Sarah R. Holley

Mutual gaze in Alzheimer's disease, frontotemporal and semantic dementia couples

Alzheimers disease (AD), frontotemporal dementia (FTD) and semantic dementia (SD) are neurodegenerative diseases that differ in their socioemotional presentations. Mutual gaze (i.e. when two individuals make eye contact) is a building block of social behavior that may be differentially affected by these diseases. We studied 13 AD patients, 11 FTD patients, 9 SD patients and 22 normal controls as they engaged in conversations with partners about relationship conflicts. Physiological reactivity was monitored during the conversations and trained raters coded mutual gaze from videotaped recordings. Results indicated that mutual gaze was preserved in AD couples. Mutual gaze was diminished in FTD couples while SD couples showed evidence of greater mutual gaze. SD couples also showed lower physiological reactivity compared to controls. Across patient groups, reduced mutual gaze was associated with greater behavioral disturbance as measured by the Neuropsychiatric Inventory, especially on the disinhibition and apathy subscales. These results point to subtle differences between the three types of dementia in the social realm that help to illuminate the nature of the disease process and could aid in differential diagnosis.

Physiological down-regulation and positive emotion in marital interaction.

Previous studies have demonstrated that 1 function of positive emotion is the undoing of physiological arousal produced by negative emotions. These studies have used single-subject paradigms, in which emotions were induced by films in college-age individuals. In the present study, we examined the relationship between physiological down-regulation and positive emotion in a sample of 149 middle-aged and older married couples engaged in a 15-min discussion of an area of marital conflict. During the conversation, autonomic and somatic physiological activity was measured, and emotional behaviors were recorded and subsequently coded. We found that during 20-s periods of down-regulation (where physiology transitioned from high arousal to low arousal), couples showed an increase in positive emotional behavior compared with periods without down-regulation. The finding was quite robust, suggesting that the undoing effect of positive emotion generalizes across age, sex, and marital satisfaction. The advantages of using positive emotion as an emotion regulation strategy are discussed.

Relationship Satisfaction and Emotional Language in Frontotemporal Dementia and Alzheimer Disease Patients and Spousal Caregivers

We studied the impact of 2 types of dementia on marital satisfaction and on the emotional language that spouses use during conflictive marital interactions. Fifteen frontotemporal dementia (FTD) and 16 Alzheimer disease (AD) patient-caregiver couples, and 21 control couples, discussed a relationship problem in a laboratory setting. Marital satisfaction was assessed through questionnaire, and emotion language was quantified using text analysis. FTD couples reported lower marital satisfaction than AD and control couples. During the interactions, FTD and AD caregivers used significantly more negative emotion words than their patient spouses (no spousal differences were found in control couples). FTD caregivers also used more negative words than AD caregivers and controls. We interpret these findings as reflecting challenges that the behavioral changes in FTD create for maintaining a healthy marital bond.

Exploring the Basis for Gender Differences in the Demand-Withdraw Pattern

During marital conflict, wives tend to demand and husbands tend to withdraw. These behaviors were historically thought to stem from essential differences between men and women. An alternative explanation implicates one form of power differences—wives desire more change and, therefore, demand; husbands desire less change and withdraw to maintain status quo. Studying same-sex as well as cross-sex couples enables an evaluation of both explanations. We examined demand-withdraw behaviors in 63 heterosexual, gay, and lesbian couples. The demand-withdraw pattern was seen regardless of type of couple. Further, for all couples, differences in the amount of change desired in partners during a conflict interaction predicted differences in demand and withdraw behaviors. These results offer further evidence that an often-observed difference in heterosexual relationships may result from social conventions that afford men greater power and women less power.

Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners

OBJECTIVE To examine the prevalence and predictors of major depressive disorder (MDD) for women and their partners during the course of fertility treatment. DESIGN Prospective cohort study during an 18-month period. Participants completed interviews and questionnaires at baseline and at 4, 10, and 18 months of follow-up. SETTING Five community and academic fertility practices. PATIENT(S) A total of 174 women and 144 of their male partners who did not have a successful child-related outcome during the time frame of the study. INTERVENTION(S) No interventions administered. MAIN OUTCOME MEASURE(S) The MDD was assessed using the Composite International Diagnostic Interview Major Depression module, a structured diagnostic interview. Additional variables were assessed with self-report questionnaire measures. RESULT(S) Of the women 39.1% and of the men 15.3% met the criteria for MDD during the 18-month course of the study. A binary logistic covariate-adjusted model showed that, for both women and men, past MDD was a significant predictor of MDD during treatment. Past MDD further predicted significant risk for MDD during treatment after controlling for other well-established risk factors (i.e., baseline levels of depression, anxiety, and partner support). CONCLUSION(S) The MDD was highly prevalent for fertility treatment patients and their partners. Past MDD predicted risk for MDD during treatment, and it contributed to MDD risk more than other commonly assessed risk factors. This suggests that patients and their partners would benefit from being routinely assessed for a history of MDD before the start of treatment to best direct psychosocial support and interventions to those most in need.

Interpersonal emotional behaviors and physical health: a 20-year longitudinal study of long-term married couples

Objectively coded interpersonal emotional behaviors that emerged during a 15-min marital conflict interaction predicted the development of physical symptoms in a 20-year longitudinal study of long-term marriages. Dyadic latent growth curve modeling showed that anger behavior predicted increases in cardiovascular symptoms and stonewalling behavior predicted increases in musculoskeletal symptoms. Both associations were found for husbands (although cross-lagged path models also showed some support for wives) and were controlled for sociodemographic characteristics (age, education) and behaviors (i.e., exercise, smoking, alcohol consumption, caffeine consumption) known to influence health. Both associations did not exist at the start of the study, but only emerged over the ensuing 20 years. There was some support for the specificity of these relationships (i.e., stonewalling behavior did not predict cardiovascular symptoms; anger behavior did not predict musculoskeletal symptoms; neither symptom was predicted by fear nor sadness behavior), with the anger-cardiovascular relationship emerging as most robust. Using cross-lagged path models to probe directionality of these associations, emotional behaviors predicted physical health symptoms over time (with some reverse associations found as well). These findings illuminate longstanding theoretical and applied issues concerning the association between interpersonal emotional behaviors and physical health and suggest opportunities for preventive interventions focused on specific emotions to help address major public health problems. (PsycINFO Database Record

Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services?

OBJECTIVE To determine the extent to which fertility patients and partners received mental health services (MHS) and were provided with information about MHS by their fertility clinics, and whether the use of MHS, or the provision of information about MHS by fertility clinics, was targeted to the most distressed individuals. DESIGN Prospective longitudinal cohort study. SETTING Five fertility practices. PATIENT(S) A total of 352 women and 274 men seeking treatment for infertility. INTERVENTION(S) No interventions administered. MAIN OUTCOME MEASURE(S) Depression, anxiety, and MHS information provision and use. RESULT(S) We found that 56.5% of women and 32.1% of men scored in the clinical range for depressive symptomatology at one or more assessments and that 75.9% of women and 60.6% of men scored in the clinical range for anxiety symptomatology at one or more assessments. Depression and anxiety were higher for women and men who remained infertile compared with those who were successful. Overall, 21% of women and 11.3% of men reported that they had received MHS, and 26.7% of women and 24.1% of men reported that a fertility clinic made information available to them about MHS. Women and men who reported significant depressive or anxiety symptoms, even those with prolonged symptoms, were no more likely than other patients to have received information about MHS. CONCLUSION(S) Psychological distress is common during fertility treatment, but most patients and partners do not receive and are not referred for MHS. Furthermore, MHS use and referral is not targeted to those at high risk for serious psychological distress. More attention needs to be given to the mental health needs of our patients and their partners.

The Relationship Between Emotion Regulation, Executive Functioning, and Aggressive Behaviors.

Emotion regulation deficits and executive functioning deficits have independently been shown to increase vulnerability toward engaging in aggressive behaviors. The effects of these risk factors, however, have not been evaluated in relation to one another. This study evaluated the degree to which each was associated with aggressive behaviors in a sample of 168 undergraduate students. Executive functioning (cognitive inhibition and mental flexibility) was assessed with a Stroop-like neuropsychological task. Emotion regulation and aggressive behaviors were assessed via self-report inventories. Results showed main effects for both emotion regulation and executive functioning, as well as a significant interaction, indicating that those who scored lowest in both domains reported engaging in aggressive behaviors the most frequently. When different types of aggression were examined, this interaction was only significant for acts of physical aggression, not for acts of verbal aggression. Therefore, for physical aggression, emotion regulation and executive functioning exerted a moderating effect on one another. The implications are that, at least for acts of physical aggression, relatively strong capabilities in either domain may buffer against tendencies to engage in aggressive behaviors. Thus, both emotion regulation skills and executive functioning abilities may be valuable targets for interventions aiming to reduce aggressive behaviors.

The intersection of interpersonal and self-directed violence among general adult, college student and sexually diverse samples

Background: Suicide and interpersonal violence (i.e. victimization and perpetration) represent pressing public health problems, and yet remain mostly addressed as separate topics. Aims: To identify the (1) frequency and overlap of suicide and interpersonal violence and (2) characteristics differentiating subgroups of violence-related experiences. Methods: A health survey was completed by 2,175 respondents comprised of three groups: college students (n = 702), adult members of a sexuality special interest organization (n = 816) and a community adult sample (n = 657). Latent class analysis was used to identify subgroups characterized by violence experiences; logistic regression was used to identify respondent characteristics differentiating subgroups. Results: Overall rates of violence perpetration were low; perpetration, victimization and self-directed violence all varied by sample. Adults with alternative sexual interests reported high rates of victimization and self-directed violence. Analyses indicated two subgroups: (1) victimization + self-directed violence and (2) self-directed violence only. The victimization + self-directed violence subgroup was characterized by older, White, female and sexual orientation minority persons. The self-directed violence subgroup was characterized by younger, non-White, male and straight counterparts engaging with more sexual partners and more frequent drug use. Conclusion: Findings support the Centers for Disease Control and Prevention (CDC) definition of suicide as self-directed violence. Suicide intervention and prevention should further account for the role of violent victimization by focusing on the joint conceptualization of self-directed and interpersonal violence. Additional prevention implications are discussed.

Romeo, Romeo: A Look at a Winding Journey to Lesbian Parenthood

Romeo, Romeo1, by filmmaker Lizzie Gottlieb, is a documentary that follows a lesbian couple as they pursue parenthood. The film begins with the two woman, Lexy and Jessica, walking down the wedding aisle in white dresses with all the traditional trappings (vows, cake, New York Times announcement). The film quickly moves to the central part of the story: Lexy and Jessica’s efforts to conceive a child. The rest of the film highlights the trials, the tribulations, and, ultimately, the joy that this couple experiences over a long progression of pregnancy attempts. This film is timely as lesbian women are increasingly using insemination procedures such as intrauterine insemination (IUI) and in vitro fertilization (IVF) to conceive a child. To place this in historical context, until relatively recently, such medically based fertility treatments were often inaccessible to lesbian couples, with medical providers citing legal, ethical, or moral arguments against same-sex parenting (Goldberg, 2010). But the situation in the United States has been rapidly improving. In 2006, the American Society for Reproductive Medicine ethics committee published a statement declaring that “the ethical arguments supporting denial of access to fertility services on the basis of marital status or sexual orientation cannot be justified” (p. 1333). The ASRM statement further emphasized the overwhelming absence of scientific evidence that parenting effectiveness is affected by parental sexual orientation. But even with these evolving attitudes and policies, there still remain challenges. A major strength of this movie is that it captures so many of the features characteristic of the lesbian route to parenthood. For example, conception by definition requires help from a third party (i.e., the sperm donor) and can involve a host of other players (e.g., doctors, psychologists, lawyers). The process requires planning, coordination, and often a substantial investment of time, money, and energy (Baetens & Brewaeys, 2001). And rather than a linear progression, the journey to parenthood tends to