Jeffrey Birk

The joint influence of emotional reactivity and social interaction quality on cardiovascular responses to daily social interactions in working adults

OBJECTIVEnSocial interaction quality is related to cardiovascular functioning. Trait emotional reactivity may amplify cardiovascular responses to social interactions, but is often examined as a tendency to react to negative events. We took a broader approach by examining the joint effects of positive and negative emotional reactivity and social interaction quality on ambulatory blood pressure (ABP) and heart rate (HR) responses to daily social interactions.nnnMETHODSnParticipants were part of a larger study on BP and cardiovascular health (Nu202f=u202f805; MAgeu202f=u202f45.3; 40.1% male). Participants completed a measure of emotional reactivity (BIS/BAS) and 24-hour ABP monitoring accompanied by ecological momentary assessments (EMA) about just-experienced social interactions and their pleasantness. Multilevel models tested the associations of emotional reactivity, average pleasantness, and momentary pleasantness with BP and HR.nnnRESULTSnParticipants who reported more pleasant interactions on average had lower BP (systolic BP: Bu202f=u202f-0.51u202fmmHg; diastolic BP: Bu202f=u202f-0.46u202fmmHg). These effects did not depend on emotional reactivity. The effect of momentary pleasantness depended on BIS/BAS; in less reactive participants, greater pleasantness was associated with lower HR, Bu202f=u202f-0.13 bpm; in more reactive participants, greater pleasantness was associated with increased HR, Bu202f=u202f0.16).nnnCONCLUSIONSnParticipants who had more pleasant social interactions throughout the day had lower mean ABP. The acute effect of a given social interaction on HR depended on emotional reactivity: HR increased for participants high in emotional reactivity during pleasant interactions. Thus, emotional reactivity may influence cardiovascular responses to social stimuli.

Identifying targets for cardiovascular medication adherence interventions through latent class analysis.

Objective: Reasons for nonadherence to cardiovascular medications vary widely between individuals. Yet, adherence interventions are often uniformly applied, limiting their effectiveness. This study employed latent class analysis (LCA) to identify multidimensional profiles of reasons for nonadherence to cardiovascular medications. Method: Participants (N = 137; MAge = 58.8, SDAge = 11.8) were drawn from an observational study of the impact of cardiac-induced posttraumatic stress disorder (PTSD) on cardiac medication adherence in patients presenting to the emergency department with a suspected acute coronary syndrome. Demographics and depressive symptoms were assessed at baseline. Extent of nonadherence to cardiovascular medications, reasons for nonadherence, and PTSD symptoms were assessed 1 month after discharge. Results: LCA identified 3 classes of reasons for medication nonadherence: capacity (related to routine or forgetting; approximately 45% of the sample), capacity + motivation (related to routine/forgetting plus informational or psychological barriers; approximately 14% of the sample), and no clear reasons (low probability of endorsing any items; approximately 41% of the sample). Participants reporting greater nonadherence were more likely to be in the capacity + motivation or no clear reasons classes compared with the capacity class. Participants endorsing higher PTSD severity were more likely to be in the capacity + motivation or capacity classes compared with the no clear reasons class. Conclusions: Three distinct classes of reasons for nonadherence were identified, suggesting opportunities for tailored interventions: capacity, capacity + motivation, and no clear reasons. These preliminary findings, if replicated, could aid identification of patients at risk for greater extent of medication nonadherence and inform tailored interventions to improve adherence.

The presence of companions during emergency department evaluation and its impact on perceptions of clinician–patient communication

Objectives Research in outpatient setting suggests that the presence of companions during a medical encounter can improve clinician–patient communication. It is not known if the presence of companions has a similar effect in the acutely stressful context of the ED. This study tested whether the presence of companions in the ED relate to stronger clinician–patient communication. We further explored effect modification by demographic factors (race/ethnicity, education and language) thought to compromise communication. Methods Participants were drawn from an observational cohort study of patients with suspected acute coronary syndrome (n=876) recruited from an urban academic medical centre between 2013 and 2016. Patient interviews occurred both in the ED and post-ED discharge; communication was assessed using the Interpersonal Processes of Care Survey with possible range of scores of 14–70. Companions were categorised as close others (ie, partner/spouse or child), non-close others (eg, neighbour) or no one. Results Perceptions of clinician–patient communication were high (mean=57.1, SD=10.6;). There was no association between companions (close/non-close/no one) and clinician–patient communication, p=0.262. Demographic factors were unrelated to communication. There was a significant interaction between education and companions. Having a close other in the ED was associated with stronger clinician–patient communication only for patients with high school education or less, p=0.027. Conclusions Neither the presence of companions nor demographic factors were related to clinician–patient communication. The interaction effect suggesting that patients completing high school or less have the most to gain from the presence of close others warrants further exploration.

Romantic Relationship Satisfaction and Ambulatory Blood Pressure During Social Interactions: Specificity or Spillover Effects?

BACKGROUNDnPeople in high-quality romantic relationships tend to have lower blood pressure (BP). People may experience lower BP specifically when interacting with romantic partners.nnnPURPOSEnThis study parsed the effects of different types of social interactions on ambulatory BP (ABP) and tested whether romantic relationship satisfaction moderated these effects during interactions with partners in particular (specificity) or with others (spillover; e.g., friends, co-workers).nnnMETHODSnPartnered participants (N = 594) were drawn from a larger study on BP and cardiovascular health (age = 46.5 ± 9.3; 57.4% female). Participants reported on romantic relationship satisfaction and completed 24-hr ABP monitoring. At each reading, participants reported whether they had a social interaction and with whom. Multilevel models accounted for nesting of data over time.nnnRESULTSnRomantic relationship satisfaction significantly modified the effects of some social interactions on systolic and diastolic BP (SBP, DBP). Participants with high (+1 SD) relationship satisfaction had significantly lower SBP (-0.77 mmHg, p = .02) during partner interactions compared with no social interaction; low-satisfaction (-1 SD) participants had a nonsignificant 0.59 mmHg increase (p = .14). A similar pattern emerged for DBP. Relationship satisfaction also modified SBP response during friend interactions (elevated SBP for low-satisfaction participants) and DBP response during other interactions (elevated DBP for high-satisfaction participants).nnnCONCLUSIONnParticipants with high levels of romantic relationship satisfaction experienced significantly lower BP during social interactions with their partner compared with situations without social interaction. Although there was some evidence for spillover to other types of relationships, effects were largely restricted to partner interactions.