Kathi L. Heffner

Older Spouses’ Cortisol Responses to Marital Conflict: Associations With Demand/Withdraw Communication Patterns

We examined 31 older couples’ wife demand/husband withdraw communication patterns and cortisol responses to marital conflict. Regression analyses indicated that wife demand/husband withdraw sequences during conflict related to cortisol responses only for wives. Based on a mixed model that accounted for the interdependence of spouses’ perceptions of communication patterns and outcomes, older spouses who reported greater wife demand/husband withdraw patterns in their marriage had greater cortisol responses during a conflict discussion; actual demand-withdraw did not relate to cortisol responses in this model. Findings suggest that perceived communication patterns contribute to neuroendocrine responses to marital conflict, and implications for marriage and health research with older couples are discussed.

Examining psychosocial factors related to cancer incidence and progression: In search of the silver lining

11 The possibility of links between psychosocial factors 12 and cancer incidence and progression have generated 13 considerable scientific and public interest. As early as the 14 mid-1920 s, psychologists were speculating about psy15 chogenic influences on cancer (Evans, 1926), and, for 16 decades, personality and individual differences have 17 been hypothesized as both etiologic and prognostic de18 terminants of cancer development (Brown, 1966; Ey19 senck, 2000; Fox, 1983). 20 With advances in psychoneuroimmunology have 21 come challenges to earlier theories addressing these links 22 (Fox, 1983; Kiecolt-Glaser & Chee, 1991). Biopsycho23 oncological researchers now emphasize the crucial role 24 of both the endocrine and immune systems in cancer 25 outcomes, and stress-associated dysregulation of bio26 logical and physiological processes have been high27 lighted. Unfortunately, this inquiry has been fraught 28 with methodological and conceptual hurdles that cloud 29 any concrete understanding about these potentially im30 portant linkages. We believe there is a silver lining be31 hind this cloud. As Segerstrom (this issue) and others 32 (Brown, 1966; Garssen & Goodkin, 1999) have indi33 cated, heterogeneous sampling and measurement have 34 produced divergent findings concerning the psychoso35 cial-cancer link. Notably, the relevance and validity of 36 the immunological and psychological assessments used 37 within cancer contexts have received little attention. 38 These are remediable weaknesses. Here, we highlight 39 some methodological points related to contextual spec40 ificity that should be considered seriously in psycho41 neuroimmunological studies of individual differences 42 and cancer outcomes. 43 Psychoneuroimmunology research on psychosocial 44 modifiers of stress responses and cancer processes have 45 primarily focused on nonspecific immune responses, in46 cluding NK cell function, mitogen stimulation of pe47 ripheral blood lymphocytes, and subsequent cytokine 48 production (Kiecolt-Glaser & Glaser, 1999).The rapid 49 methodological advancements in immunological, cellular 50 and molecular assaying techniques permit psychoneu51 roimmunological researchers to examine extraordinarily 52 micro-level physiological and biological processes. Im53 portantly, this technology affords examination of specific, 54 cancer-related mechanisms. 55 A potentially productive research focus for psycho56 social oncology is the study of stress effects on cellular 57 processes. Many carcinogens appear to induce tumors 58 by damaging cellular DNA and producing abnormal 59 cells (Fox, 1978; Setlow, 1978; Tomei, Kiecolt-Glaser, 60 Kennedy, & Glaser, 1990). The body s defenses against 61 this process include enzymes that destroy chemical car62 cinogens, processes for repairing damaged cellular 63 DNA, and the destruction of abnormal cells via apop64 tosis, a process of genetically programmed alterations in 65 cell structure that leads to failure of proliferation and 66 differentiation, and eventual cell suicide (Fox, 1978; 67 Tomei et al., 1990). Stress can alter each line of defense. 68 First, levels of methyltransferase, an important DNA 69 repair enzyme induced in response to carcinogen dam70 age, were significantly lower in stressed rats spleenic 71 lymphocytes compared to nonstressed controls (Glaser, Brain, Behavior, and Immunity xxx (2002) xxx–xxx

Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults.

Social isolation confers increased risk for coronary heart disease (CHD) events and mortality. In two recent studies, low levels of social integration among older adults were related to higher levels of C-reactive protein (CRP), a marker of inflammation, suggesting a possible biological link between social isolation and CHD. The current study examined relationships among social isolation, CRP, and 15-year CHD death in a community sample of US adults aged 40 years and older without a prior history of myocardial infarction. A nested case-cohort study was conducted from a parent cohort of community-dwelling adults from the southeastern New England region of the United States (N = 2321) who were interviewed in 1989 and 1990. CRP levels were measured from stored sera provided by the nested case-cohort (n = 370), which included all cases of CHD death observed through 2005 (n = 48), and a random sample of non-cases. We found that the most socially isolated individuals had two-and-a-half times the odds of elevated CRP levels compared to the most socially integrated. In separate logistic regression models, both social isolation and CRP predicted later CHD death. The most socially isolated continued to have more than twice the odds of CHD death compared to the most socially integrated in a model adjusting for CRP and more traditional CHD risk factors. The current findings support social isolation as an independent risk factor of both high levels of CRP and CHD death in middle-aged adults without a prior history of myocardial infarction. Prospective study of inflammatory pathways related to social isolation and mortality are needed to fully delineate whether and how CRP or other inflammatory markers contribute to mechanisms linking social isolation to CVD health.

How stress and anxiety can alter immediate and late phase skin test responses in allergic rhinitis.

Allergic rhinitis (AR) is the fifth most common chronic disease, and the association between allergic disorders and anxiety is well-documented. To investigate how anxiety and stressors modulate skin prick test (SPT) responses and associated inflammatory responses, 28 men and women with AR were selected by clinical history and skin test responses. The participants were admitted twice to a hospital research unit for 4h in a crossover trial. Changes in SPT wheals were assessed before and after a standardized laboratory speech stressor, as well as again the following morning; skin responses assessed twice during a lab session without a stressor and again the following morning served as the contrast condition. Anxiety heightened the magnitude of allergen-induced wheals following the stressor. As anxiety increased, SPT wheal diameters increased after the stressor, compared to a slight decrease following the control task. Anxiety also substantially enhanced the effects of stress on late phase responses: even skin tests performed the day after the stressor reflected the continuing impact of the speech stressor among the more anxious participants. Greater anxiety was associated with more IL-6 production by Con A-stimulated leukocytes following the stressor compared to the control visit. The data suggest that stress and anxiety can enhance and prolong AR symptoms.

Neuroendocrine Effects of Stress on Immunity in the Elderly: Implications for Inflammatory Disease

Age-related changes in immune function leave older adults at risk for a host of inflammatory diseases. Immune-mediated inflammatory processes are regulated by neuroendocrine hormones, including glucocorticoids, dehydroepiandrosterone, and the catecholamines, epinephrine, and norepinephrine. This regulation, however, becomes impaired in older adults in light of age-related changes in endocrine function. Chronic stress shows similarly harmful effects on neuroendocrine and immune function and may, therefore, combine with age to further increase disease risk in older adults. This article highlights evidence for the impact of age and stress on neuroendocrine regulation of inflammatory processes that may substantially increase risk for inflammatory disease at older ages.

Chronic Low Back Pain, Sleep Disturbance, and Interleukin-6

ObjectivesSleep disturbance is a common comorbidity of chronic pain. Inflammatory processes are dysregulated in sleep disturbance and also contribute to pain sensitivity. Thus, inflammation may play an important role in bidirectional associations between pain and sleep. Little is known about concurrent relationships among chronic pain, sleep, and inflammation. The aim of our study was to examine associations between sleep disturbance and circulating levels of the inflammatory cytokine, interleukin-6 (IL-6), in individuals with and without chronic low back pain. MethodsSex-matched and age-matched adults with chronic low back pain (CLBP; n=25) or without chronic pain (controls; n=25) completed measures of sleep quality in the past month and depressive symptoms in the past week, and provided a blood sample for IL-6. The next morning, participants reported their sleep quality the previous night and their current experience of morning pain. ResultsIndividuals with CLBP had more sleep disturbance than controls. Circulating IL-6 levels were similar for the 2 groups; however, in adults with CLBP, poorer sleep quality was associated with higher IL-6 levels, and both sleep and IL-6 related to pain reports. Unlike CLBP participants, controls showed normal, age-related increases in IL-6 levels, whereas sleep quality was unrelated to IL-6 levels. Depressive symptoms could not fully explain the observed associations. DiscussionInflammatory processes may play a significant role in the cycles of pain and sleep disturbance. Clinical interventions that improve sleep and reduce concomitant inflammatory dysregulation hold promise for chronic pain management.

Sleep disturbance and older adults' inflammatory responses to acute stress.

OBJECTIVES Poor sleep diminishes mental and physical health. The objective of this study was to examine associations between sleep disturbance and interleukin-6 (IL-6) responses to acute mental stress in older adults. DESIGN Observational study of community-dwelling, healthy older adults. SETTING Participants completed the study in a clinical research laboratory of a mid-sized university. PARTICIPANTS Generally healthy, community-dwelling men and women age 50 and older. MEASUREMENTS IL-6 and negative affect at rest and following a series of challenging cognitive tests; sleep quality; depressive symptoms; perceived stress; loneliness. RESULTS Participants categorized as poor sleepers on the basis of Pittsburgh Sleep Quality Index scores had significantly larger IL-6 responses to the cognitive stressors than good sleepers. The association between poor sleep and heightened IL-6 response to acute stress was not explained by other psychosocial factors previously linked to immune dysregulation, including depressive symptoms, perceived stress, and loneliness. CONCLUSIONS Findings add to the growing evidence for poor sleep as an independent risk factor for poor mental and physical health. Older adults may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulation.

Elevated Sleep Disturbance among Blacks in an Urban Family Medicine Practice

Purpose: Blacks experience a number of health disparities. Sleep disturbances contribute to poor health. This preliminary study explores whether a disparity in sleep disturbances exists among blacks compared with whites and others. Methods: A cross-sectional study was conducted in a sample (n = 92) of urban primary care patients (52% black, 46% white, and 2% other) from a university-based family medicine practice. Mean (SD) age was 51.9 years (8.9 years). Participants completed the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression Scale, Revised, and a checklist of chronic health conditions. Results: The rate of clinically meaningful sleep disturbance was 71%. In bivariate logistic regressions, black race was associated with sleep disturbance (odds ratio [OR], 3.00; 95% CI, 1.17–7.69). Controlling for income attenuated that association by about 11% (race OR, 2.71; 95% CI, 1.04–7.06). Education explained about 35% (race OR, 2.39; 95% CI, 0.89–6.42). Adjustment for depression, chronic illness, and education simultaneously resulted in an estimate for race of OR, 2.44; 95% CI, 0.85–7.01. Conclusion: Being black is associated with a sleep disturbance that is accounted for only partially by depression, socioeconomic status, and disease burden. Black primary care patients may benefit from additional screening and monitoring of sleep difficulties.

Moderating Effects of Moderate-Intensity Physical Activity in the Relationship Between Depressive Symptoms and Interleukin-6 in Primary Care Patients

Objective: To determine whether the relationship between interleukin (IL)-6 and depressive symptoms is moderated by participation in moderate-intensity physical activity in a sample of primary care patients. Elevated inflammation has been associated with a number of poor health outcomes. Depressive symptoms may be related to higher levels of the inflammatory marker IL-6; however, previous findings are inconsistent, possibly due to unidentified moderating factors. Methods: A total of 107 participants, aged ≥40 years, were recruited in Rochester, New York, in 2006 to 2007. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale-Revised, participation in moderate-intensity physical activity was measured using a modified version of the Community Health Activities Model Program for Seniors Activity Questionnaire for Older Adults, and serum IL-6 concentrations were determined using standard enzyme-linked immunosorbent assay protocols and high-sensitivity, anti-cytokine antibody pairs. A hierarchical multiple regression analysis was conducted. Results: The correlation between IL-6 and depressive symptoms was nonsignificant (r = .086, p = .40). The association between IL-6 and depressive symptoms was moderated by participation in moderate-intensity physical activity (p = .02). Among those who did not engage in moderate-intensity physical activity, higher levels of depressive symptoms were significantly associated with higher levels of IL-6 (r = .28, p = .05), whereas this association was not significant among those who did participate in moderate-intensity physical activity (r = −.13, p = .38). Conclusion: Participation in moderate-intensity physical activity may buffer the risk of higher inflammation often associated with higher levels of depressive symptoms. IL = interleukin; CESD-R = Center for Epidemiologic Studies Depression Scale-Revised.

Self presentation and cardiovascular reactivity.

This research was concerned with two issues: first, whether cardiovascular response patterns to a social stressor (i.e. self-presentation under evaluative circumstances) differ as a function of ones ability to control the impression one makes on others; second, whether cognitive appraisals are necessary or sufficient for the cardiovascular components of emotional arousal. Forty-two male subjects (Ss), monitored for cardiac impedance and blood pressure, were shown a previously recorded videotape of themselves in which each S verbally described personal aspects about himself. Ss in an Active condition were allowed to mark segments of the tape they wanted to re-shoot before the tape was evaluated by reviewers. Ss in a Passive condition viewed their tape but could not indicate whether to revise it. Control conditions allowed assessment of the activity entailed in tape marking and of evaluation per se. Self-reports of stress, threat, and coping ability regarding the upcoming task were taken. Blood pressure elevations occurred equally in both experimental conditions, but apparently through different underlying mechanisms. The Active condition produced myocardial responses (increased ejection fraction), while the Passive condition produced a vascular response (increased total peripheral resistance). However, while cardiovascular reactivity patterns did differ as a function of the opportunity to control the impression one could make on evaluative others, they did not differ as a function of having appraised the task as a challenge or as a threat. Consideration also is given to the conditions necessary for cognitive appraisal to occur and to influence reactivity.