Pilot randomized trial of an acceptance-based telehealth intervention for women with ovarian cancer and PARP inhibitor-related fatigue.

OBJECTIVE: Poly(ADP-ribose) polymerase inhibitors (PARPi) have dramatically changed treatment for advanced ovarian cancer, but nearly half of patients experience significant fatigue. We conducted a two-site pilot randomized trial to evaluate the feasibility, acceptability, and preliminary efficacy of a brief, acceptance-based telehealth intervention (REVITALIZE) designed to reduce fatigue interference in patients on PARPi. METHODS: From June 2021 to April 2022, 44 participants were randomized 1:1 to REVITALIZE (6 weekly one-on-one sessions+booster) or enhanced usual care. Feasibility was defined as: ≥50% approach-to-consent among potentially eligible patients and ≥70% completion of 12-week follow-up assessment; acceptance was <20% participants reporting burden and <20% study withdrawal. Fatigue, anxiety, depression, and quality of life were assessed at baseline, 4-, 8- and 12-weeks. RESULTS: Among 44 participants (mean age = 62.5 years, 81.8% stage III/IV disease), the study was feasible (56.4% approach-to-consent ratio, 86.3% completion of 12-week assessment) and acceptable (0% reporting burden, 11.3% study withdrawal). At 12-week follow-up, REVITALIZE significantly reduced fatigue interference (Cohen's d = 0.94, p = .008) and fatigue severity (d = 0.54, p = .049), and improved fatigue levels (d = 0.62, p = .04) relative to enhanced usual care. REVITALIZE also showed promise for improved fatigue self-efficacy, fatigue catastrophizing, anxiety, depression, and quality of life (ds = 0.60-0.86, p ≥ .05). Compared with enhanced usual care, REVITALIZE participants had fewer PARPi dose reductions (6.7% vs. 19.0%), and dose delays (6.7% vs. 23.8%). CONCLUSIONS: Among fatigued adults with ovarian cancer on PARPi, a brief, acceptance-based telehealth intervention was feasible, acceptable, and demonstrated preliminary efficacy in improving fatigue interference, severity, and levels. REVITALIZE is a novel, scalable telehealth intervention worthy of further investigation.

A dyadic analysis of relationship satisfaction and depressive symptoms among same-sex couples.

Sexual minority individuals experience depression at a disproportionately higher rate than their heterosexual peers. One predictor of depression is low romantic relationship satisfaction, and research on different-sex couples demonstrates that one's own and one's partner's levels of relationship satisfaction are negatively associated with one's own level of depressive symptoms (i.e., actor and partner effects, respectively). However, little research has explored partner effects of relationship satisfaction on depression in same-sex couples. Furthermore, little is known regarding the degree to which relationship satisfaction is associated with depression in same-sex couples, over and above their shared association with demographic characteristics and internalized heterosexism, a known correlate of both relationship satisfaction and depression. This study examined cross-sectional actor and partner effects of relationship satisfaction on depressive symptoms in a sample of 102 same-sex couples (68 female), and evaluated whether these effects were significant when adjusting for sex, relationship length, and internalized heterosexism. Multilevel analyses were conducted to estimate actor-partner interdependence model (APIM) effects for indistinguishable dyads. Results indicated that (a) there were statistically significant actor and partner effects for relationship satisfaction on depressive symptoms, such that higher levels of relationship satisfaction were associated with lower levels of depressive symptoms and (b) actor and partner effects for relationship satisfaction remained statistically significant when adjusting for sex, relationship length, and actor and partner effects for internalized heterosexism. Furthermore, there were statistically significant actor (but not partner) effects for internalized heterosexism on depressive symptoms, such that higher levels of internalized heterosexism were associated with higher levels of depressive symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Love and war: Prospective associations between relationship distress and incidence of psychiatric disorders in active-duty Army personnel.

Research with probability samples of civilians has found that marital distress is associated with incidence of several psychiatric disorders. However, there is little longitudinal research on marital distress and incidence of psychiatric disorders in military personnel. This study examined the prospective association between marital distress and incidence of major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder, posttraumatic stress disorder (PTSD), and substance use disorder in a probability sample of active-duty soldiers from the U.S. Army (N = 934). Results indicated that among individuals who did not meet diagnostic criteria for the associated disorder at baseline, marital distress at baseline was associated with 30-day incidence of MDE, GAD, and PTSD assessed 5 years later. These results support continued research on the role of marital distress and the onset and course of psychopathology in active-duty military personnel and suggest that couple-based interventions designed to prevent or reduce marital distress may be effective in the prevention and treatment of psychopathology in military personnel. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Couples in arms: Marital distress, psychopathology, and suicidal ideation in active-duty Army personnel.

Although distress in intimate relationships such as marriage is positively associated with psychiatric symptoms and disorders and suicidal ideation in probability samples of the civilian population in the United States, relatively little is known regarding these associations in probability samples of active-duty military personnel. The present study evaluated the association between marital distress and past-30-day prevalence of psychiatric disorders (i.e., mood, anxiety, and substance use disorders) and suicidal ideation in a sample of 8,669 married active-duty soldiers in the U.S. Army who participated in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Results indicated that marital distress was significantly and positively associated with past-30-day prevalence of major depressive disorder, generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and substance use disorder, as well as past-30-day prevalence of suicidal ideation. These associations were incremental to shared associations with demographics and co-occurring psychiatric disorders. The findings support continued research on the association between relationship distress and psychopathology in active-duty service personnel, and suggest the potential utility of adapting existing, evidence-based couple interventions for the prevention and treatment of psychopathology or relationship distress, currently in use in veteran and civilian settings, for use with active-duty military personnel and their partners. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relationship discord and depressive symptoms in sexual minority individuals over time.

Although there is a well-established positive association between romantic relationship discord and depressive symptoms, there have been few studies assessing this association with sexual minority individuals, who are at increased risk for depression and whose relationships may be subjected to unique challenges (and strengths) given their sexual minority status. This study examined the cross-sectional and longitudinal associations between romantic relationship discord and depressive symptoms in sexual minority individuals using data from Project STRIDE, which is a longitudinal survey of 18-59 year-old residents of New York City. Data from 107 individuals in romantic relationships showed significant positive cross-sectional associations between relationship discord and depressive symptoms both at baseline and at a 1-year follow-up. Results from multiple regression analyses indicated that relationship discord at baseline was significantly and positively associated with depressive symptoms 1 year later, whereas depressive symptoms at baseline were not significantly associated with relationship discord 1 year later. The longitudinal association between relationship discord and depressive symptoms remained statistically significant adjusting for internalized heterosexism and discrimination at baseline. Findings are largely similar to those in research conducted in samples not recruited based on sexual minority status and provide an important extension of work that has shown a positive association between relationship discord and depressive symptoms for sexual minority individuals cross-sectionally. If replicated, these findings may have implications for the use of couple-based interventions for depression in sexual minority individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Marital satisfaction and mortality in the United States adult population.

OBJECTIVE: The present study examined the association between marital satisfaction and all-cause mortality in a large, representative sample of American adults. Gender was evaluated as a potential moderator of this association. METHOD: Ratings of marital satisfaction from married adults <90 years of age (N = 19,246) were extracted from the 1978 - 2010 waves of the General Social Survey and linked to mortality data from the National Death Index. Discrete-time survival analysis was used to evaluate the association between marital satisfaction and mortality. RESULTS: After statistically adjusting for demographic variables, the odds of dying for married individuals who described their marriage as very happy or pretty happy were significantly lower than the odds of dying for married individuals who described their marriage as not too happy. The association between marital satisfaction and mortality was not moderated by gender. CONCLUSIONS: The significant prospective association between marital satisfaction and mortality suggests that reducing marital dissatisfaction may increase longevity. Further longitudinal research is warranted to (a) replicate the current findings, and (b) evaluate whether increasing marital satisfaction through clinical intervention increases longevity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Treating refractory mental illness with closed-loop brain stimulation: Progress towards a patient-specific transdiagnostic approach.

Mental disorders are a leading cause of disability, morbidity, and mortality among civilian and military populations. Most available treatments have limited efficacy, particularly in disorders where symptoms vary over relatively short time scales. Targeted modulation of neural circuits, particularly through open-loop deep brain stimulation (DBS), showed initial promise but has failed in blinded clinical trials. We propose a new approach, based on targeting neural circuits linked to functional domains that cut across diagnoses. Through that framework, which includes measurement of patients using six psychophysical tasks, we seek to develop a closed-loop DBS system that corrects dysfunctional activity in brain circuits underlying those domains. We present convergent preliminary evidence from functional neuroimaging, invasive human electrophysiology, and human brain stimulation experiments suggesting that this approach is feasible. Using the Emotional Conflict Resolution (ECR) task as an example, we show that emotion-related networks can be identified and modulated in individual patients. Invasive and non-invasive methodologies both identify a network between prefrontal cortex, cingulate cortex, insula, and amygdala. Further, stimulation in cingulate and amygdala changes patients' performance in ways that are linked to the task's emotional content. We present preliminary statistical models that predict this change and allow us to track it at a single-trial level. As these diagnostic and modeling strategies are refined and embodied in an implantable device, they offer the prospect of a new approach to psychiatric treatment and its accompanying neuroscience.