Sleep Quality as a Critical Pathway Between Adverse Childhood Experiences and Multimorbidity and the Impact of Lifestyle.

OBJECTIVES: This study aims to establish the effects of ACEs on multimorbidity through sleep quality and investigate whether lifestyle factors (e.g., eating habits and exercise) may influence this relationship among middle-aged and older adults. METHODS: Participants were drawn from a cross-sectional sample of community dwelling older adults (N = 276, 55+) and three waves of data from the Midlife in the United States study (MIDUS, N = 843). We examined the direct and indirect effects of ACEs, sleep quality, and health conditions, as well as the conditional effects of physical activity and eating habits. RESULTS: Across both samples, sleep quality mediated the relationship between ACEs and chronic health conditions. Moderating effects of unhealthy eating and physical activity differed between samples. DISCUSSION: Sleep quality is an important pathway connecting ACEs and adult multimorbidity, and health behaviors may provide targets for intervention particularly in older adults.

Prospective exploration of the role of combined internalizing symptoms in self-reported memory among older adults during the COVID-19 pandemic.

OBJECTIVES: A growing literature suggests depression and anxiety increase risk of cognitive decline. However, few studies have examined their combined effects on cognition, among older adults, especially during periods of high stress. METHOD: Based on a sample of community dwelling older adults (N = 576), we evaluated the effects of pre-pandemic anxiety and depressive symptoms, obtained in September 2018, to changes in self-reported memory (SRM) assessed 3 months into the COVID-19 pandemic. RESULTS: In separate models, we found participants with depression scores at least 1-SD above the mean and participants with anxiety scores at least 2-SD above the mean to report a significant decline in SRM. Moderation analyses revealed those with high depressive symptoms (at or above the mean) showed a decrease in SRM regardless of anxiety. The extent to which high pre-pandemic anxiety symptoms influenced SRM is dependent on whether pre-pandemic depression was at or above the mean. CONCLUSIONS: Pre-pandemic depression predicted a decline in SRM regardless of anxiety. Moderation analyses revealed that the extent to which anxiety symptoms influenced SRM was dependent on depression being at or above the mean. Those with high anxiety and depression are at highest risk of experiencing cognitive consequences related to stressful exposures like COVID-19.

A longitudinal examination of the protective effect of resilience against anxiety among older adults with high COVID-related worry.

This longitudinal study of community dwelling older adults (N = 453) examined consequences of COVID-related worries on changes in anxiety symptoms before relative to during the pandemic. We further evaluated if pre-COVID psychological resilience (PR) buffered the impact of COVID-related worry. Pre-COVID data were collected in September 2018. COVID-related worry and COVID anxiety symptoms were collected in October 2020 (Wave 2). Controlling for pre-COVID anxiety symptoms, we examined if COVID-related worries (e.g. I'm worried that I might die from COVID-19) were associated with increased anxiety symptoms, and whether pre-COVID PR moderated the association between COVID-related worries and prospective increases in anxiety symptoms. COVID-related worries were associated with increased anxiety symptoms (ß = 0.005, p < .01), whereas pre-COVID PR was associated with a decrease in anxiety symptoms (ß = -0.029, p < .05). PR moderated the association; COVID-related worries were associated with greater increases in anxiety symptoms among those with low pre-COVID PR (Model η2 = 0.35). Thus, the extent to which COVID-related worries influenced psychological health was dependent on pre-COVID levels of PR. We conclude the combined vulnerabilities of low pre-COVID PR and high COVID-related worries significantly increased the psychological consequences of COVID-19 for our sample of older adults.

History of childhood mistreatment and the psychological health consequences of COVID-19 for older adults.

OBJECTIVES: We examine the associations between childhood mistreatment (emotional abuse, physical abuse, sexual abuse, and emotional neglect) and older adults' changes in depressive symptoms from before to during the COVID-19 pandemic (September 2018-June 2020). METHODS: Using a community-based sample of older adults in North Florida (N = 581), we used ordinary least-squares regression to estimate associations between childhood mistreatments and depressive symptoms in June 2020, controlling for baseline symptoms and demographic characteristics. Additional models tested whether emotion regulation and social support attenuated associations between childhood mistreatments and depressive symptoms. RESULTS: Older adults exposed to emotional neglect in childhood saw a greater increase in depressive symptoms than those who did not experience childhood mistreatment. Those reporting childhood physical abuse had higher baseline depressive symptoms, but they did not increase during the pandemic. These associations remained stable after controlling for emotion regulation and social support, coping resources thought to contribute to linkages between childhood mistreatment and psychological health in adulthood. CONCLUSION: Childhood mistreatment might inform the psychological consequences of major stressors in later life. Thus, early life interventions for children experiencing mistreatment could be especially important for long-term psychological health outcomes and responses to major stressful events. Identifying older people with histories of childhood mistreatment could also help clinicians gauge patients' risk of psychological decline during times such as the COVID-19 pandemic and tailor psychological health interventions.

Prediction of COVID-19-related distress: the role of anxiety and resiliency.

OBJECTIVES: Among older adults, anxiety is a likely risk factor for COVID-19-related distress, whereas psychological resilience may attenuate the negative impact of the pandemic. In this longitudinal study, we hypothesized that pre-pandemic anxiety would predict higher COVID-19-related distress, whereas resiliency would predict lower distress. Further we hypothesized that resilience would moderate the association between anxiety and distress. METHODS: Pre-pandemic data (July 2018) was obtained from a community sample of older adults and included measures of anxiety and resiliency. We conducted a follow-up survey (n = 571) during the pandemic (June 2020) and evaluated COVID-19-related distress. We used OLS regression to test our hypotheses. RESULTS: Anxiety symptoms predicted higher COVID-19-related distress; resiliency predicted lower distress. Resiliency did not moderate the association between anxiety and distress. High levels of resiliency, compared to low levels, attenuated the influence of anxiety on COVID-19-related distress, but only among those with low-to-moderate levels of anxiety. CONCLUSION: Older adults with anxiety may be more susceptible to COVID-19 related distress. Interventions that increase resilience, may mitigate distress, and promote healthy aging for those with low-to-moderate anxiety. Further research, however, is needed to help those older adults with high anxiety contend with such adverse experiences and build on psychological resources.

Emotion regulation and the late positive potential (LPP) in older adults.

Emotion regulation (ER) processes in older adults may be important for successful aging. Neural correlates of ER processes have been examined using event-related brain potentials (ERPs), such as the late-positive potential (LPP) during cognitive reappraisal paradigms. The current study sought to extend this research by examining the LPP from an ER task in a sample of 47 community-dwelling older adults between the ages of 60 and 84 years, scoring either high on emotional well-being (as measured by habitual ER use and resiliency; high WB group, n = 20) or low on emotional well-being (as measured by habitual ER use, resiliency, and depression; low WB group, n = 27). Participants viewed unpleasant and neutral images and were instructed to simply react to the images or reappraise their emotional response. Both pre- and post-instruction LPP amplitudes were scored, in addition to self-reported ratings of negative emotion collected during the task. We found greater LPP amplitude to emotionally salient compared to neutral stimuli, reduced LPP amplitude following instructions to reappraise emotional response to stimuli across groups, and a blunted LPP overall for individuals with higher depressive symptoms. Additionally, we demonstrated that older adults with low emotional well-being were less successful at reappraisal according to self-reported ratings of negative emotion, although this was not reflected in the LPP. Collectively, these data suggest that laboratory-based ER tasks might be used to understand abnormal ER use-though the LPP may be more sensitive to depression than individual differences in ER ability.

Cognitive reappraisal, emotional suppression, and depressive and anxiety symptoms in later life: The moderating role of gender.

OBJECTIVES: Although socioemotional selectivity (SST) suggests that people experience more positive affect as they age, symptoms of anxiety and depression persist and are often greater in older women than men. Coping strategies may influence the extent to which older adults experience these symptoms. The purpose of the current study is to examine possible gender differences in the use of an adaptive (cognitive reappraisal (CR) and a maladaptive (emotive suppression (ES) emotion regulation strategy in relation to depressive and anxiety symptoms. METHOD: Our study uses cross-sectional data drawn from a community sample of older adults (60+; n = 906). We used OLS regression and moderation analyses to test our study hypotheses. RESULTS: Gender moderated the association between CR in both depressive and anxiety symptoms. Women reported greater use of CR relative to men. Further, CR use was negatively related to symptoms of anxiety and depression in women, but not men. In contrast, men used ES more frequently than women, though older men and women's use of ES was unrelated to anxiety or depressive symptoms. CONCLUSION: Our findings provide initial evidence that greater CR use in older women is related to lower symptoms of both anxiety and depression relative to older men. Age-related increases in CR use (e.g. SST) among women may serve to decrease anxiety and depression symptoms. Findings suggest decreasing anxiety and depressive symptoms via CR may benefit older women more than older men. Future research is needed to identify the coping strategies that are most beneficial for men.

Dog Walking and the Social Impact of the COVID-19 Pandemic on Loneliness in Older Adults.

Pet ownership can provide important companionship and facilitate social connections, which may be particularly important to socially isolated older adults. Given the significant deleterious impact of loneliness on health and wellbeing in later life, many predicted that public safety measures imposed during the COVID-19 pandemic would greatly increase loneliness, particularly among vulnerable populations like older adults. We investigated whether dog walking buffers loneliness in the context of stressors imposed by the COVID-19 pandemic. Longitudinal survey data were obtained from a Florida community-based sample of adults (n = 466) aged 60+ years old in September 2018 and October 2020. Using OLS regression models, we tested: a) the association between the social consequences of COVID-19 and changes in loneliness, and b) the buffering effect of dog walking on this relationship. The high social consequences of COVID-19 were related to increases in loneliness. Walking a dog daily buffered the relationship. These results suggest potential therapeutic effects of dog walking for the promotion of mental health in older adults, particularly in the context of stressful situations that accentuate risks for loneliness.

Cognitive reappraisal and the association between depressive symptoms and perceived social support among older adults.

OBJECTIVES: There is an association between depression and diminished social support; indeed, interpersonal dysfunction is often a central feature of depression. The purpose of this study is to examine the role that an emotion regulation (ER) strategy, cognitive reappraisal, plays in influencing the association between depressive symptoms and perceived social support in older adults. METHOD: Data for this cross-sectional study come from a community-based survey of older adults (60+, N = 910). We examined the effects of depressive symptoms and cognitive reappraisal on perceived social support. We then examined the potential moderating role of cognitive reappraisal on the association between depressive symptoms and perceived social support. RESULTS: Depressive symptoms were associated with lower levels of perceived social support. Cognitive reappraisal was associated with higher levels of perceived social support. Cognitive reappraisal moderated the negative consequences of depressive symptoms on perceived social support. Whereas depressive symptoms had a negative effect on perceived social support, the negative effect was greater for those with lower levels of cognitive reappraisal compared to those with higher levels of cognitive reappraisal. DISCUSSION: ER strategies may play a role in attenuating the negative consequences of depressive symptoms on social support in older age. It may be possible to help individuals maintain social support in later life, even in the face of mental health challenges, if they cultivate ER skills.

The Interpersonal and Psychological Impacts of COVID-19 on Risk for Late-Life Suicide.

Older adults experience increased risk for suicide compared to the general population, and the circumstances surrounding the Coronavirus Disease 2019 (COVID-19) may potentiate this risk. We discuss how current COVID-19 pandemic-related policies are likely to harm older adults disproportionately. COVID-19 pandemic social distancing policies and ethical guidelines for COVID-19 treatment may exacerbate experiences of social isolation, perceived expendability, and exposure to suffering, which are related to the 3 main components of the Interpersonal Theory of Suicide (i.e., thwarted belongingness, perceived burdensomeness to society, and capability for suicide). The COVID-19 pandemic poses a drain on services and has drawn ethical debates about policies around treating younger adults first. These experiences may lead older adults to have reduced access to needed medical and psychiatric services and may convey damaging messages of expendability. Furthermore, the potential prolonged stress associated with the COVID-19 pandemic may affect neurological, immunological, and health functioning-exacerbating suicide risk. Potential venues to increase treatment options and decrease social isolation are discussed. We acknowledge optimistic effects as well, such as "pulling together" as a society and the many valuable ways older adults may contribute during this crisis.

Suicidal ideation in the context of prospective firearm ownership.

Most suicide deaths in the United States are enacted with a firearm, and recent and first-time purchasers of firearms represent at-risk groups. This study aimed to examine differences in indicators of suicide risk among individuals who either (a) reported current firearm ownership/access or (b) denied current firearm ownership/access but reported an intention to obtain a firearm (i.e., prospective firearm owners). Participants were 96 young adults with a lifetime history of suicidal ideation and firearm ownership, access, or interest. We assessed recent suicidal ideation severity with the Depressive Symptom Index-Suicidality Subscale (DSI-SS) and sought to internally replicate findings with the Patient Health Questionnaire (PHQ-9) item 9. Fifty-two (54.2%) participants reported firearm ownership/access and 44 (45.8%) identified as prospective firearm owners. Prospective firearm owners had significantly greater DSI-SS suicidal ideation severity scores compared with those who already own/have access to a firearm, corresponding to a medium effect size; results were consistent with the PHQ-9 suicidal ideation item. Findings of this initial investigation suggest that the intention to commence firearm ownership might represent an at-risk period, especially for individuals with a history of suicidal thinking. Replication of findings in larger and more clinically severe samples is needed.

A pilot randomized clinical trial of a lethal means safety intervention for young adults with firearm familiarity at risk for suicide.

OBJECTIVE: Firearms are the most common method of suicide in the United States. The provision of firearm-specific lethal means safety interventions is a best practice for the prevention and management of suicide risk. However, few data exist to inform firearm-specific lethal means safety interventions. This study tested four different lethal means safety interventions that varied on two dimensions salient to health behavior change (i.e., fear appeals and emphasis on temporariness). METHOD: Overall, 96 college-enrolled young adults with a history of suicidal ideation and current firearm familiarity (i.e., firearm ownership, access, and/or a desire/intention to obtain a firearm) were randomized to one of four different firearm-specific lethal means safety interventions occurring in the context of the Safety Planning Intervention. Assessments occurred at preintervention, postintervention, and 1-month follow-up. RESULTS: Participants who received the firearm-specific lethal means safety intervention that deemphasized fear and emphasized temporariness reported significantly greater intentions to adhere to clinician recommendations to limit their access to firearms for safety purposes compared to individuals randomized to the other groups (Intervention × Time), F(6, 184) = 2.300, p = .036, corresponding to a medium effect size (ηp² = .070). Across groups, 35.4% of participants reported an increase in engagement in firearm safety thoughts/behaviors from preintervention to 1-month follow-up; there were no significant group differences. All four intervention approaches were rated as similarly highly acceptable. CONCLUSIONS: Findings underscore the potential importance of deemphasizing fear and emphasizing temporariness in firearm-specific lethal means safety interventions. Future studies leveraging these pilot data are needed to replicate and extend findings. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Psychological Health Benefits of Companion Animals Following a Social Loss.

BACKGROUND AND OBJECTIVES: In later life, the loss of a spouse due to divorce or widowhood is common and can lead to elevated depressive symptoms and loneliness. Research suggests that companion animal (CA) may be beneficial for psychological health, but limited research has explored whether CA can buffer negative consequences of social losses. RESEARCH DESIGN AND METHODS: This study uses data drawn from the Health and Retirement Study (HRS) to examine changes in depressive symptoms and loneliness in relation to a social loss among those with/without a CA. We used inverse-probability weighted regression to adjust for selection factors and isolate effects of CA ownership on changes in psychological health. RESULTS: Regardless of CA ownership, spousal loss was associated with psychological health consequences. Facing a social loss without a CA was related to statistically greater increases in depressive symptoms relative to those with a pet (2.580 vs. 1.207 symptoms, respectively). Similarly, experiencing a loss was associated with significantly greater increases in loneliness, with statistically greater increases in loneliness among those without a CA (p < .01). However, those with a CA did not experience greater increases in loneliness than those who did not experience a loss. DISCUSSION AND IMPLICATIONS: In later life, CA ownership may buffer against the detrimental consequences of major social losses on psychological health. Future research on the therapeutic effects of CA ownership, as well as pet therapy, during other major life stage transitions is needed to help isolate potential mechanisms driving the benefits of human-animal interactions.

Adverse childhood experiences and coping strategies: identifying pathways to resiliency in adulthood.

OBJECTIVE: The current study examined whether coping strategies mediate the link between adverse childhood experiences (ACEs) and adult psychiatric and physical health outcomes. METHODS: Data were drawn from wave I (N = 7108), wave II (N = 4963), and wave III (N = 3294) of the Midlife Development in the United States (MIDUS) Survey. An ACE count was created using seven aspects of early adversity based on prior literature. Coping variables were created using subscales of the COPE inventory. Psychiatric and health outcomes were assessed at baseline and at the 20-year follow-up. Bootstrapping mediation analyses were conducted using MPLUS to examine the link between ACEs and health outcomes and to determine if coping strategies mediate these relationships. RESULTS: Results of path analyses in Mplus showed that ACEs, reported at Wave I, were associated with worse psychiatric and physical health outcomes at Wave III. ACEs at Wave I were associated with greater use of avoidant emotion-focused coping and lower use of problem-focused strategies at Wave II. Avoidant emotion-focused coping at Wave II partially mediated the relationship between ACEs, reported at Wave I, and psychiatric and physical health outcomes reported at Wave III. No significant mediation was detected for problem-focused coping. CONCLUSIONS: Coping strategies may be an important point target for prevention or intervention for individuals who have experienced ACEs.

The Role of Maternal Relationship in the Persisting Effect of Combat Exposure.

BACKGROUND AND OBJECTIVES: The veteran population is aging. Combat exposure is associated with negative health and psychological outcomes in some, but not all veterans; others even appear to experience gains. One mechanism driving these varied responses might be early life relationships. This study investigated the extent to which the quality of early maternal relationships influences the association between combat exposures and life satisfaction (LS) among older male veterans. RESEARCH DESIGN AND METHODS: Data were drawn from a pooled sample of male veterans in the Health and Retirement Study who completed the 2013 Veteran Mail Survey (N = 1,160). We used ordinary least squares regression to examine the association between combat exposures (with and without exposure to death) and LS, and the moderating effect of maternal relationship quality on this association. RESULTS: We found a significant positive association between maternal relationship quality and LS, and a significant association of combat that was dependent on maternal relationship quality. Specifically, combat-exposed veterans with poor maternal relationship quality reported lower LS, whereas combat-exposed veterans with high relationship quality reported higher LS-relative to their noncombat-exposed counterparts. The effects of exposure to death of hazardous toxins did not mediate or moderate this relationship. DISCUSSION AND IMPLICATIONS: Findings indicate that maternal relationships had a lasting influence on whether combat contributed to a positive, negative, or neutral long-term effect on wellbeing. Findings support previous studies that suggest early life factors may play an important role in the fostering of resilient health outcomes over the life course. Implications for preventative strategies in soldiers are discussed.

Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation.

Firefighters experience high rates of posttraumatic stress disorder (PTSD). It is imperative to identify malleable factors that protect against the development of PTSD symptoms among this population. We examined whether perceptions of belongingness broadly (Study 1) and social support from supervisors, coworkers, and family/friends specifically (Study 2) are associated with lower PTSD symptom severity among firefighters. Study 1 included 840 U.S. firefighters (91.1% male); participants completed the Interpersonal Needs Questionnaire and PTSD Checklist-Civilian Version. Study 2 included 200 U.S. women firefighters exposed to a Criterion A traumatic event; participants completed the Generic Job Stress Questionnaire, Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders-5, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5. Linear regression analyses were conducted, adjusting for the number of years participants served as firefighters. Greater belongingness broadly (Study 1; b = -0.740, p < .001) as well as social support specifically (Study 2) from supervisors (b = -4.615, p < .001), coworkers (b = -4.465, p = .001), and family/friends (b = -3.206, p = .021) were associated with less severe PTSD symptoms. When all sources of social support were entered into a single model, only support from supervisors was significantly associated with lower overall PTSD symptom severity (b = -4.222, p = .004). Belongingness and social support may protect against the development of PTSD among firefighters. Supervisor social support may be particularly salubrious, suggesting that top-down mental wellness promotion within the fire service may be indicated to protect firefighters against PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Typologies of older adult companion animal owners and non-owners: moving beyond the dichotomy.

Objectives: Research on the influence of companion animals (CA) on the health of older adults has yielded contradictory results. Selection factors, leading to heterogeneity both between and within groups of CA owners and non-owners, likely bias results. We conduct analyses to identify typologies of owners and non-owners. Methods: Using data on older adults (60+) from the 2012 Health and Retirement Study (HRS), and the HRS companion animal module, (owners = 478) and (non-owners = 624), we conducted latent class analyses (LCA). We used key demographic, health, daily engagement, and pet characteristic variables to complete our analyses. Results: Analyses revealed five clusters of CA owners and four clusters of non-owners. Health and CA related characteristics distinguishing clusters suggest important sources of variability and reflect qualitatively different profiles of owners and non-owners. We also found CA owners were more likely than non-owners to be high on neuroticism and to be less extroverted than non-owners-but again there was considerable within group variability. Implications: Factors that select people into pet ownership not only work individually to characterize ownership, they create distinct typologies of CA owners and non-owners that likely contribute to subsequent health outcomes. In order to determine if having a CA is beneficial to health in later life and for whom, future research should consider selection factors like those identified in the typologies. Statistical analyses, such as LCA, that can adequately account for these selection factors is necessary to avoid biases in the interpretation of results.