Ari J. Elliot

Perceived Control Mediates Effects of Socioeconomic Status and Chronic Stress on Physical Frailty: Findings From the Health and Retirement Study

Objective To investigate the psychosocial etiology of physical frailty by examining the influence of chronic stress and perceived control. Method Using population-based samples of older adults from the Health and Retirement Study, this study employed structural equation modeling in cross-sectional (N = 5,250) and longitudinal (N = 2,013) samples to estimate the effects of chronic stress and socioeconomic status (SES) on baseline frailty and change in frailty status over 4 years and the extent to which perceived control mediates or moderates effects of chronic stress. Results Perceived control fully mediated effects of chronic stress and partially mediated effects of SES on both baseline frailty and change in frailty. Multigroup analyses revealed that the mediating role of perceived control was consistent across age, gender, and racial/ethnic subgroups. There was no evidence to support a moderating role of perceived control in the chronic stress and frailty relationship. Discussion Findings provide novel evidence for a mediating role of perceived control in pathways linking SES and chronic stress to frailty, further underscoring the importance of psychosocial constructs to the development and progression of frailty in older adults.

Virtual Look AHEAD Program: Initial Support for a Partly Virtualized Intensive Lifestyle Intervention in Type 2 Diabetes

The Look AHEAD (Action for Health in Diabetes) program produces clinically significant weight loss and improvements in glycemic control, blood pressure, and quality of life in patients with type 2 diabetes (1,2), yet lifestyle interventions are time-intensive and less effective when delivered with lower intensity in primary care settings (2). Obesity guidelines endorse using technology to increase the reach of effective lifestyle interventions in the population (2), and therefore we conducted a pilot evaluation of a partly virtualized intervention that delivered content from the 16 initial group sessions of the Look AHEAD program along with 6 monthly visits with a registered dietitian. The theoretical framework for this pilot evaluation was self-determination theory, which is an organismic approach to human motivation that has applications to health-behavior change and maintenance. We posited that perceptions of the virtual clinician (VC) as supportive of the basic …

Social Relationships and Inflammatory Markers in the MIDUS Cohort: The Role of Age and Gender Differences:

Objective: To better understand age and gender differences in associations of social relationships with chronic inflammation. Method: Using a sample of middle-aged and older adults (N = 963) from the Midlife Development in the United States (MIDUS) biomarker project, we examined interactions of age and gender with structural and functional social network measures in predicting interleukin-6 (IL-6) and C-reactive protein (CRP). Results: Significant interactions involving age and gender showed that social support was associated with lower IL-6 in older women, whereas perceived positive relationships and social integration were related to lower IL-6 in both men and women of advanced age. Functional measures were associated with higher CRP in both men and women after adjustment for health conditions and behaviors, with some further variation by age. Discussion: Greater social support may be related to lower IL-6 in older women. Further research is needed to understand observed associations of social support with higher CRP.

Lifetime Trauma, Perceived Control, and All-Cause Mortality: Results From the Midlife in the United States Study

Objective: To investigate whether lifetime-trauma exposure predicts all-cause mortality and whether this association is mediated or moderated by perceived control. Method: A sample of middle-aged and older adults (N = 4,961) who participated in the second wave of the Midlife in the United States Study (MIDUS) provided data. Lifetime trauma was operationalized using the reported number of potentially traumatic experiences spanning childhood through adulthood. Both the perceived constraints and mastery dimensions of perceived control were examined. Cox regression models tested main effects and interactions of lifetime trauma with mastery and constraints predicting 10-year mortality risk. Results: There was a significant main effect of lifetime trauma, b = .06, hazard ratio (HR) = 1.07, p = .032, and an interaction of trauma with mastery, b = −.08, p = .004. A greater number of traumatic experiences was associated with increased mortality risk at below-average levels of mastery, −1 SD; HR = 1.14, p < .001, but not at above-average levels, +1 SD; HR = 0.97, p = .48. This interaction persisted after further adjustment for health status, psychological, and behavioral covariates. An association of constraints with elevated mortality risk, HR = 1.33, p = .008, was attenuated in a fully adjusted model, HR = 1.06, p = .26. Conclusion: A strong sense of mastery may buffer elevated mortality risk associated with exposure to traumatic experiences. Findings extend evidence that mastery may foster resilience to the adverse health effects of traumatic stressors, whereas constraints may show stronger independent associations with health outcomes.

Associations of Lifetime Trauma and Chronic Stress With C-reactive Protein in Adults Ages 50 Years and Older: Examining the Moderating Role of Perceived Control

Objective The aim of the study was to investigate whether high perceived control mitigates systemic inflammatory risk associated with traumatic and chronic stress exposures in older adults. Methods A sample of community-dwelling adults ages 50 years and older (N = 4779) was drawn from the Health and Retirement Study. Structural equation models tested interactions of lifetime trauma and chronic stress with mastery and perceived constraints predicting baseline levels and 4-year change in C-reactive protein (CRP). Results There were significant interactions of lifetime trauma (&bgr; = −.058, p = .012) and chronic stress (&bgr; = −.069, p = .010) with mastery as related to baseline CRP levels. Both measures were associated with higher CRP at low (&bgr; = .102, p = .003; &bgr; = .088, p = .015) but not high levels of mastery. In addition, chronic stress interacted with baseline mastery (&bgr; = .056, p = .011) and change in mastery (&bgr; = −.056, p = .016) to predict 4-year change in CRP. Chronic stress was associated with an increase in CRP at high baseline mastery (&bgr; = .071, p = .022) and when mastery decreased during follow-up (&bgr; = .088, p = .011). There were no main effects of stress or control variables other than an association of constraints with a larger increase in CRP (&bgr; = .062, p = .017). Interactions were minimally attenuated (<15%) upon further adjustment for negative affect, body mass index, smoking, and physical activity. Conclusions High mastery may protect against elevated systemic inflammation associated with substantial lifetime trauma exposure. Individuals who experience declines in mastery may be most susceptible to increases in inflammation associated with chronic stress.

Perceived control and frailty: The role of affect and perceived health.

Mechanisms underlying prospective associations of perceived control with frailty and other health outcomes are not well understood. In the present study we used 3 waves of data from the Health and Retirement Study (N = 2,127) to test potential psychological and biological pathways linking perceived control with frailty over an 8-year period, and whether 4-year change in control predicts frailty independent of initial control. Lower odds of increasing frailty were associated with higher initial levels of perceived control (odds ratio [OR] = .74, p < .001, 95% confidence interval [CI] [.65, .83]) and a more positive change in perceived control (OR = .82, p = .006, 95% CI [.73, .92]), independent of the personality traits neuroticism and conscientiousness. In cross-lagged mediation models, the association of initial perceived control with frailty was partially mediated by positive affect, negative affect, and self-rated health, but not C-reactive protein or allostatic load. Associations of perceived control with positive and negative affect were bidirectional, with mediation in both directions. Initial frailty status was not related to 4-year change in perceived control. Perceived control may affect frailty risk through influences on affective states as well as perceived health. Findings also extend evidence that changes in perceived control may be prognostic of future health outcomes in older adults.

Associations of mindfulness with depressive symptoms and well-being in older adults: the moderating role of neuroticism

ABSTRACT Objective: To investigate whether observed interactions of mindfulness with the personality trait neuroticism extend to older adults and to aspects of psychological functioning other than depressive symptoms, and whether effects of mindfulness training in this population depend on levels of neuroticism. Method: We performed a secondary analysis of data from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) for community-dwelling older adults. We investigated whether neuroticism moderates associations of dispositional mindfulness with various aspects of psychological and physical functioning at baseline, as well as effects of MBSR on these outcomes. Results: Significant two-way interactions showed that greater mindfulness was associated with fewer depressive symptoms and less negative affect at baseline in individuals with average or higher levels of neuroticism. In contrast, mindfulness was associated with greater positive affect and vitality and fewer physical symptoms regardless of the level of neuroticism. There were no effects of MBSR on these outcomes at any level of neuroticism. Conclusion: Mindfulness may be more protective against psychological ill-being in older adults with higher levels of neuroticism, but conducive to positive psychological and physical well-being regardless of this personality trait. The potential moderating role of neuroticism should be further evaluated in studies of mindfulness-based interventions in older adults.