventionist and an interviewer. Intervention content for the 4 sessions was condensed into 2, 90 min. sessions. Couples participated in the exercises and then completed semi-structured interviews and
written evaluations including Likert-scale and open-ended questions to
solicit their feedback regarding content and materials. Sessions were
video/audio-recorded and then transcribed. All study participants
perceived each component of the intervention to be either "beneficial"
or "very beneficial" (0-4 scale; µ's=3.7-3.9). On 6-point scale,
participants indicated that during the sessions they felt "calm" (µ=4.8,
SD=1.2), "relaxed" (µ=5.3, SD=0.8), and "energized" (µ=4.6, SD=1.4).
None of the participants endorsed feeling states of "nervous," "tense,"
"upset" or "sad." On 6-point scale, immediately after the sessions,
participants endorsed having improved their emotional (µ=4.6,
SD=1.3), social (µ=4.3; SD=1.4), and physical (µ=4.8, SD=1.0)
wellbeing. All participants would recommend the program to other
couples. Open-ended comments were very encouraging regarding
general acceptability and usefulness of the program. As the intervention
was deemed acceptable, we are currently conducting a 3-arm trial,
randomizing couples to either the intervention, an attention control, or
usual care control group to examine the feasibility and initial efficacy
of this novel treatment for an understudied population.

41) Abstract 1284

THE EFFECTS OF HEART-RATE VARIABILITY BIOFEEDBACK ON LEVELS OF THE TUMOR MARKER CEA IN METASTATIC COLON CANCER: A PILOT CONTROLLED STUDY

Yori Gidron, PhD, Medincine and Pharmacy, Free University of Brussels - VUB, Waterloo, Walloon Brabant, Belgium, Inge De Leeuw, MSc, Medincine and Pharmacy, Free Univ of Brussels - VUB, Brussels, Belgium, Marijke De Couck, PhD, Medical psychology, University of Leuven, Belgium, Leuven, Flemish Brabant, Belgium, Kees Blase, MSc, Heartfocus, Heartfocus, Loosdrecht, Utrecht, The Netherlands, Leen Vanacker, MD, Oncology, UZ Brussels Hospital, Brussels, Brussels, Brussels, Belgium

Background: High activity of the vagus nerve, indexed by heart-rate variability (HRV), predicts better prognosis in many cancers. Furthermore, in several studies, an intact vagal nerve causes less metastasis. This pilot study tested the effects of vagal activation via HRV-biofeedback (HRV-B) on levels of a tumor marker in patients with metastatic colon cancer.

Methods: This preliminary pilot study used a matched-controlled pre-
post design. Three patients with stage 4 colon cancer performed HRV-
B for approximately 20 min/day, during 3 months. They were guided to
increase their vagal nerve activity via paced slow breathing with an
HRV-B device. These patients were matched with three others on 1.
Cancer type; 2. Cancer stage; 3. Type of chemotherapy treatment; 4.
Baseline CEA (the tumor marker of colon cancer). Data were extracted
from medical files. CEA level was the main outcome variable.

Results: Levels of CEA did not change in controls, while they declined in the HRV-B condition, a difference approaching statistical significance at 3 months (p = 0.055). Patients in the HRV-B condition were able to perform this self-intervention daily and it appeared feasible.

Conclusions: The results of this preliminary matched-controlled pilot study suggest that vagal nerve activation via HRV-B is feasible and may possibly have promising effects on tumor burden in colon cancer. However, before claiming any positive effects with certainty, this requires testing HRV-B in a large randomized controlled trial, which is planned.

42) Abstract 1444

COMPARISON OF THE TREATMENT OUTCOME IN
PATIENTS WITH AN EATING DISORDER WITH A
PATIENTS WITH A PSYCHOSOMATIC DISORDER

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

Psychosomatic and Psychotherapeutic Medicine, Lindenhospital, Bern,
Switzerland

Patients with severe depressive, anxiety, eating, somatoform, personality and trauma related disorders improve during a multidisciplinary, multimodal psychotherapeutic in-patient/day clinic treatment. We explored whether the treatment outcome was differentially affected by the presence of an eating disorder.
From 6/2006 until 8/2016 928 patients (mean age of patients with psychosomatic disorders 40.7 ± 14.6; 65.5% female, patients with eating disorders, 25.4 ± 9.5; 94.7% female) were treated as in-patients and/or in the day clinic of the Department of Psychosomatic and Psychotherapeutic Medicine of a non-profit private hospital. 39.7% suffered from a depressive disorder as main diagnosis, 9.6% from anxiety disorders, 24% from eating disorders, 5.4% from somatoform disorders, 5.4% from personality disorders and 7 % from disorders related to trauma.

All patients were assessed at the beginning and at the end of treatment with the SF36 (Short Form 36 Quality of Life Questionnaire), BSCL (Brief Symptom Checklist), HADS (Hospital Anxiety and Depression Scale), and (for patients with eating disorders only) EDI-2 (Eating Disorder Inventory).

Patients treated for an eating disorder were stat. sig. younger, female, single and still in education (p<.05). There was no difference in the divorce rate of the parents. The improvement of the mental component of QOL (F(2, 679) = 54.94, p< 0.0001, R² = 0.1393), depressive symptoms (F(2, 675) = 110.09, p< 0.0001, R² = 0.246), anxiety (F(2, 675) = 99.61, p< = 0.0001, R² = 0.228), distress (F(2, 297) = 81.02, p< 0.0001, R² = 0.353) and somatization (F(2, 297) = 71.72, p< 0.0001, R² = 0.3257) was equal in the two groups and was predicted by the value at the beginning but was not affected by the presence of an eating disorder. However, the presence of an eating disorder affected stat. sig. the physical component of QOL (F(2, 679) = 313.20, p< 0.0001, R²= 0.48).

The improvement in QOL, distress, depressive symptoms, anxiety and somatization is comparable in patient with psychosomatic disorders and patients with eating disorders. Only the physical component of QOL is differentially affected by the presence of an eating disorder.

43) Abstract 1447

IMPACT OF TREATMENT OUTCOME ON QUALITY OF LIFE IN PATIENTS WITH AN EATING DISORDER

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

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

From 6/2006 until 8/2016 436 patients with an eating disorder (mean age 24.5, 25.4 ± 9.5; 95.1% female) were treated as in-patients and/or in the day clinic of the Department of Psychosomatic and Psychotherapeutic Medicine of a non-profit private hospital. Outcome data were available at the end of treatment for 293 (66.9%) patients.

Patients were assessed at the beginning and at the end of treatment with the SF36 (Short Form 36 Quality of Life Questionnaire) and EDI-2 (Eating Disorder Inventory). A follow up assessment 6 months after the end of treatment was carried through since 2 years with the SF36.

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

The physical dimension of QOL at the beginning and a good treatment outcome had a positive impact on the physical dimension or QOL at the end of treatment (F(2, 284) = 79.63, p< .0001; R² = 0.3593). The physical dimension of QOL at the beginning but not treatment outcome
had a positive impact on the physical dimension of quality of life at
follow up (F(2, 44) = 8.18, p = .0001; R² = 0.2709).

The mental dimension of QOL at the beginning and a good treatment outcome had a positive impact on the mental dimension or QOL at the end of treatment (F(2, 284) = 79.03; p<0.0001; R² = 0.3576). Treatment outcome only but not the mental dimension of QOL at the beginning had a positive impact on the mental dimension of quality of life only at follow up F(2, 44) = 8.03, p = 0.0011, R² = 0.2673).

46% of the patients with an eating disorder reached a good treatment outcome, 38% a moderate and 16% got worse. The physical and mental dimensions of QOL of life are differentially affected by treatment outcome. Treatment outcome impacts more the mental dimension of QOL than the physical.

## 44) Abstract 1392

# MOOD VARIABILITY AND REACTIVITY IN BIPOLAR SPECTRUM DISORDERS: AN ECOLOGICAL MOMENTARY ASSESSMENT STUDY

Femke Lamers, PhD, Psychiatry, VU University Medical Center, Amsterdam, -, Netherlands, Joel Swendsen, PhD, PSL Research University, University of Bordeaux, Bordeaux, -, France, Lihong Cui, MSc, Genetic Epidemiology Research Branch, NIMH, Bethesda, MD, Mathilde Husky, PhD, Psychology, University of Bordeaux, Bordeaux, -, France, Vadim Zipunnikov, PhD, Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Kathleen Merikangas, PhD, Genetic Epidemiology Research Branch, NIMH, Bethesda, MD

**Aim:** Ecological Momentary Assessment (EMA) is an important tool in identifying mood fluctuations that may characterize specific types of mood disorder. We evaluated differences in mood disorder groups in emotional reactivity to daily events, and variability in the intensity and tonality of emotional states.

**Method:** Participants with bipolar I disorder (BP-I; n=33), bipolar II disorder (BP-II; n=37), major depressive disorder (MDD; n=116), anxiety disorders without comorbid mood disorders (n=36) and unaffected controls (n=65) completed two weeks of EMA measuring emotional status (low mood & anxious mood) and daily event occurrence (positive-negative-neutral). All analyses were corrected for age and sex.

**Results:** Individuals with BP-I disorder experienced a significantly greater decrease in sad and anxious mood following positive events than controls. By contrast, individuals with BP-II, MDD or anxiety disorders experienced greater increases in anxious mood than controls specifically following negative events. The BP-II group showed the greatest variability in mood states. Compared to controls, significantly increased variability was observed in BP-II and MDD groups for low and anxious moods, and in BP-I for anxious mood.

**Conclusion:** The findings suggest that mood variability is a nonspecific characteristic of diverse forms of psychopathology. However, the finding that people with BP-I have greater reactivity to positive events, whereas those with BP-II, MDD and anxiety have greater reactivity to negative events provides further support for distinguishing these subtypes. Future research is needed to examine whether reactivity patterns comprise an endophenotype that indexes heterogeneity of bipolar spectrum disorders.

## 45) Abstract 1568

# PSYCHOLOGICAL DISTRESS AND ANTIBODIES TO STRESS PROTEIN (ANTI-HSP60) IN VENEZUELA

Jose R. Pena, MD PhD, Internal Medicine, University of Carabobo, Valencia, Carabobo, Venezuela, Babette Weksler, MD, Internal Medicine-Hematology Oncology, Sabrina Islam, MD, Internal Medicine, Weill Cornell Medical College, New York, NY, Maria A. Lopez, Psy.D, Psychology, University of Carabobo, Valencia, Carabobo, Venezuela, Jose M. Poveda, MD PhD, Psychiatry, University Autonoma of Madrid, Madrid, Madrid, Spain

**Introduction/Background:** Research on socio-political conflicts has focused on the association between violence, psychological stress and health and Venezuela has been declared by Human Rights Watch and The American Organization of Estates as a country suffering of a Humanitarian Crisis. In stressed individuals antibodies to "Stress Proteins" or Heat Shock Proteins (Hsps) have been associated with atherogenesis, hypertension and coronary heart disease therefore we investigated the association of these antibodies (Anti-Hsp60) in a sample of men and women from Venezuela. **Method:** This is a quantitative transversal study of 117 healthy voluntary individuals, 53 men and 64 women, with age between 20 and 70 years old. Clinical exam, resting standard 12-lead ECG, routine laboratory tests, 2 psychosocial tests [the life event scale (Holmes) and the Stress Reactivity Index (SRI-32)] were performed, a serum sample was collected and frozen for determination of Anti-Hsp60. **Results:** 43% of individuals showed high psychological test scores, 44% of women and 40% of men showed high psychological test scores. The mean Anti-Hsp60 in High Psychological Test Scores Individuals was 330ng/ml versus 181ng/ml in Low Psychological Test Scores individuals (P<0.05). Pearson correlation showed a moderate tendency that the higher the Psychological Tests Scores the higher the Anti-Hsp60 concentration. **Conclusions:** Anti-Hsp60 titer could serve as markers of cardiovascular risk in these individuals with High Psychological Test Scores.

## 46) Abstract 1476

# THE MEDICAL INCAPACITY HOLD: A NOVEL HEALTHCARE POLICY ADDRESSING AN EXISTING GAP IN COMMITMENT STATUTES

Jonathan P. Heldt, MD, Sharlena Wilson, MD, Erick Cheung, MD, Psychiatry, UCLA, Los Angeles, CA

### Introduction

Inpatients with altered mental status often lack capacity to make informed healthcare decisions and are at risk of harm, disability, or death if they leave the hospital. Despite this, relevant statutes do not have provisions for involuntarily detaining a patient who lacks capacity. Instead, the only forms of civil commitment permitted are intended for patients with mental disorders, resulting in the inappropriate use of involuntary psychiatric holds (IPH) even in cases where no mental disorder is present. This study examines outcomes after a novel healthcare policy known as a medical incapacity hold (MIH), which permitted involuntary detainment of patients who lacked capacity to leave but did not meet probable cause for a mental disorder, was introduced.

### Methods

A retrospective chart review was conducted on all patients over the age of 18 placed on an IPH (n=64) at two academic medical centers over a 3-month period. These cases were then compared to all patients placed on an IPH (n=X) or a MIH (n=33*) over a 3-month period after the introduction of the MIH. The primary outcome compared was the frequency of inappropriate use of IPH in patients without probable cause of a mental illness. Statistical analysis was conducted using Microsoft Excel.

### Results

Prior to the MIH policy, 18.8% (12/64) patients were determined to have been placed on an IPH with minimal or no evidence of a mental disorder as the cause of their lack of capacity. The most common diagnoses necessitating the use of the MIH were delirium and substance withdrawal. The MIH policy resulted in a reduction in inappropriate use of IPH from 18.8% to Y%.

### Discussion

Our results demonstrated that inappropriate use of IPH decreased* after implementation of the MIH policy. Further improvements are expected with further dissemination of this policy to relevant departments. While this represents an improvement, it should be noted that the MIH in our study was a hospital policy rather than representing a change in law.
Further studies should be conducted to replicate these findings before proposing changes to relevant statutes.

Note: At the time of submission, only 2 months of data since the introduction of the MIH policy were available. Any numbers substituted by a letter or marked by * represent preliminary data based upon available information.

## Poster 47) WILL NOT BE PRESENTED

### 48) Abstract 1386

## ONLINE TREATMENTS FOR MOOD AND ANXIETY DISORDERS IN PRIMARY CARE: A RANDOMIZED CONTROLLED TRIAL

Bruce L. Rollman, MD, MPH, Bea Herbeck Belnap, DrBiolHum, Scott D. Rothenberger, PhD, Kaleab Z. Abebe, PhD, Internal Medicine, Armando J. Rotondi, PhD, Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, Jordan F. Karp, Professor, Psychiatry, University of Pittsburgh, Pittsburgh, PA

**Background:** Internet support groups (ISGs) that enable individuals with similar conditions to access and exchange self-help information and emotional support have proliferated, yet clinical trials have not established their benefit. Conversely, several computerized cognitive behavioral therapy (CCBT) programs have been proven effective at treating mood and anxiety disorders and used by hundreds of thousands of people outside the U.S., yet CCBT is largely unknown within the U.S.

**Methods:** Primary care physicians (PCPs) at 26 Pittsburgh-area practices referred patients to our trial via an EMR-generated prompt that launched when “depression”, “anxiety” or “panic” was entered as a visit diagnosis for patients aged 18-75. We randomized consenting patients with at least moderate levels of mood and/or anxiety symptoms (PHQ-9 or GAD-7 ≥10) and Internet access in a 3:3:1 ratio to either: (1) six months of care manager-guided access to the 8-session *Beating the Blues* CCBT program (CCBT-only); (2) CCBT-only plus access to a care manager-moderated ISG accessible via personal computer or smartphone (CCBT+ISG); or (3) their PCP’s “usual care” (UC). Blinded telephone assessors administered the PROMIS Depression and Anxiety Short Forms at baseline, 3-, 6- and 12-months follow-up.

**Results:** From 8/12-9/14, PCPs made 2,884 electronic referrals and 704 patients met all protocol-eligibility criteria and consented to randomization (301 CCBT-only, 302 CCBT+ISG, 101 UC); their baseline characteristics were similar by study arm (mean age: 42 years, 80% female, 82% White, mean PHQ-9: 13.3 (SD: 5.0) and GAD-7: 12.9 (4.4)). At 6-months, 86% of all patients with CCBT access started the program and 37% completed all 8 sessions (mean sessions completed: 5.4); 75% of CCBT+ISG patients logged into the ISG at least once, and 46% commented at least once (mean: 9.5). Compared to UC, CCBT-only patients reported 6-month improvements in mood (effect size (ES): 0.31; P=0.006) and anxiety symptoms (ES: 0.26; P=0.02) that increased with program engagement (ES mood, completed: ≥4 sessions, 0.41; all 8 sessions, 0.52) and persisted 6 months later. Moreover, ES improvements for CCBT+ISG vs CCBT-only patients were similar.

**Conclusion:** Providing care manager-supported CCBT to depressed and anxious primary care patients is an effective and durable strategy for providing mental health care at scale.

### 49) Abstract 1571

## INTERDISCIPLINARY PAIN REHABILITATION FOR YOUNG ADULTS: PRELIMINARY FINDINGS OF A NOVEL PILOT PROGRAM

Eleshia J. Morrison, PhD, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, Larissa L. Loukianova, MD, PhD, Jeannie A. Sperry, PhD, Psychiatry and Psychology, Tracy E. Harrison, MD,

Anesthesiology, Wesley P. Gilliam, PhD, Cynthia Harbeck-Weber, PhD, Psychiatry and Psychology, Mayo Clinic, Rochester, MN

Introduction: Comprehensive interdisciplinary pain rehabilitation programs for adult and pediatric populations demonstrate significant pain-related and quality of life outcomes; however these programs are not tailored to the unique psychosocial and functional needs of young adults. The present study provides preliminary results of a pilot program tailored to the needs of young adults with chronic pain and associated symptoms. Methods: Participants were consecutive patients of an outpatient interdisciplinary pain rehabilitation program based on cognitive-behavioral principles, which included daily occupational and physical therapy. Novel programming components included individualized vocational assessment and counseling, financial planning, sexual health, and skills training for parents. Inclusion criteria were ages 19 to 29; completion of high school; and functional or financial dependence on parents. Patients completed a computerized survey at admission and program completion. Analyses examined pre- versus post-treatment differences in measures of pain (MPI, PCS), quality of life (SF-36), and depressive symptoms (CES-D). Prospective data will be collected at 3 and 6 months post-treatment. Results: Participants (N=31) had a mean age of 21 years (range: 18-26) and were predominantly female (88.6%). Generalized pain was the most common diagnosis (17.4%), followed by abdominal pain, headache/migraine, and POTS (all 13.0%). 60.8% noted secondary pain/symptoms, the most common of which were fatigue and POTS-like symptoms (both 21.4%). Mean duration of pain/symptoms was 6.5 years (range: 0.5-14). Results demonstrate significant improvements at program completion. Participants reported reduced pain severity (t(30)=4.85, d=.87), pain interference (t(30)=6.78, d=1.22), pain catastrophizing (t(30)=7.53, d=1.35), and depressive symptoms (t(30)=5.44, d=.98) (all ps<.001), as well as improvements in mental (t(30)=-9.80, d=-1.76) and physical (t(30)= 10.20, d=-1.83) quality of life. Conclusion: Findings demonstrate the clinical success of a pain rehabilitation program tailored to young adults to significantly reduce pain-related outcomes and depressive symptoms, and improve quality of life. Programming tailored to the needs of this age group may mitigate the otherwise negative impact of chronic pain and symptoms on young adults' functional and psychosocial well-being.

### 50) Abstract 1006

## DISTRESS IN A LONGITUDINAL STUDY OF A POPULATION WITH NONSPECIFIC LOW BACK PAIN

Anne-Kathrin Puschmann, PhD, Sociology of Physical Activity and Health, University of Potsdam, Potsdam, Brandenburg, Germany, Heidrun Beck, MD, University Hospital Carl Gustav Carus, TU Dresden University, Dresden, Sachsen, Germany, Marcus Schiltenwolf, Prof., Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany, Pia-Maria Wippert, Prof., Sociology of Physical Activity of Health, Frank Mayer, Prof., Sport Medicine Outpatient Clinic, University of Potsdam, Potsdam, Brandenburg, Germany

**Background:** As chronic low back pain (LBP) is one of the greater burdens of health care systems in the industrialized nations, the German national research network for Medicine in Spine Exercise (MiSpEx) was founded to clarify aspects of LBP development and treatment using an interdisciplinary approach that includes a social science perspective. One longitudinal study conducted by the network aimed at finding out more about the physiological and psycho-social risk factors for LBP and their development over time. One of the main psychosocial risk factors is stress and chronic stress. One difficulty is to define the kind of stress which influences LBP development. Another question concerns the stability or variability over time, which influences the pain predictions in later analyses.

**Methods:** Over a time frame of 2 years N=1048 participants were included at 7 measurement points between 2012 and 2014. Both psychosocial factors and biomechanical as well as medical parameters were assessed, respectively. Chronic pain was assessed through the
Chronic Pain Grade questionnaire. Psychosocial stress was evaluated in a broad manner: perceived stress, chronic stress experiences, vital exhaustion and life event stress. Furthermore, self-efficacy was assessed. To be able to estimate the stability over time, ANOVA with repeated measures were conducted for each of the stress measures. To assess the predictive strength regression analyses were conducted.

**Results:** It could be shown that some aspects of stress, especially chronic stress experiences, show the required stability that makes them useful predictors for LBP development. Further, the stress variables serve as predictors for LBP over a time period of up to 2 years.

**Conclusion:** The reported 2-year observation shows the difficulty of assessing stress as a Yellow Flag risk factor for the development of LBP. It points out the caution researchers should have in the election of their psychometric measurements, since some of them might change over time due to third unknown individual processes. One of these might be the occurrence of critical life events. Additional moderating factors which influence both stress and pain should be taken into account, such as physical activity and social support.

## 51) Abstract 1107

### SLOWLY REPEATED EVOKED PAIN (SREP) PROTOCOL VERSUS PAIN THRESHOLD AND TOLERANCE AS PAIN EVOKED MEASURES IN FIBROMYALGIA: ASSOCIATIONS WITH CLINICAL-PSYCHOLOGICAL FACTORS.

Pablo de la Coba, Research Assistant - Psy, Carmen M. Gálvez-Sánchez, Research Assistant - Psy, Psychology, University of Jaén, Jaén, Jaén, SPAIN, Stephen Bruehl, Professor of Anesthesiol, Anesthesiology, Vanderbilt University. School of Medicine, Nashville, TN, Tennessee, Gustavo A. Reyes del Paso, Professor of Psychology, Psychology, University of Jaén, Jaén, Jaén, SPAIN

**Introduction.** The pathophysiology of fibromyalgia (FM) has been related to central pain sensitization. Traditional pain evoked measures (threshold and tolerance) indicate this sensitization, but these indices are influenced by individual pain sensitivity and emotional-cognitive factors. Our novel index Slowly Repeated Evoked Pain (SREP) protocol appeared as a potential marker of pain sensitization and FM status.

**Objective.** To examine the association between SREP and some clinical-psychological factors, in comparison with associations with pain threshold and tolerance.

**Method.** Twenty-four FM patients and 24 healthy females were interviewed to measure clinical pain, fatigue, catastrophizing, anxiety and depression. The SREP protocol consisted of a single series of nine low intensity pressure stimuli in the left third finger nail of 5s duration and 30s inter-stimulus interval. SREP sensitization was quantified as the difference between 9th and 1st painful stimulus. Subjective evoked pain intensity was assessed with a visual analogical scale. Pain threshold/tolerance was measured by pressure algometry in the same localization.

**Results.** Lower pain threshold and tolerance were observed in FM than healthy participants. SREP sensitization was observed in FM, but not in healthy subjects. Pain threshold and tolerance was not associated with SREP. SREP was more strongly associated with the sensory dimension of clinical pain than were pain threshold or tolerance. Regarding emotional-related aspects, higher fatigue and catastrophizing were associated to lower pain threshold and tolerance, and with higher SREP. On the other hand, higher anxiety was only related to lower pain threshold and tolerance, but not to SREP.

**Conclusions.** SREP was more predictive of overall clinical pain and specifically of the sensorial dimension of pain than were threshold or tolerance. SREP could have different underlying factors and seems to be associated with different clinical-psychological factors than threshold or tolerance. We concluded that the SREP protocol is a useful clinical marker in FM probably related to central sensitization that could have utility as an index of FM's pathophysiology status.

<table><caption>**Table 1.** Correlations between Slowly Repeated Evoked Pain (SREP), pain threshold and tolerance, and clinical-psychological factors for fibromyalgia patients.</caption><thead><tr><th>Clinical-<br>Psychological<br>Factors</th><th>SREP</th><th>Threshold</th><th>Tolerance</th></tr></thead><tbody><tr><td>Sensorial pain</td><td>0.63**</td><td>0.13</td><td>-0.14</td></tr><tr><td>Evaluative pain</td><td>0.16</td><td>-0.46*</td><td>-0.54**</td></tr><tr><td>Emotional pain</td><td>0.54**</td><td>-0.35</td><td>-0.48*</td></tr><tr><td>Total McGill<br>Score</td><td>0.68**</td><td>-0.09</td><td>-0.40</td></tr><tr><td>Fatigue</td><td>0.43*</td><td>-0.45*</td><td>-0.48**</td></tr><tr><td>Anxiety</td><td>0.11</td><td>-0.46*</td><td>-0.50*</td></tr><tr><td>Depression</td><td>0.40*</td><td>-0.31</td><td>-0.45*</td></tr><tr><td>Catastrophizing</td><td>0.44*</td><td>-0.43*</td><td>-0.60**</td></tr></tbody></table>

## 52) Abstract 1617

### THE MODERATING ROLE OF PAIN IN THE ASSOCIATIONS BETWEEN ALCOHOL USE AND DEPRESSIVE/ANXIETY SYMPTOMS AMONG LATINOS IN PRIMARY CARE

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

**Background:** Depression and anxiety are common mental health problems among Latinos in primary care. Although past work has shown that alcohol use co-occurs with anxiety and depression among Latinos, little work has examined variable that qualify such associations. The present investigation sought to address whether pain severity moderated relations between pain intensity/pain-related disability and depressive/anxious arousal symptoms among an economically disadvantaged Latino sample recruited from a primary care medical setting. **Methods:** Participants included 253 adult Latinos ($M_{age}=38.5$ years, $SD=10.8$; 86.6% female) who attended a community-based primary care clinic. **Results:** There was a significant interaction of hazardous drinking with pain intensity in relation to depressive symptoms and significant interactions of hazardous drinking and pain-related disability in relation to depressive and anxious arousal symptoms. Specifically, hazardous drinking was associated with more severe depressive/anxious arousal symptoms only when pain intensity/disability was high. **Conclusions:** This is the first study to demonstrate the moderating role of pain severity in hazardous drinking-affective associations among Latinos in a primary care medical setting. Future work is needed to develop and examine targeted interventions among the Latino population who experience severe pain and report hazardous drinking in an effort to reduce symptoms of anxiety and depression.

## 53) Abstract 1559

### DISENTANGLING THE RELATIONSHIPS AMONGST SOMATIZATION, PAIN SEVERITY, AND KINESIOPHOBIA IN ADULTS WITH SICKLE CELL DISEASE

David Gray, B.A., Erica Brooks, M.A., Amy E. Kupper, Ph.D., Miriam Feliu, Psy.D., Mary Wood, M.A., Camela Barker, M.A., Christopher L. Edwards, Ph.D., Psychiatry, Duke University Medical Center, Durham, NC

<footnote>*p <.05; **p <.01.</footnote>
Sickle cell disease (SCD) is the most common blood disorder, affecting over seven million individuals worldwide. Pain crises are the most common complication of SCD, and can be variable and unpredictable. Research has found that in individuals with SCD, somatization and kinesiophobia (fear of movement) are commonly experienced and are linked to poorer treatment outcomes. Presently, the nature of these relationships is unclear and warrants further investigation. The aim of the current study was to disentangle the relationships amongst pain severity, somatization, and kinesiophobia in adult African Americans with SCD as well as to extend our understanding of previous findings (Pells et al., 2007). First, we hypothesized that pain severity would significantly predict somatization. Second, we hypothesized that kinesiophobia would mediate the relationship between pain severity and somatization. Cross-sectional survey data collected as part of a five-year, IRB-approved, longitudinal study, of medical and psychosocial factors in SCD were used. Ninety-eight individuals with SCD were included in the analyses. Pain severity was found to significantly predict somatization, *b* = .31, *t* = 5.03, *p* < .001. There was a significant indirect effect of kinesiophobia on the relationship between pain severity on somatization, *b* = .028, BCa CI [.002, .080]. This represents a relatively small effect, *β*² = .041, 95% BCa CI [.003, .118]. As such, kinesiophobia may be a small but meaningful mediator. These findings imply that kinesiophobia plays a role in the relationship between pain severity and somatization. The findings suggest that interventions that target kinesiophobia might be associated with decreased presence of somatization. Future research should examine the role of somatization and kinesiophobia in this context further to disentangle these relationships.

## 54) Abstract 1635

# DIFFERENCES IN CARDIAC VAGAL ACTIVITY BETWEEN HEALTHY CONTROLS AND CHRONIC PELVIC PAIN PATIENTS IN RESPONSE TO A LABORATORY PSYCHOLOGICAL STRESSOR

DeWayne P. Williams, MA, Psychology, The Ohio State University, Columbus, Ohio, Jeffrey Janata, PhD, Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, Gisela Chelimsky, MD, Pediatrics, Medical College of Wisconsin, Milwaukee, WI, Kathy Pajer, MD, Psychiatry, Childrens Hospital of Eastern Ontario, Ottawa, Ontario, Canada, Julian F. Thayer, PhD, Psychology, The Ohio State University, Columbus, Ohio, Thomas Chelimsky, MD, Neurology, Medical College of Wisconsin, Milwaukee, WI

Recent research evidence suggests that patients with chronic pelvic pain (CPP), specifically Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) and/or myofascial pelvic pain (MPP), can demonstrate an aberrant stress response. For example, one study found that individuals with CPP (e.g., IC/BPS) demonstrated lower vmHRV, an index of healthy autonomic function and overall health, both at rest and in response to a physiological stressor compared to healthy controls. However, research has not yet evaluated differences in vmHRV responses to a psychological stressor between healthy controls and CPP patients. Thus, the following preliminary study sought to explore differences between healthy controls' and CPP patients' vmHRV in response to the Trier Social Stress Test (TSST). Participants included healthy controls (n = 9), and subjects with IC/BPS and/or MPP (CPP group, n = 9). Using an ambulatory heart rate monitor, continuous data were collected while participants completed a 5-minute baseline period followed by the TSST; participants first prepared a speech (5-minutes), followed by the presentation of their speech to a panel of emotionally neutral judges. Following the speech, subjects perform serial subtraction aloud to panel of judges for 5-minutes. Anxiety was indexed using the Spielberger State Anxiety Inventory at baseline, following the math test, and following the end of the experiment. The root mean square of successive differences (natural log transformed) was calculated and used as an index of vmHRV. Results showed that in

CPP patients only, anxiety levels increased from baseline to the task, and returned to baseline levels (F (1,8) = 13.77, *p* = .006). Preplanned contrasts showed a significant quadratic trend (F (1,15) = 4.93, *p* = .042) in the CPP group, such that vmHRV decreased from baseline to the interview, and return to baseline levels during the math test. In contrast, the healthy controls showed no significant linear or quadratic trends in either anxiety or vmHRV trends throughout the experiment. These data suggest that patients in the CPP group showed poorer self-regulation, as indexed by decreased vmHRV and increased anxiety, during the TSST compared to healthy controls. In combination with previous research, the current study suggests that CPP patients may experience maladaptive responses to both physiological and psychological stressors.

## 55) Abstract 1326

# PAIN AND THE POSITIVITY EFFECT: HOW ACUTE PAIN INFLUENCES RECALL, RECOGNITION, AND RESPONSE TIME TOWARD POSITIVE IMAGES IN OLDER AND YOUNGER ADULTS

Ian A. Boggero, M.S., Suzanne C. Segerstrom, Ph.D., Psychology, University of Kentucky, Lexington, KY

The positivity effect refers to the tendency to favor positive over negative stimuli and can be assessed by measuring how well people recall, recognize, and quickly respond to stimuli of positive or negative valence. Socioemotional selectivity theory posits that as people age, they become increasingly likely to demonstrate the positivity effect, because they become more motivated to maximize positive emotions and minimize negative ones. Yet, pain can threaten positivity. The threat is particularly relevant for the 70% of older adults who report experiencing physical pain within the previous month. It was hypothesized that older adults would recall, recognize, and respond faster to positive images following pain than younger adults. Forty-eight older (ages 18-28) and 48 younger (ages 65-84) pain-free adults underwent a pain-free and a painful task where they were asked to submerge their non-dominant hand in room temperature (71.6°F) or cold (39.2°F) water for one minute, respectively. Immediately after each hand submersion, they were asked to recall, recognize, and respond to previously-seen neutral, negative, and positive images. A within-subject design was used, so that each participant experienced both the pain-free and painful task in counterbalanced order. With regard to recall, older adults remembered significantly fewer negative pictures than younger adults (*t*(98) = 3.18, *p* = .002) but did not differ from younger adults in recall of positive (*t*(98) = 0.73, *p* = .46) or neutral pictures (*t*(98) = 0.46, *p* = .65). With regard to recognition, after experiencing pain, both older and younger adults were marginally more willing to judge a negative picture as having been previously seen (*t*(97) = 1.79, *p* = .08). With regard to latency, older adults took significantly longer than younger adults to recognize negative images (age x valence interaction, *t*(97) = 7.40, *p* < .001). The hypothesized three-way interaction of age group x pain condition x valence was not found for any of the three outcomes. The strategies older and younger adults use to maintain positivity in the face of pain may be similar in nature. Future research should investigate whether older adults have additional strategies that allow them to counteract the negativity of frequent pain, and if so, test whether those strategies can be applied to others experiencing acute pain.

## 56) Abstract 1007

# THE EFFECTS OF A NEW PRACTICAL AND SYNERGETIC MULTIMODAL TREATMENT FOR CHRONIC BACK PAIN ON PAIN-RELATED COGNITIONS AND WELLBEING

Jessica De Witt Huberts, PhD, Sociology of Physical Activity and Health, University of Potsdam, Potsdam, Brandenburg, Germany, Daniel Niederer, PhD, Sports Medicine, Goethe University Frankfurt, Frankfurt, Nordrhein-Westfalen, Germany, Pia-Maria Wippert, Prof., Sociology of Physical Activity of Health, Frank Mayer, Prof., Sport
Medicine Outpatient Clinic, University of Potsdam, Potsdam, Brandenburg, Germany

**Introduction:** Chronic back pain (CBP) can be best described as an interaction between biological, psychological and social processes. However, to date, multimodal intervention programs for CBP that target all three aetiological factors have demonstrated limited effectiveness. This lack of supportive evidence could be due to the fact that few programs are suitable for long-term and unsupervised use in everyday life. Moreover, in combining the elements from various therapies, little attention has been paid to the mechanisms underlying the synergistic effects of the separate components. A new multimodal intervention that addressed these limitations was developed and tested in a Randomised Controlled Trial (RCT).

**Methods:** A total of 660 participants participated in one of the three treatment groups (Control: n= 216, Unimodal: n= 222, Multimodal: n= 222). In the two treatment groups, 3 weeks of center-based training was followed by 9 weeks of unsupervised home-based training. In the multimodal treatment the sensorimotor training of the unimodal treatment was supplemented with specifically selected cognitive-behavioral and psycho-physiological techniques. Pain and pain-relevant psychosocial factors were assessed 5 times over a 6-month period. Here the effects of the intervention on pain-related cognitions and general wellbeing will be presented.

**Results:** After the center-based phase both interventions were more effective than the no-intervention control arm in reducing pain-related cognitions as well as anxiety and depression, yet no difference was observed between the unimodal and multimodal groups. However, during the home-based training these changes were sustained or reduced further in the multimodal group compared to the unimodal and control group, suggesting that the multimodal program has a sustainable impact on pain related cognitions and wellbeing.

**Discussion:** The RCT indicated that the newly developed multimodal treatment for LBC was practical and had more sustainable effects on pain-related cognitions and wellbeing than a unimodal treatment. The unique contents of the multimodal intervention in relation to the outcomes will be discussed.

## 57) Abstract 1203

# PAINFUL EMOTIONS? PROCESSING OF EMOTIONAL FACES IN PATIENTS WITH CHRONIC PAIN DISORDER: AN EYE TRACKING STUDY

Katrin Giel, Prof. Dr., Psychosomatic Medicine and Psychotherapy, University Tübingen, Tübingen, Baden-Württemberg, Germany, Sarah Paganini, Dipl. Psych., Psychology, University Freiburg, Freiburg, Baden-Württemberg, Germany, Irena Schank, Dipl. Psych., Psychosomatic Medicine and Psychotherapy, Paul Enck, Prof., Psychosomatic Medicine and Psychotherapy, Stephan Zipfel, Prof. Dr., Florian Junne, Dr., Psychosomatic Medicine and Psychotherapy, University Tübingen, Tübingen, Baden-Württemberg, Germany

**Background:** Problems in emotion processing potentially contribute to the development and maintenance of chronic pain. These difficulties might also become evident in attentional processing of emotional information.

**Method:** We assessed self-reported alexithymia, attentional orienting to and maintenance on emotional stimuli using eye tracking in 17 patients with chronic pain disorder (CP) and two age- and sex-matched control groups, 17 healthy individuals (HC) and 17 individuals who were matched according to depressive symptoms (DC). In a choice viewing paradigm, a dot indicated the position of the emotional picture in the next trial to allow for strategic attention deployment. Picture pairs consisted of a happy or sad facial expression and a neutral facial expression of the same individual. Participants were asked to explore picture pairs freely.

**Results:** CP and DC groups reported higher alexithymia than the HC group. HC showed a previously reported emotionality bias by preferentially orienting to the emotional face and preferentially maintaining on the happy face. CP and DC participants showed no

facilitated early attention to sad facial expressions, and DC participants showed no facilitated early attention to happy facial expressions. We found no group differences in attentional maintenance.

**Conclusion:** Our findings are in line with the clinical large overlap between pain and depression. The blunted initial reaction to sadness could be interpreted as a failure of the attentional system to attend to evolutionary salient, potentially rewarding emotional stimuli or as an attempt to suppress negative emotions. These difficulties in emotion processing might contribute to etiology or maintenance of chronic pain and depression.

## 58) Abstract 1625

# A MULTI-DIMENSIONAL MODEL OF MENTAL HEALTH IN ADULTS WITH CHRONIC PAIN

Miriam H. Feliu, Psy.D., LaBarron H. Hill, Ph.D, Keisha O'Garo, Psy.D., Amy Kupper, Ph.D., Risa Long, MA, Christopher L. Edwards, Ph.D., Psychiatry, Duke University Medical Center, Durham, North Carolina

Chronic pain has been defined as pain that persist past the normal time of healing, usually more than three months. Patients experiencing unrelenting pain are more likely to develop psychiatric co-morbidities including depression, anxiety and sleep disturbances, which adversely impact their ability to manage pain effectively. In addition, the growing epidemic of medication misuse and associated addiction, accidental overdose and increased rates of mortality have spurred attention to the need for mental health providers to more effectively identify at-risk patients and provide alternative modes of treatment and long-term care. While there is consensus that a multidisciplinary approach is the gold standard in pain management; there is considerable variation in the composition of patient management teams and methodologies used to derive and implement treatment recommendations. We propose a comprehensive, empirically-based, multidimensional model for patient risk assessment and treatment currently implemented in the outpatient chronic pain management psychology clinic as part of a multidisciplinary pain clinic at a major academic medical center in the Southeast US. Based on the biopsychosocial model of pain, the multidimensional approach spans multiple domains including: 1) Psychosocial Assessment/Evaluation, 2) Crisis Intervention, 3) Consultation Liaison, 4) Staffing, 5) Treatment (i.e. psychotherapy, behavioral pain management and coping skills training, Biofeedback), 6) Referral, 7) Teaching/Training and 8) Research and Implementation. A primary outcome of this model is the integration of information across domains to derive a risk level, assigning a rank of 1-4 corresponding to treatment recommendations including suitability for chronic opioid management and surgical considerations for neuromodulation with implantable devices and/or targeted drug delivery systems. Advances in the field of pain have guided changes in standards of practice in primary care settings and other specialties. Given the inherent complexities involved in safely and effectively treating chronic pain, we propose that this comprehensive model assessing eight dimensions and four levels of functioning, may provide a defined structure for integrated care of chronic pain patients for medical psychologists and other providers working as part of a multidisciplinary pain management team.

## 59) Abstract 1513

# CLINICAL CHARACTERISTICS OF PATIENTS SEEN BY A CHILD PSYCHIATRIST EMBEDED IN AN OUTPATIENT MULTIDISCIPLINARY PEDIATRIC CHRONIC PAIN CLINIC.

Monique Ribeiro, MD, Psychiatry, Harvard Medical School, Boston, MA, Kimberly Lobo, MS, MPH, Anesthesiology and Preoperative Medicine, Boston Children's Hospital, Boston, MA, Patricia Ibeziako, MD, Deirdre Logan, PhD, Psychiatry, Charles Berde, MD, PHD, Anesthesia, Harvard Medical School, Boston, MA

**Background:** In general pediatric practice, chronic pain is reported by 2/3 of school-age children, while 6% report daily pain lasting 3 months
or longer.¹Pediatric chronic pain is associated with significant functional impairment, poor quality of life, and increased risk for psychopathology, including a somatic symptom disorder.² Physical rehabilitation and cognitive-behavioral therapy are evidence based treatments. Informal survey of pediatric pain clinics in the U.S. shows that they commonly involve psychologists, but rarely involve psychiatrists. We describe demographic and clinical characteristics of patients seen by a part-time psychiatrist embedded in a multidisciplinary pediatric pain service which includes 4 psychologists who regularly perform initial evaluations. Methods: We conducted a retrospective clinical database review of patients seen by a pain clinic at a tertiary pediatric academic center from 2012–2016. Primary outcomes included measures of functional disability, anxiety, and depression including CDI-2, FDI, RCMAS-2, PedsQL, PCS, CSI, and FOPQ. Psychological inventories and demographics were compared between patients referred to a psychiatrist versus those who were not referred. Wilcoxon's Rank Sum tests were used for between-group comparisons; significance was determined at p<0.05.

**Results:** Of the 976 patients seen at the clinic, 45 were referred to the psychiatrist. The majority of these patients were female (80%) with a mean age of 15 years. Overall, patients seen by the psychiatrist had significantly higher scores for depression (p=0.01), anxiety (p=0.02), somatic complaints (p=0.05) and fear of pain (p=0.02), as well as poorer quality of life (p=0.03).

**Conclusion:** Children with chronic pain are a vulnerable population. A subset of patients with comorbid psychiatric conditions and more severe impairment and disability will benefit from ready access to psychiatric evaluation and management. Pediatric pain clinics should consider staffing models that include a psychiatrist in an integrated care model. 1. Rask, C.U., et al., Functional somatic symptoms and associated impairment in 5-7-year-old children: the Copenhagen Child Cohort 2000. Eur J Epidemiol, 2009. 24(10): p. 625-34. 2. Santalahti, P., et al., Have there been changes in children's psychosomatic symptoms? A 10-year comparison from Finland. Pediatrics, 2005. 115(4): p. e434-42.

## 60) Abstract 1536

# IS FLOURISHING A RESILIENCY FACTOR IN CARDIOVASCULAR DISEASE RISK AMONG AFRICAN AMERICANS? PRELIMINARY FINDINGS

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

Amid growing acknowledgement of the importance of psychosocial factors in exacerbating the risk and impact of cardiovascular disease (CVD) among African Americans, there is a need to identify factors which may be protective of mental and physical health. Flourishing, a state of positive mental health characterized by high levels of psychological, emotional, and social well-being, has been associated with a decreased risk of CVD mortality. Given the disparate CVD burden faced by African Americans, our aim in the present study was to examine the potential association between flourishing and subclinical CVD risk in a sample (N=63) of African American emerging adults (mean age = 21.9 ± 5.5, 66% female). Cardiovascular functioning was determined via baseline assessments of blood pressure (BP). Anthropometric data (i.e. body mass index and waist circumference) and self-reported physical activity were also obtained. Flourishing was assessed using the Mental Health Continuum- Short-Form (MHC-SF) which yields categories (i.e. Languishing, Moderate and Flourishing) describing current mental health status. Approximately 50% of the sample met criteria for flourishing; while 40.3% and 9.7% of participants were classified as having moderate or languishing mental health, respectively. Separate general linear models revealed no differences in systolic BP or anthropometric data as a function of flourishing status. However, there was a significant main effect of

flourishing on diastolic blood pressure (DBP) and physical activity (p's <.05). Flourishers endorsed higher levels of physical activity compared with moderates and languishers. Moreover, individuals classified as having flourishing or moderate mental health exhibited lower DBP compared to individuals with languishing mental health, and this pattern was enhanced when accounting for differences in physical activity. Previous research has suggested that African Americans may possess a modest mental health advantage due to greater-than-average levels of flourishing. Although preliminary, our findings provide initial evidence indicating that this benefit may extend to cardiovascular functioning among African American emerging adults. Additional research is needed to determine whether flourishing is associated with lower CVD risk across the lifecourse among African Americans and other groups affected by CVD disparities.

## 61) Abstract 1034

# CORTISOL DAY PROFILES IN PATIENTS WITH STABLE CORONARY HEART DISEASE AND ASSOCIATIONS WITH ANXIETY - DATA FROM THE SPIRR-CAD TRIAL

Cora S. Weber, PD MD, Psychosomatic Medicine, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany, Matthias Michal, Professor, Dept. of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Hessen, Germany, Joram Ronel, MD, Dept. of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Bavaria, Germany, Karl-Heinz Ladwig, Professor, Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, Neuherberg, Bavaria, Germany, Christoph Herrmann-Lingen, Professor, Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Hessen, Germany, Christian Albus, Professor, Dept. of Psychosomatics and Psychotherapy, University of Cologne, Cologne, NRW, Germany, Kristina Orth-Gomer, Professor, Dept. of Clinical Neuroscience, Karolinska Institutet, Stockholm, Stockholm, Sweden, Matthias Rose, Professor, Hans C. Deter, Professor, Psychosomatic Medicine, Charité Campus Benjamin Franklin, Berlin, Berlin, Germany

Introduction: Anxiety has been posited as an independent risk factor for incident coronary heart disease (CHD) and CHD mortality. The cortisol awakening reaction (CAR) has been widely used as a distinct indicator of HPA axis functioning. In a previous study, higher anxiety values were associated with a higher total cortisol output within the first hour of awakening (area under the curve with respect to ground, AUCg) and a nonsignificant trend towards a more pronounced increase within the first 30 min of awakening (area under the curve with respect to increase, AUCi). We aimed to check these associations in a subsample from the German multicenter SPIRR-CAD trial.

**Methods:**

In 87 CHD patients (59 (SD 8) y, 18 f) from the SPIRR-CAD study sample (HADS depression score >7) complete saliva sets were available. Samples were collected following a standardized sampling protocol (+0, +30, +45, +60 min after awakening). Cortisol was measured via radioimmunoassay. AUCg and AUCi were computed using standardized formulas. Anxiety was measured using the HADS. Patients were grouped following the cut-off (>10 vs 10 and below).

**Results:**

Repeated measures ANOVA (4 steps, 2 groups) yielded a significant time effect (F[df2.271]=10.370; p<0.0001) and a significant quadratic time effect (F[df1]=25.854; p<0.0001) referring to the typical CAR with steep increase of cortisol levels within the first 30 min of awakening. There was a significant time by group interaction (F[df3.963]=3.963; p=0.017) referring to a steeper increase in the anxious group.

AUCi was significantly higher in the anxious patients (F[df1]=5.089; p=0.027).

High anxiety subjects showed significantly lower cortisol levels compared to the high anxiety subjects at +0 min (9.3 (SD 5.4) vs 13.6 (SD 8.5) nmol/l; (F[df1]=7.141; p=0.009).
Conclusion:

Our data suggest a steeper increase of cortisol within the first 30 min of
awakening (AUCi) in anxious CHD patients but no difference in the
total cortisol output (AUCg). These findings are backed by the
literature but do not fully replicate our previous findings. Limitations
are a) preselection of depressed CHD patients (HADS depression score
>7) and b) singular sampling (one day). Therefore findings cannot be
regarded as representative. However, anxiety as a substrate of
psychosocial stress may be mirrored by a distorted HPA axis
functioning.

## 62) Abstract 1524

### EFFECTS OF VERBAL SUGGESTIONS ON PSYCHOSOCIAL PARAMETER IN FEMALE PATIENTS WITH STRESS-INDUCED CARDIOMYOPATHY

Elisabeth Olliges, M.Sc., Medical Psychology, Ludwig-Maximilians University, Munich, Bayern, Germany, Simon Schneider, Dr. med., Schmidt Georg, Prof. Dr. med., Alexander Mueller, Dipl.-Ing., Cardiology, Technical University, Munich, Munich, Bavaria, Germany, Christof Burgdorf, PD Dr. med., Cardiology, Herz- und Gefaesszentrum, Bad Bevensen, Bad Bevensen, Niedersachsen, Germany, Joram Ronel, Dr. med., Psychosomatics, Technical University, Munich, Munich, Bavaria, Germany, Karin Meissner, Professor, Dr. med., Medical Psychology, Ludwig-Maximilians University, Munich, Bavaria, Germany

Placebo and nocebo effects are conceptualized as clinical outcomes of positive respectively negative expectations towards a treatment. Outcome expectations can be elicited by verbal suggestions, accompanying drug delivery. The present study aimed to investigate placebo and nocebo effects in patients who experienced a Stress-induced-Cardiomyopathy (SCM) as compared to catheter-confirmed heart-healthy individuals. The etiology of SCM – a very rare, reversible, and acquired form of primary myocardial disorders – is not yet fully explained. Preceding, extremely stressful events are supposed to be triggers and an exaggerated, inadequate activation of the sympathetic nervous system is discussed to be of key importance. Hence, one may assume that the cardiological regulation of patients diagnosed with SCM differs from that of heart-healthy individuals.

Within this randomized, single-blind experiment, 20 patients with a history of SCM and 20 catheter-confirmed heart-healthy individuals were examined in a single session. After a baseline period, saline solution (NaCl) was successively administered three times in combination with either neutral, positive, or negative verbal suggestions that the given substance (NaCl) would either support or burden the heart, or would cause no changes. Numeric stress ratings and blood samples (copeptin, cortisol) were repeatedly obtained, and the electrocardiogram was continuously assessed.

Results revealed nocebo effects on subjective stress levels and heart rate, with no differences between SCM patients and heart-healthy individuals. There was a significant increase in stress after the negative suggestion as compared to both other conditions (p < .001). Correspondingly, the mean heart rate showed no group difference, but a statistical trend for increase after negative suggestions as compared to positive ones (p= .06). Analysis of heartrate variability and hormonal correlates did not reveal any statistically significant results and positive verbal suggestions had no beneficial effects.

In conclusion, the hypothesis that SCM-patients are generally more vulnerable for aversive stimuli, represented here in form of a nocebo treatment, received no support by the present results.

## 63) Abstract 1022

### EFFECTS OF A 1-DAY INTERVENTION ON ANXIETY AND VASCULAR DYSFUNCTION

Lilian Dindo, PhD, Psychiatry and behavioral sciences, Baylor College of Medicine, Houston, Texas, Jess Fiedorowicz, MD, Psychiatry, Gary Pierce, MD, Internal Medicine, University of Iowa, Iowa City, IA

**Background:** Anxiety is commonly present in those at risk for vascular disease and independently contributes to risk of vascular events, morbidity, and mortality. Yet, anxiety is an underappreciated risk factor and effective treatments have rarely been investigated. Acceptance and Commitment Therapy (ACT) is an empirically supported behavioral therapy that incorporates acceptance and mindfulness strategies with behavioral change modalities. ACT is effective in treating depression and anxiety which are common in patients with cardiovascular disease, as well as illnesses like chronic pain. Importantly, when presented as a brief intervention, ACT has resulted in positive long-term outcomes. **Objective:** To examine the efficacy of a 1-day (6-hour) Acceptance and Commitment Training group workshop (ACT) compared to Treatment as Usual (TAU) on forearm blood flow and on anxiety symptoms. **Method:** 55 patients with significant anxiety were randomly assigned to an 1-day ACT workshop or to Treatment as Usual (TAU). Assessment of anxiety and blood vessel flow were completed prior to the workshop and 3 months following the workshop. **Results:** At the 3-month follow up, participants in the ACT condition exhibited significantly improved forearm blood flow (p < .05) and significantly greater improvements in anxiety symptoms (p < .01) than patients in the TAU group. **Conclusion:** A 1-day ACT workshop is a promising approach for the treatment of anxiety and may improve vascular disease risk factors. Brief interventions, such as the 1-day intervention developed for this study, offer the potential for optimal treatment adherence, participant acceptability, and broad dissemination.

## 64) Abstract 1028

### WE GOT THE BEAT: LOWER SLEEP-WAKE RHYTHMICITY IS ASSOCIATED WITH LARGER BRACHIAL ARTERY DIAMETER

Marissa A. Bowman, BA, Psychology, Stephen F. Smagula, PhD, Ryan C. Brindle, PhD, Psychiatry, Christopher E. Kline, PhD, Health and Physical Activity, Suresh R. Mulukutla, MD, Cardiology, Robert R. Krafty, PhD, Biostatistics, Ellen Frank, PhD, David J. Kupfer, MD, Psychiatry, University of Pittsburgh, Pittsburgh, PA, Julian F. Thayer, PhD, Psychology, Ohio State University, Columbus, OH, Martica H. Hall, PhD, Psychiatry, University of Pittsburgh, Pittsburgh, PA

Psychosomatic medicine has demonstrated that psychological, social, and behavioral factors contribute to cardiovascular health. More recently, this work has extended to sleep. Yet, our waking and sleeping lives are not independent of one another – they are, in fact, interdependent. Examination of objective rest-activity patterns over the 24-hour day will advance our understanding of the interdependent effects of our waking and sleeping lives on cardiovascular health. Here, we used actigraphy-assessed rest-activity rhythms (RARs) to capture sleep and wake patterns in relation to structural and functional measures of vascular health. We hypothesized that fragmented or inconsistent sleep-wake rhythms would be associated with poorer cardiovascular health. That is, the beat of an individual's 24-hour day would be related to the beat of one's heart and vasculature.

Participants were 156 adults (aged 36-82; 102 female) who completed wrist actigraphy collection and clinical assessments of vascular health including brachial artery diameter (BAD), flow-mediated dilation, carotid intima-media thickness, and carotid-femoral pulse-wave velocity. Vascular measures were collected in the fasting state. Three RAR measures were computed: (1) intradaily variability, with higher values reflecting fragmented nocturnal sleep and frequent transitions between rest and activity during the day; (2) interdaily stability, with lower values reflecting a more variable sleep-wake schedule across days; and (3) acrophase, with higher values reflecting a later transition from sleep to wake.
After false discovery rate correction at *q* < 0.1, univariate analyses
revealed only one significant association between RAR-assessed
intradaily variability and brachial artery diameter (β = 0.28, *p* =
0.002, *q* = 0.04). This association remained significant after adjusting
for sex, age, smoking, body mass index, diabetes, and hypertension (β
= 0.15, *p* = 0.03, R² = 0.5).

Lower sleep-wake rhythmicity is associated with larger brachial artery diameter, a structural indicator of subclinical vascular disease. Thus, the beat of one's day does seem to be related to the beat of the heart. Future studies of cardiovascular disease risk should probe the sleep-wake relationship further by using other measures of heart structure, as well as look at the relationship longitudinally.

65) Abstract 1604

EMOTION REGULATION IN PATIENTS WITH CHRONIC
HEART FAILURE: RELATIONSHIP TO DEPRESSIVE
SYMPTOMS

Mira-Lynn Chavanon, Dr. rer. nat., Clinical Child- and Adolescent Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Hessen, Germany, Birgit H. Belnap, Dr.Biol.Hum., Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, Thomas Meyer, Dr. mult., Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Nds, Germany, Kaleab Z. Abebe, PhD, Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, Christoph Herrmann-Lingen, Dr. med., Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Göttingen, Nds, Germany, Bruce L. Rollman, MD, MPH, Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, PA

**Introduction:** Chronic heart failure (CHF) is a progressive condition with significant morbidity and mortality. Despite treatment advances, long-term prognosis is still poor, and comorbid depression contributes to the adverse prognosis. Recent evidence suggests that emotion regulation is a key factor in the development and treatment of depression, but its role for mental and physical health in CHF is unknown. Therefore, we explored the relationships between emotion regulation, depressive symptoms, and rehospitalization in patients with CHF using data from a previous study (Rollman et al., 2012).

**Methods:** Hospitalized patients with CHF (ejection fraction <40%, NYHA class II-IV) were screened for depressive symptoms with the 2-item Patient Health Questionnaire (PHQ-2) and classified as screen-positive if they endorsed at least one item. For the present analysis, we included 394 patients (n=311 screen-positive) who had completed the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003) 1-month after hospital discharge. The ERQ assesses individual differences in two emotion regulation strategies: suppression (i.e., inhibition of emotional expression) and reappraisal (i.e., change the way you think about an emotional event). Outcomes were depression symptoms using the PHQ-9 assessed at 1-, 3-, and 6 months after discharge and all-cause rehospitalization (6 months follow-up). Cox proportional hazard models were adjusted for CBAG, sex, age, statin use and hyperlipidemia.

**Results:** In our sample (N=394), only suppression was associated with PHQ-9 scores 1-month after discharge (r=.15; p <.003). Overall, PHQ-9 scores decreased from month 1 to 6 (-0.12 points/month; p<.01), but neither ERQ scale modulated the slope of that change. The adjusted Cox models revealed that reappraisal and suppression were not related to rehospitalization in the whole sample, but reduced all-cause rehospitalization risk by 24% (HR=0.76; p<.03) for screen-positive patients.

**Discussion:** Suppression and reappraisal seem to relate differently to CHF key outcomes: Suppression was related to PHQ-9 scores, whereas reappraisal was associated with rehospitalization in patients screened positively for depression. Further studies are needed to examine whether emotion-regulation skill training improves mental and physical health in depressed CHF patients or might prevent depression in those at risk.

66) Abstract 1129

PREDICTORS OF SEXUAL CONFIDENCE, INTEREST AND SATISFACTION IN THE YEAR AFTER PERCUTANEOUS CORONARY INTERVENTION - THE THORESCI STUDY

Nina Kupper, PhD, Medical & Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, the Netherlands, Michael Magro, MD PhD, Jos Widdershoven, MD PhD, Cardiology, Elisabeth - TweeSteden Hospital, Tilburg, Noord-Brabant, the Netherlands

**Background** - Prior studies show severity of coronary artery disease (CAD) is related to changes in sexual functioning. Also, gender differences exist. Patients undergoing percutaneous coronary intervention (PCI) for obstructed coronaries may either be treated acutely, or electively in a daycare setting. Little is known about sexual functioning in these subgroups. Therefore, we examined predictors of sexual satisfaction, confidence and interest in sex across the first year post-PCI in elective and acute patients.

**Methods** - 510 PCI patients (33% elective treatment; Mean age=66±11 years; 79.8% men; 87% married) filled out a psychosocial survey at the time of the index PCI and a year later. We used dedicated questions (WHOQOL-bref, Cardiac Self Efficacy scale, BDI) to gauge sexual functioning.

**Results** - At baseline (BL), 31% of women, and 13% of men reported substantial loss of interest in sex (OR=2.06; p=.026). Interest was not associated with PCI indication (elective vs. acute) or cardiac history, but was predicted by lower education (OR=3.60; p<.0001), use of beta-blocking agents (OR=2.86; p=.001), diabetes (OR=2.28; p=.025) and depression (OR=1.11; p=.001) and anxiety (OR=1.14; p=.0003). At 1 year FU, anxiety and depression remained significant predictors of loss of interest. Importantly, elective PCI patients had a substantial loss of interest at FU (OR=2.49; p=.014). Reduced confidence (13% men; 12% women) was related to lower education (OR=3.41; p<.0001), cardiac history (OR=1.91; p=.049), diabetes (OR = 2.93; p=.006)), anxiety (OR = 1.15; p=.00006) and depression (OR = 1.13; p=.0001). After one year, only diabetes, anxiety and depression remained significant predictors of low confidence. At baseline, 23% of men vs. 15% of women were dissatisfied with their sexual functioning (OR=2.02; p=.027). At one year follow-up, elective PCI patients felt more dissatisfied than acute PCI patients (OR=2.11; p=.044). Further, depression (BL: OR=1.13; p=.0001; FU: OR=1.16; p=.0004) and anxiety (BL: OR=1.15; p<.0001; FU: OR=1.27; p<.0001) were significantly associated with reduced satisfaction with the sexual relationship at both time points.

**Discussion** - Elective PCI was associated with poorer sexual functioning at 1 year FU. Further, emotional distress played an important predictive role. In the clinic, sexual functioning should be discussed with CAD patients regularly.

67) Abstract 1202

OPENNESS TO EXPERIENCE AND STRESS RESPONSIVITY:
AN EXAMINATION OF CARDIOVASCULAR AND
UNDERLYING HEMODYNAMIC TRAJECTORIES WITHIN
AN ACUTE STRESS EXPOSURE

Páraic S. Ó Súilleabháin, PhD, School of Psychology, National University of Ireland, Galway, Galway City, Galway, Ireland, Siobhán Howard, PhD, Department of Psychology, Mary Immaculate College, University of Limerick, Limerick City, Limerick, Ireland, Brian M. Hughes, PhD, School of Psychology, National University of Ireland, Galway, Galway City, Galway, Ireland

The personality trait of openness to experience has been implicated in cardiovascular wellbeing, however underlying mechanisms of effect remain unclear. Research examining cardiovascular stress responsivity have typically examined the stress response by reducing it to a single measurement. Facilitated by continuous cardiovascular technology, this study examined the role of openness in cardiovascular responsivity during an acute psychological stress exposure. Blood pressure, heart rate, and hemodynamic response data was collected for 62 young female adults. All cardiovascular data were reduced to mean 10 second
readings, with phases determined through examinations of shifts in
responsivity between each 10 second pairing. Analyses revealed a
significant linear interaction for openness across the entire exposure for
systolic blood pressure, and cardiac output. A significant between-
subjects effect for heart rate also emerged. Those higher in openness
exhibited an increasingly myocardial hemodynamic response profile
throughout the exposure, with their lower counterparts displaying an
attenuated myocardial trajectory. Comparisons of response curves
suggest adaptive stress response trajectories for those higher in
openness compared to diminished responsivity characterizing their
lower counterparts. While being the first to examine a stress exposure
in this manner, this study provides evidence that an attenuation of
myocardial responsivity during a stress exposure may underpin blunted
blood pressure responding. This study implicates openness in
cardiovascular stress responding and provides a potential mechanism in
reported health associations.

**68) Abstract 1550**
**CHOLESTEROL PARTIALLY MEDIATES THE**
**RELATIONSHIP BETWEEN DEPRESSION AND**
**ENDOTHELIAL FUNCTION IN CARDIAC PATIENTS**

Darren A. Mercer, PhD(c), Psychology, McGill University, Montreal, Quebec, Canada, Kim L. Lavoie, PhD, Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada, Blaine Ditto, PhD, Psychology, McGill University, Montreal, Quebec, Canada, Roxanne Pelletier, PhD, Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada, André Arsenault, MD, Médecine Nucléaire, Hôpital Jean-Talon, Montreal, Quebec, Canada, Simon Bacon, PhD, Exercise Sciences, Concordia University, Montreal, Quebec, Canada

Objective: Research suggests depression is associated with endothelial function (EF), a measure of prognostic value in predicting cardiovascular disease (CVD). However, mechanisms explaining this relationship are unclear. High cholesterol levels and inflammation stimulate atherosclerosis, a process contributing to poor EF. This study aimed to assess cholesterol and C-reactive protein (CRP), a marker of inflammation, as potential mediators for the relationship between depression and EF in cardiac patients.

Methods: A sample of outpatients referred for myocardial perfusion single photon emission computed tomography stress testing at the Montreal Heart Institute was recruited (n = 289). Patients were administered the PRIME-MD, a brief psychiatric screening interview, by a graduate student or trained research assistant, to assess the presence of a DSM-IV-TR mood disorder. Brachial artery reactivity, a proxy of EF, was assessed using a nuclear medicine variation of the well-established ow-mediated dilatation technique, which calculates the rate of uptake ratio (RUR) between hyperaemic and non-hyperaemic arms. A blood sample was drawn to quantify fasting cholesterol and CRP levels. Analyses were performed with SAS 9.3 using the PROCESS macro.

Results: In a model assessing cholesterol as a potential mediator, a significant direct effect of mood disorder predicting RUR was observed (β=-.87, t=-3.17, p<.01). This relationship was partially mediated by total cholesterol levels, 95% Bootstrap CI (-.24, -.01). In a separate model assessing CRP, a significant direct effect of mood disorder predicting RUR was observed (β=-.96, t=-3.39, p<.01). However, this relationship was not mediated by CRP, 95% Bootstrap CI (-.14, .06). All models were adjusted for a priori defined covariates.

Conclusions: These results suggest a significant relationship between
depression and EF that is partially mediated by cholesterol, but not
CRP. It is possible this relationship may be explained by disordered
eating habits and negative health behaviours that are features of
depression, which in turn increase cholesterol levels and could lead to
impaired EF. Another theory suggests that the dysregulated
inflammatory processes often associated with depression explain
depression's relationship with EF. As CRP was not a mediator in this
study, our results are not consistent with this theory.

**69) Abstract 1150**
**HEALTH STATUS AND PSYCHOSOCIAL FACTORS IN**
**NONOBSTRUCTIVE CORONARY ARTERY DISEASE; SEX**
**DIFFERENCES AND EFFECT OF AGE AND EDUCATION.**

Paula M.C. Mommersteeg, PhD, Lindy Arts, MSc, Medical and clinical psychology, Tilburg University, Tilburg, NoordBrabant, Netherlands, Jos W. Widdershoven, MD PhD, Wilbert Aarnoudse, MD PhD, Cardiology, Elisabeth-Tweesteden Hospital, Tilburg, NoordBrabant, Netherlands, Johan Denollet, PhD, Medical and clinical psychology, Tilburg University, Tilburg, NoordBrabant, Netherlands

**Background.** Women present more often with cardiac complaints in the absence of obstructive coronary artery disease (CAD), and report a poor quality of life and higher levels of psychosocial distress compared to men. We examined sex differences in health status, mood, and personality between patients with nonobstructive CAD (NOCAD; wall irregularities, occlusion < 60%), and an age and sex matched reference group of the general population.

**Method:** Generic and disease specific health status (SF12 and SAQ), and psychosocial factors were compared between 523 patients (61 years, SD 9, 49% male) with NOCAD, as part of the 'TWeesteden mild Stenosis' TWIST observational cohort study, and an age and sex matched group of 1347 people from the general population.

**Results:** Both women and men with NOCAD reported poorer health status, more fatigue (FAS), anxiety, depressive symptoms (HADS), negative affect (DS14), and Type D personality, and less positive affect compared to the reference group (all p<.001). Women with NOCAD reported significantly poorer physical and mental health status (p's<.001), poorer physical limitation (p<.001), more fatigue (p=.007) and anxiety (p<.001), and less positive affect (p=.038) compared to men with NOCAD, but no differences in depressive symptoms (p=.28), angina frequency, stability, disease perception or treatment satisfaction (p's>.35), or Type D personality (p=.105). No significant sex-by-group interaction effects were observed. Additional adjustment for age, education, partner, employment and alcohol use showed that these gender and diversity factors explained the sex differences in psychosocial factors in the NOCAD group (Figure 1; anxiety and depression). Overall, higher educated men over 55 years had lower anxiety and depression scores, whereas lower education and being a women were related to more anxiety and depression.

**Conclusion:** In both women and men, NOCAD is associated with worse health status, negative mood and Type D personality when compared to a reference population. Within the NOCAD group women, showed more anxiety, generic health status and less positive affect, and these differences reflected gender and diversity rather than sex differences.

<figure><img src="image_10.png" /><figcaption>**Figure 1.** Sex, age, and education stratified anxiety and depression scores in patients with NOCAD. Significant group differences were observed for sex, age, and education level in anxiety, and for education in depression.</figcaption></figure>

**Poster 70) WILL NOT BE PRESENTED**