Daily Marital Tension and Symptom Severity in Older Adults With Diabetes or Osteoarthritis.

Background: Greater marital quality is associated with better psychological and physical health. The quality of daily marital interactions is likely to be especially important for individuals with chronic illness, but this question has received little attention. Purpose: Using data from two diary studies, the current study examined whether individuals with chronic illness would experience more severe symptoms on days with more marital tension due in part to greater negative affect on those days. Methods: The samples included individuals with knee osteoarthritis (OA, N = 145) or type 2 diabetes mellitus (T2DM, N = 129) and their spouses. Participants reported on daily marital interaction quality, affect, and symptom severity (patients only) for 22 days (knee OA) or 24 days (T2DM). Separate multilevel models were run for patients and spouses, controlling for the partner's marital tension and negative affect as well as both partners' daily marital enjoyment and positive affect. We examined same-day and across-day associations. Results: For individuals with T2DM or knee OA, more severe symptoms on days with more marital tension were due in part to their greater negative affect on those days. Individuals with knee OA who experienced more pain had more negative affect and marital tension the next day. Conclusions: Negative marital interactions may exacerbate physical symptoms. Effects of daily marital tension likely accumulate over time and have long-term implications for health.

Independent and Interactive Effects of OPRM1 and DAT1 Polymorphisms on Alcohol Consumption and Subjective Responses in Social Drinkers.

BACKGROUND: The current study examined independent and interactive effects of polymorphisms of the mu opioid receptor gene (OPRM1, A118G) and variable number tandem repeats of the dopamine transporter gene (DAT1, SLC6A3) on alcohol consumption and subjective responses to alcohol in 127 young, healthy, social drinkers. METHODS: Participants completed an in-person assessment, which included self-reported alcohol drinking patterns and blood sampling for DNA, and in a second visit, a cumulative alcohol dosing procedure with subjective ratings across multiple time points and breath alcohol contents (0.03 to 0.1%). DNA was analyzed for OPRM1 AA versus AG/GG (*G) genotypes, DAT1 10-repeat allele (A10) versus 9 or lesser alleles (A9), and ancestral informative markers. RESULTS: There were significant epistatic interactions between OPRM1 and DAT1 genotypes. Subjective High Assessment Scale scores after alcohol consumption were highest in *G and A9 carriers, and lowest in *G and A10 carriers. Negative subjective effects were also highest in *G and A9 carriers. Effects were similar in a sensitivity analysis limited to Caucasian subjects. There were independent and epistatic interactions on drinking. The OPRM1 *G allele was independently associated with fewer heavy drinking days. The A9 allele was associated with a greater number of drinking days, which was attenuated in carriers of the *G allele. CONCLUSIONS: These findings highlight the biological importance of interactions between these 2 genes and interactions between brain opioid and dopamine systems.

Anxiety, Anxiety Sensitivity, and Perceived Stress as Predictors of Recent Drinking, Alcohol Craving, and Social Stress Response in Heavy Drinkers.

BACKGROUND: Stress and anxiety are widely considered to be causally related to alcohol craving and consumption, as well as development and maintenance of alcohol use disorder (AUD). However, numerous preclinical and human studies examining effects of stress or anxiety on alcohol use and alcohol-related problems have been equivocal. This study examined relationships between scores on self-report anxiety, anxiety sensitivity, and stress measures and frequency and intensity of recent drinking, alcohol craving during early withdrawal, as well as laboratory measures of alcohol craving and stress reactivity among heavy drinkers with AUD. METHODS: Media-recruited, heavy drinkers with AUD (N = 87) were assessed for recent alcohol consumption. Anxiety and stress levels were characterized using paper-and-pencil measures, including the Beck Anxiety Inventory (BAI), the Anxiety Sensitivity Index-3 (ASI-3), and the Perceived Stress Scale (PSS). Eligible subjects (N = 30) underwent alcohol abstinence on the Clinical Research Unit; twice daily measures of alcohol craving were collected. On day 4, subjects participated in the Trier Social Stress Test; measures of cortisol and alcohol craving were collected. RESULTS: In multivariate analyses, higher BAI scores were associated with lower drinking frequency and reduced drinks/drinking day; in contrast, higher ASI-3 scores were associated with higher drinking frequency. BAI anxiety symptom and ASI-3 scores also were positively related to Alcohol Use Disorders Identification Test total scores and AUD symptom and problem subscale measures. Higher BAI and ASI-3 scores but not PSS scores were related to greater self-reported alcohol craving during early alcohol abstinence. Finally, BAI scores were positively related to laboratory stress-induced cortisol and alcohol craving. In contrast, the PSS showed no relationship with most measures of alcohol craving or stress reactivity. CONCLUSIONS: Overall, clinically oriented measures of anxiety compared with perceived stress were more strongly associated with a variety of alcohol-related measures in current heavy drinkers with AUD.

Spouse confidence and physical function among adults with osteoarthritis: The mediating role of spouse responses to pain.

OBJECTIVE: This study of adults with osteoarthritis and their spouses examined spouse responses to patients' pain as mediators of the associations between spouse confidence in patients' ability to manage arthritis and improvements in patients' physical function and activity levels over time. METHOD: Participants were 152 older adults with knee osteoarthritis and their spouses. In-person interviews were conducted with patients and spouses (separately) at 3 time points: baseline (Time[T] 1), 6 months after baseline (T2), and 18 months after baseline (T3). At each time point, patients reported their self-efficacy for arthritis management, functional limitations, and time spent in physical activity; spouses reported their confidence for patients' arthritis management and their empathic, solicitous, and punishing responses to patients' pain. Multiple mediation regression models were used to examine hypothesized associations across 2 distinct time frames: 6 months (T1-T2) and 12 months (T2-T3). RESULTS: Across 6 months, spouse confidence was indirectly related to improvements in patients' functional limitations and activity levels through increased empathic responses to patient pain. Across 12 months, spouse confidence was indirectly related to improvements in patients' functional limitations and activity levels through decreased solicitous responses to patient pain. CONCLUSIONS: This study adds to the literature on spousal influences on health by identifying 2 spouse behaviors that help to explain how spouse confidence for patients' illness management translates into improvements in patients' physical health over time. Findings can inform the development of couple-focused illness management interventions aiming to increase the positive influence of the spouse on patients' health behaviors and outcomes. (PsycINFO Database Record

Too much of a good thing? Overexertion of self-control and dietary adherence in individuals with Type 2 diabetes.

OBJECTIVES: The resource model of self-control posits that self-control is a finite resource that can be depleted. Individuals with diabetes must continually restrict their diet, requiring self-control. As a result, dietary adherence is difficult, and lapses are common. People with diabetes who overexert self-control following a lapse may be especially likely to experience a subsequent relapse, as suggested by the resource model. This investigation used the resource model of self-control to test whether overexertion of dietary self-control following a lapse would be predictive of a subsequent relapse in dietary control. DESIGN: We tested this prediction in a daily diary study of 128 individuals with diabetes (Mage  = 66.12). METHODS: Participants' reports of their daily dietary adherence were used to define lapses in adherence, post-lapse adherence, and relapses. RESULTS: Individuals who overexerted self-control after a lapse were more likely to experience a subsequent relapse (OR = 3.276, p = .016) and to do so sooner (HR = 2.12, p = .023). CONCLUSIONS: People with diabetes may seek to compensate for a lapse in adherence by overexerting self-control, but doing so may deplete their self-control and increase the risk of a future relapse. Statement of contribution What is already known on this subject? The resource model of self-control posits that self-control is a limited resource that can be temporarily depleted. Numerous experimental studies have demonstrated support for this model showing that when participants are instructed to engage in a self-control task, they produce less self-control on a subsequent task. The majority of the existing studies are not conducted in naturalistic settings and do not use patient populations. What does this study add? This study is an ecologically valid test of the resource model of self-control. This study applies the resource model of self-control to a patient population.

Hypothalamic-pituitary-adrenal axis response to acute psychosocial stress: Effects of biological sex and circulating sex hormones.

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis influences the risk for developing stress-related disorders. Sex-dependent differences in the HPA axis stress response are believed to contribute to the different prevalence rates of stress-related disorders found in men and women. However, studies examining the HPA axis stress response have shown mixed support for sex differences, and the role of endogenous sex hormones on HPA axis response has not been adequately examined in humans. This study utilized the largest sample size to date to analyze the effects of biological sex and sex hormones on HPA axis social stress responses. Healthy, 18- to 30- year-old community volunteers (N=282) completed the Trier Social Stress Test (TSST), a widely used and well-validated stress-induction laboratory procedure. All women (n=135) were tested during the follicular phase of their menstrual cycle (when progesterone levels are most similar to men). Adrenocorticotropic hormone (ACTH) and cortisol measures were collected at multiple points throughout pre- and post-TSST. Testosterone and progesterone (in men) and progesterone and estradiol (in women) were determined pre-TSST. Following the TSST, men had greater ACTH and cortisol levels than women. Men had steeper baseline-to-peak and peak-to-end ACTH and cortisol response slopes than women; there was a trend for more cortisol responders among men than women. Testosterone negatively correlated with salivary cortisol response in men, while progesterone negatively correlated with ACTH and cortisol responses in women. These data confirm that men show more robust activation of the HPA axis response to the TSST than do women in the follicular phase of the menstrual cycle. Testosterone results suggest an inhibitory effect on HPA axis reactivity in men. Progesterone results suggest an inhibitory effect on HPA axis reactivity in women. Future work is needed to explain why men mount a greater ACTH and cortisol response to the TSST than do women during the follicular phase of the menstrual cycle.

Emotional reactivity to daily stress, spousal emotional support, and fasting blood glucose among patients with type 2 diabetes.

Stress is associated with higher blood glucose in patients with diabetes, but the strength of this association varies considerably across patients. The current daily diary study of 129 patients with type 2 diabetes examined whether individual differences in emotional stress reactivity were associated with fasting blood glucose and whether emotional support provided by spouses moderated this association. Greater stress reactivity was related to greater variability in patients' fasting glucose readings and, among patients with less support, to higher fasting glucose levels. Investigating individual differences in emotional stress reactivity may help to clarify the role of stress in blood glucose control.

Effects of change in arthritis severity on spouse well-being: The moderating role of relationship closeness.

The severity of a patient's illness may be detrimental for the psychological well-being of the spouse, especially for those in a particularly close relationship. Using 2 waves of data collected from a sample of 152 knee osteoarthritis (OA) patients and their spouses, we examined associations between change in patients' illness severity and change in 3 indicators of spouses' well-being (positive affect, depressive symptoms, and life satisfaction) over a 6-month period. We also tested the hypothesis that spouses' perceived relationship closeness with the patient would moderate these associations. Consistent with our prediction, a high level of relationship closeness exacerbated the negative impact of increases in patient illness severity on spouses' positive affect and depressive symptoms over 6 months. Spouses' life satisfaction declined when patients became more ill, regardless of level of relationship closeness. Our findings highlight the value of examining change in illness as a predictor of change in spouse well-being and the potential downside of relationship closeness for couples living with chronic illness.

Spouse confidence in self-efficacy for arthritis management predicts improved patient health.

BACKGROUND: In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention. PURPOSE: The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health. METHODS: Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients' efficacy were assessed in a sample of knee osteoarthritis patients (N = 152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models. RESULTS: Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year. CONCLUSIONS: Our findings add to a growing literature that highlights the important role of spouse perceptions in patients' long-term health.

Spouses' involvement in their partners' diabetes management: associations with spouse stress and perceived marital quality.

Spouses frequently attempt to influence (control) or support their chronically ill partners' adherence behaviors. Studies have documented effects of spousal control and support on chronically ill individuals, but little is known about how these two forms of involvement in a partner's disease management may be associated with spouses' stress or the quality of their interactions with their ill partners. The current study sought to address this gap by examining spouses' day-to-day involvement in their marital partner's management of type 2 diabetes (n = 129). Multilevel analyses of daily diary data revealed that on days when spouses exerted control, they reported more stress and more tense marital interactions, although these associations were more pronounced when patients exhibited poor adherence, had been ill for a longer period of time, and had more comorbid health conditions. On days when spouses provided support, in contrast, they reported less stress and more enjoyable marital interactions. The findings from the current study suggest that spouses' day-to-day stress and quality of interactions with their partners are associated with spouses' involvement in their partners' disease management, with health-related social control and support exhibiting distinctive associations.

The impact of daily arthritis pain on spouse sleep.

Although chronic pain has been linked to poorer psychosocial well-being in the spouse, the extent to which patient pain affects spouse sleep is unknown. The aim of the present study was to test the hypothesis that greater daily knee pain would be associated with poorer sleep for the spouse that evening. We also tested the hypothesis that this pain contagion is exacerbated in couples who have a close relationship. A total of 138 knee osteoarthritis (OA) patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that greater knee OA pain at the end of the day was associated with spouses' poorer overall sleep quality that night and feeling less refreshed after sleep. In contrast, there was no evidence that spouse sleep was related to greater patient pain the next day. The effects of patient pain on spouse sleep were not due to disturbances in patient sleep and were also independent of spouse sex, depressive symptoms, and physical comorbidities; both partners' negative affect; and the quality of marital interactions throughout the day. As predicted, we also found that patient pain was more strongly related to less refreshing sleep for spouses who were in a close relationship. Findings illustrate that chronic pain may place the spouse's health at risk and suggest an important target for couple-oriented interventions.

Daily verbal and nonverbal expression of osteoarthritis pain and spouse responses.

The current study applied a model of pain communication to examine the distinction between verbal and nonverbal pain expression in their prediction of punishing, empathic, and solicitous spouse responses to patient pain. It was hypothesized that on days when patients engaged in more nonverbal expression, spouses would respond more positively (ie, with less punishing and more solicitous and empathic behavior). The same pattern was predicted for verbal expression. In addition, it was expected that associations between patient nonverbal pain expression and positive spouse responses would be strengthened, and that the association with punishing responses would be weakened, on days when levels of verbal pain expression were higher than usual, regardless of daily pain severity. In a 22-day diary study, 144 individuals with knee osteoarthritis and their spouses completed daily measures of pain expression, spouse responses, health, and affect. The predicted positive main effect of nonverbal expression on empathic and solicitous responses was supported by the data, as was the positive main effect for verbal pain expression. Results from moderation analyses partially supported our hypothesis in that patients' nonverbal pain expression was even more strongly related to empathic and solicitous spouse responses on days of high verbal pain expression, and patients were buffered from spouse punishing responses on days when both nonverbal and verbal expression were high. These findings suggest that pain expression in both verbal and nonverbal modes of communication is important for positive and negative spousal responses.

Older adults' beliefs about the timeline of type 2 diabetes and adherence to dietary regimens.

The common-sense model posits that behavioural coping with illness is shaped by a complex combination of individuals' abstract and concrete beliefs about their illness. We investigated this theoretical assumption in a study of 116 older adults diagnosed with type 2 diabetes who completed in-person interviews at baseline and six and 12 months later. Specifically, we examined (1) the interaction of patients' abstract and concrete beliefs about the timeline of their diabetes as a predictor of change in adherence to a healthy diet and (2) whether these interactive effects differ among male and female patients. Abstract timeline beliefs were conceptualised as those pertaining to disease duration; concrete timeline beliefs were conceptualised as those pertaining to variability of disease symptoms (i.e. symptoms are stable versus fluctuating). As predicted, duration beliefs were positively associated with improvement in adherence among patients who viewed disease symptoms as stable, but not among those who viewed symptoms as variable. When gender was considered, these interactive effects were observed among male (but not female) patients. Findings revealed that the behavioural effects of men's abstract knowledge about their diabetes were conditioned by their concrete representations of the disease, suggesting a bottom-up process of influence with implications for intervention.

Influences of spousal support and control on diabetes management through physical activity.

OBJECTIVES: Spouses may be involved in their partner's diabetes management by providing social support to affirm healthy behaviors and social control to modify health behaviors. Yet, investigations of the influence of spousal involvement on daily patient health behaviors are limited. In daily diaries, we investigated how spousal support and control independently and jointly influence patient physical activity and efficacy to engage in physical exercise on a daily basis. METHODS: Older adults (age 55 and older) with Type 2 diabetes and their spouses (N = 70 couples) completed electronic diaries for seven consecutive days that assessed spouse-reported involvement and patient-reported minutes of physical exercise and efficacy to engage in future physical exercise. A subset of patients (N = 53) also wore an activity monitoring device on the wrist that provided a measure of energy expenditure. RESULTS: Multilevel analyses indicated that on a daily basis, spousal support was positively associated with physical activity, whereas spousal control was either unrelated or linked to less physical activity. On days in which spouses provided high levels of both support and control, however, patients felt more efficacious that day about exercising tomorrow and exhibited an increase in energy expenditure on the next day. CONCLUSIONS: Findings suggest that spousal exercise support on its own or in conjunction with spousal exercise control may facilitate daily diabetes management through physical activity.

Spouses' attempts to regulate day-to-day dietary adherence among patients with type 2 diabetes.

OBJECTIVE: To investigate daily dietary adherence and diabetes-specific distress among older adults with type 2 diabetes mellitus (T2DM) as a function of spouses' diet-related support and diet-related control (persuasion and pressure) and whether these daily processes differ among couples who do and do not appraise responsibility for managing T2DM as shared. METHODS: End-of-day diaries were completed by 126 couples in which one partner had T2DM (patient) and the other did not (spouse). Using electronic diary methods, each partner independently recorded data for 24 consecutive days (patients recorded their day's dietary adherence and diabetes-specific distress; spouses recorded their day's involvement in patients' dietary management). To assess dietary adherence, patients reported the extent to which they followed dietary recommendations that day with items from the Summary of Diabetes Self-Care Activities Measure. To assess diabetes-specific distress, patients reported the extent to which they worried about diabetes that day using items from the Problem Areas in Diabetes (PAID) scale. RESULTS: Multilevel modeling revealed that, relative to the prior day, spouses' diet-related support was associated with increases in patients' adherence whereas diet-related persuasion and pressure were associated with decreases in adherence; spouses' pressure was associated with increases in patients' diabetes-specific distress. When partners appraised responsibility for managing T2DM as shared, support was associated with decreases in diabetes-specific distress; pressure was associated with decreases in adherence. CONCLUSIONS: Our findings offer insight into partners' day-to-day disease-related interactions and identify those that are likely to be beneficial versus detrimental for patients' physical and psychological health.

Daily spousal influence on physical activity in knee osteoarthritis.

BACKGROUND: Physical activity is critical for the management of knee osteoarthritis, and the spouse may play a role in encouraging or discouraging physical activity. PURPOSE: The purpose of this study was to examine four types of spousal influence-spouses' daily activity, autonomy support, pressure, and persuasion-on the daily physical activity of adults living with knee osteoarthritis. METHODS: A total of 141 couples reported their daily experiences for 22 days using a handheld computer and wore an accelerometer to measure moderate activity and steps. RESULTS: Spouses' autonomy support for patient physical activity, as well as their own level of activity, was concurrently associated with patients' greater daily moderate activity and steps. In addition, on days when male patients perceived that spouses exerted more pressure to be active, they spent less time in moderate activity. CONCLUSIONS: Couple-oriented interventions for knee osteoarthritis should target physical activity in both partners and spousal strategies for helping patients stay active.

Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement.

For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes (N = 139 couples) from the perspectives of the patient and spouse. Partners' dyadic expectations and spouses' gender were posited to moderate spouses' diet-related control and patients' diet adherence. Among male patients, when both partners shared an expectation for spouse involvement greater diet-related spouse control was associated with better diet adherence of patients. In contrast, when expectations for spouse involvement were not shared, greater spouse control by wives was associated with poorer diet adherence. Dyadic expectations for spouse involvement did not moderate the association between spouse control and diet adherence among female patients. Findings suggest that shared expectations for spouse involvement can facilitate spouses' attempts to improve patients' dietary adherence, especially among male patients and their wives.

Serotonin transporter-linked polymorphic region (5-HTTLPR) genotype is associated with cortisol responsivity to naloxone challenge.

RATIONALE: The serotonergic and opioidergic neurotransmitter systems are critical regulators of the hypothalamic-pituitary-adrenal (HPA) axis through their respective excitatory and inhibitory inputs. Serotonin transporter (5-HTT) genotype has been studied as a marker of HPA axis dysregulation and for predicting risk of psychopathology, with mixed findings. OBJECTIVES: We stimulated the HPA axis with naloxone, an opioid receptor antagonist, to examine cortisol reactivity based on 5-HTT-linked polymorphic region (5-HTTLPR) genotypes. METHODS: Healthy community volunteers (N = 78) received intravenous (IV) placebo followed by sequential doses of IV naloxone (50, 100, 200, and 400 µg/kg) every 30 min. Plasma cortisol was measured every 15 min. Participants were genotyped for the long (L) and short (S) alleles of the 5-HTT gene and for rs25531 (A/G) in the 5-HTTLPR repetitive element and compared by the 5-HTTLPR/rs25531 genotype (triallele) and by the 5-HTTLPR genotype (biallele) classification. RESULTS: In triallele analyses, individuals with one or more L(A) alleles showed higher cortisol response to naloxone compared with individuals with no L(A) alleles. In biallele analyses, less robust effects were found, although individuals with two L alleles showed a higher cortisol response compared with other genotypes. CONCLUSIONS: Naloxone blockade leads to a greater activation of the HPA axis among individuals with the L(A) allele. Including rs25531 in the analysis with the 5-HTTLPR genotype appears more sensitive in detecting genetic differences in naloxone-induced cortisol than when using only the 5-HTTLPR genotype. Future research should investigate the interactive effects between the serotonergic and opioidergic systems on HPA axis dysregulation and psychopathophysiology.

Setbacks in diet adherence and emotional distress: a study of older patients with type 2 diabetes and their spouses.

OBJECTIVES: We investigated patients' difficulties in managing their diet (i.e. diet setbacks) and associations with change in disease-specific and general emotional distress (diabetes distress and depressive symptoms) among patients with type 2 diabetes and their spouses. METHOD: Data for this study were collected in couples' homes (N=115 couples) using structured interviews and self-administered questionnaires at three time points: baseline (T1), six months after baseline (T2) and 12 months after baseline (T3). RESULTS: Patients' diet setbacks were associated with an increase in their diabetes distress in the shorter-term (over six months). Patients' diet setbacks were not associated with longer-term change in diabetes distress or with change in depressive symptoms at either time point (six months or one year). In contrast, spouses' perceptions of patients' diet setbacks were associated with increases in their own diabetes distress at both time points (over six months and one year), and also with an increase in their depressive symptoms in the longer-term (over one year). CONCLUSION: Findings reveal detrimental consequences of patients' diet nonadherence for emotional well-being that extend to the well-being of their spouses.

Stress and the HPA axis: role of glucocorticoids in alcohol dependence.

Stress has long been suggested to be an important correlate of uncontrolled drinking and relapse. An important hormonal response system to stress-the hypothalamic-pituitary-adrenal (HPA) axis-may be involved in this process, particularly stress hormones known as glucocorticoids and primarily cortisol. The actions of this hormone system normally are tightly regulated to ensure that the body can respond quickly to stressful events and return to a normal state just as rapidly. The main determinants of HPA axis activity are genetic background, early-life environment, and current life stress. Alterations in HPA axis regulation are associated with problematic alcohol use and dependence; however, the nature of this dysregulation appears to vary with respect to stage of alcohol dependence. Much of this research has focused specifically on the role of cortisol in the risk for, development of, and relapse to chronic alcohol use. These studies found that cortisol can interact with the brain's reward system, which may contribute to alcohol's reinforcing effects. Cortisol also can influence a person's cognitive processes, promoting habit-based learning, which may contribute to habit formation and risk of relapse. Finally, cortisol levels during abstinence may be useful clinical indicators of relapse vulnerability in alcohol-dependent people.