Development, feasibility, and acceptability of a process based intervention to decrease internalized ageism.

A lifetime of exposure to ageism may be internalized in older adults, and these ageist beliefs that are directed inwards can have severe consequences. However, research on reducing internalized ageism is scarce. To address this, we designed and implemented a six-week online process-based intervention to reduce internalized ageism and to assess its feasibility. The intervention utilized a process-based therapy approach targeting psychological, behavioral, and physiological pathways through which internalized ageism negatively impacts health, as specified by stereotype embodiment theory. Intervention components included education, acceptance and commitment therapy techniques, and attributional retraining. A total of 81 older adult participants participated in the feasibility study. Most participants rated each session and the overall program as very useful after each session (average program usefulness rating of 4.54/5). Participants also attributed a wide range of novel behaviors to this intervention and stated that they felt it changed their perspectives on ageism and/or internalized ageism. Results from this study provide a promising foundation from which to advance research on interventions that address internalized ageism - a problem that has severe consequences on the health and well-being of growing numbers of older adults globally.

Reimagine Aging: A Process-Based Intervention to Decrease Internalized Ageism.

OBJECTIVES: Exposure to ageism may be internalized in older adults, and this can have severe consequences. However, little research has addressed reducing internalized ageism. Thus, Reimagine Aging, a 6-week process-based intervention to reduce internalized ageism, was designed and implemented, using education, acceptance and commitment therapy, and attributional retraining to target theoretically based mechanisms of change. METHODS: Seventy-two older adults (M = 70.4 years, SD = 6.4 years) participated in Reimagine Aging, consented to participate in this robust single-sample pilot study, and provided valid data. Participants completed questionnaires prior to, immediately following, and 2 months after the intervention. RESULTS: Participants' self-perceptions of aging (ηp2=0.37, p < .001) and perceptions of older adults (ηp2=0.27, p < .001) became significantly more positive, associated with large effect sizes. Furthermore, these positive gains were mediated by increases in psychological flexibility, mindfulness, and perceived control. DISCUSSION: This study provides initial support for this process-based intervention targeting a reduction of internalized ageism. CLINICAL IMPLICATIONS: This program has the potential to reduce the negative impact internalized ageism has on the health of older adults. Furthermore, it provides novel insights into intervention targets and tools that may be useful in achieving this reduction.

A Qualitative Analysis of the Impact of Preoperative Mindfulness-Based Stress Reduction on Total Knee Arthroplasty Surgical Experiences.

We qualitatively explored the impact of preoperative mindfulness-based stress reduction (MBSR) on total knee arthroplasty (TKA) experiences. Participants (n = 10) who received MBSR prior to TKA participated in semi-structured interviews concerning their experiences with MBSR and its perceived impact on surgery. We analyzed interviews according to reflexive thematic analysis, and coded data into three main themes: 1) Impact of MBSR on surgery experiences; 2) Contributors to change; and 3) Motivations for participation. Participants noted they were able to relax, feel more confident, and cope more effectively during the preoperative period, and that others in their lives noticed positive changes following their participation in MBSR. Participants' openness to mindfulness and health-related beliefs and may have contributed to the positive impacts they experienced from MBSR. Participants described being motivated to participate in MBSR to help them prepare for their surgery and to learn new coping strategies. Participants described a strong level of commitment to the intervention. With further research, integration of MBSR into prehabilitation for TKA may be appropriate.

Perceived control moderates the internalized stigma model of seeking mental health services in distressed older adults.

Older adults are especially unlikely to seek mental health services, and internalized stigma is a key reason why. However, little research has investigated which older adults are particularly likely to have stigma influence help-seeking. To address this, we tested whether perceived control (PC) moderates an internalized stigma model in which public stigma is internalized as self-stigma, which negatively predicts help-seeking attitudes and help-seeking intentions. We employed moderated mediation analysis of cross-sectional, secondary data from 348 psychologically distressed Canadian adults aged 65 years and older. Participants completed an online survey that included measures of public stigma of help-seeking, self-stigma of help-seeking, help-seeking attitudes, conditional help-seeking intentions, psychological distress, and PC. PC emerged as a moderator of the internalized stigma model. Those lower in PC were more likely to have public stigma negatively predict help-seeking intentions through the serial mediation of (a) self-stigma and (b) help-seeking attitudes. Further, those lower in PC were more likely to have public stigma internalized as self-stigma and more likely to have negative help-seeking attitudes predict lower help-seeking intentions. Finally, those lower in PC also had lower help-seeking intentions in the face of low levels of self-stigma. These results contribute to a nuanced understanding of which older adults are unlikely to seek help. Identifying PC as a moderator of the internalized stigma model suggests that interventions that enhance PC should protect against public stigma's internalization and improve help-seeking behaviors for older adults who need such help. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neuroticism as a moderator of symptom-related distress and depression in 4 noncancer end-of-life populations.

OBJECTIVES: Neuroticism is a significant predictor of adverse psychological outcomes in patients with cancer. Less is known about how this relationship manifests in those with noncancer illness at the end-of-life (EOL). The objective of this study was to examine the impact of neuroticism as a moderator of physical symptoms and development of depression in patients with amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), end-stage renal disease (ESRD), and frailty in the last 6 months of life. METHODS: We met this objective using secondary data collected in the Dignity and Distress across End-of-Life Populations study. The data included N = 404 patients with ALS (N = 101), COPD (N = 100), ESRD (N = 101), and frailty (N = 102) in the estimated last 6 months of life, with a range of illness-related symptoms, assessed longitudinally at 2 time points. We examined neuroticism as a moderator of illness-related symptoms at Time 1 (∼6 months before death) and depression at Time 2 (∼3 months before death) using ordinary least squares regression. RESULTS: Results revealed that neuroticism significantly moderated the relationship between the following symptoms and depression measured 3 months later: drowsiness, fatigue, shortness of breath, wellbeing (ALS); drowsiness, trouble sleeping, will to live, activity (COPD); constipation (ESRD); and weakness and will to live (frailty). SIGNIFICANCE OF RESULTS: These findings suggest that neuroticism represents a vulnerability factor that either attenuates or amplifies the relationship of specific illness and depressive symptoms in these noncancer illness groups at the EOL. Identifying those high in neuroticism may provide insight into patient populations that require special care at the EOL.

Where would Canadians prefer to die? Variation by situational severity, support for family obligations, and age in a national study.

BACKGROUND: Death at home has been identified as a key quality indicator for Canadian health care systems and is often assumed to reflect the wishes of the entire Canadian public. Although research in other countries has begun to question this assumption, there is a dearth of rigorous evidence of a national scope in Canada. This study addresses this gap and extends it by exploring three factors that moderate preferences for setting of death: situational severity (entailing both symptoms and supports), perceptions of family obligation, and respondent age. METHODS: Two thousand five hundred adult respondents from the general population were recruited using online panels between August 2019 and January 2020. The online survey included three vignettes, representing distinct dying scenarios which increased in severity based on symptom management alongside availability of formal and informal support. Following each vignette respondents rated their preference for each setting of death (home, acute/intensive care, palliative care unit, nursing home) for that scenario. They also provided sociodemographic information and completed a measure of beliefs about family obligations for end-of-life care. RESULTS: Home was the clearly preferred setting only for respondents in the mild severity scenario. As the dying scenario worsened, preferences fell for home death and increased for the other options, such that in the severe scenario, most respondents preferred a palliative care or hospice setting. This pattern was particularly distinct among respondents who also were less supportive of family obligation norms, and for adults 65 years of age and older. CONCLUSIONS: Home is not universally the preferred setting for dying. The public, especially older persons and those expressing lower expectations of families in general, express greater preference for palliative care settings in situations where they might have less family or formal supports accompanied by more severe and uncontrolled symptoms. Findings suggest a) the need for public policy and health system quality indicators to reflect the nuances of public preferences, b) the need for adequate investment in hospices and palliative care settings, and c) continuing efforts to ensure that home-based formal services are available to help people manage symptoms and meet their preferences for setting of death.

A Profile of Social Participation in a Nationally Representative Sample of Canadian Older Adults: Findings from the Canadian Longitudinal Study on Aging.

Social participation has tremendous implications for the physical and mental health of older adults. A growing body of Canadian literature has examined social participation among older adults, including frequency of participation; gender, age, and regional differences in participation; and associations with self-perceived health, loneliness, and life dissatisfaction. The current study adds to this important body of research, using a large, nationally representative sample of adults 45-85 years of age (Canadian Longitudinal Study on Aging [CLSA] baseline data [n = 51,338]), to examine nuanced characteristics associated with social participation (socio-demographics, social support, cognitive ability, mental health, physical conditions), frequency of participation, and the relationship between the aforementioned characteristics and frequency of participation. Findings indicated that compared with those who reported infrequent/no participation, more frequent participation was associated with greater social support, higher cognitive abilities, increased satisfaction with life, fewer depressive symptoms, reduced odds of self-reported mood and anxiety disorders, and fewer self-reported physical conditions. Findings highlight the importance of active social participation, and have important implications for the development and implementation of accessible community programs across Canada.

Examining differential responses to the Take Care of Me trial: A latent class and moderation analysis.

Given prevalent alcohol misuse-emotional comorbidities among young adults, we developed an internet-based integrated treatment called Take Care of Me. Although the treatment had an impact on several secondary outcomes, effects were not observed for the primary outcome. Therefore, the goal of the current study was to examine heterogeneity in treatment responses. The initial RCT randomized participants to either a treatment or psychoeducational control condition. We conducted an exploratory latent class analysis to distinguish individuals based on pre-treatment risk and then used moderated regressions to examine differential treatment responses based on class membership. We found evidence for three distinct groups. Most participants fell in the "low severity" group (n = 123), followed by the "moderate severity" group (n = 57) who had a higher likelihood of endorsing a previous mental health diagnosis and treatment and higher symptom severity than the low group. The "high severity" group (n = 42) endorsed a family history of alcoholism, and the highest symptom severity and executive dysfunction. Moderated regressions revealed significant class differences in treatment responses. In the treatment condition, high severity (relative to low) participants reported higher alcohol consumption and hazardous drinking and lower quality of life at follow-up, whereas moderate severity (relative to low) individuals had lower alcohol consumption at follow-up, and lower hazardous drinking at end-of-treatment. No class differences were found for participants in the control group. Higher risk individuals in the treatment condition had poorer responses to the program. Tailoring interventions to severity may be important to examine in future research.

Perceived Need, Mental Health Literacy, Neuroticism and Self- Stigma Predict Mental Health Service Use Among Older Adults.

OBJECTIVES: Older adults are the least likely age group to seek mental health services. However, few studies have explored a comprehensive range of sociodemographic, psychological, and social barriers and facilitators to seeking treatment in later life. METHODS: A cross-sectional, national sample of Canadian older adults (55+, N = 2,745) completed an online survey including reliable and valid measures of predisposing, enabling, and need characteristics, based on Andersen's behavioral model of health, as well as self-reported use of mental health services. Univariate and hierarchical logistic regressions predicted past 5-year mental health service use. RESULTS: Mental health service use was most strongly and consistently associated with greater perceived need (OR = 11.48) and mental health literacy (OR = 2.16). Less self-stigma of seeking help (OR = .65) and greater neuroticism (OR = 1.57) also predicted help-seeking in our final model, although their effects were not as strong or consistent across gender, marital status, and age subgroups. CONCLUSIONS: The need category was crucial to seeking help, but predisposing psychological factors were also significant barriers to treatment. CLINICAL IMPLICATIONS: Interventions that target older adults high in neuroticism by improving perceptions of need for treatment, mental health literacy, and self-stigma of seeking help may be particularly effective ways of improving access to mental health services.

Efficacy of a minimally guided internet treatment for alcohol misuse and emotional problems in young adults: Results of a randomized controlled trial.

Many young adults struggle with comorbid alcohol misuse and emotional problems (i.e., depression and anxiety). However, there is currently a paucity of evidence-based, integrated, accessible treatment options for individuals with these comorbidities. The main goal of this study was to examine efficacy of a novel online, minimally guided, integrated program for comorbid alcohol misuse and emotional problems in young adults. Method: The study was an open-label two-arm RCT. Participants (N = 222, M age = 24.6, 67.6% female) were randomized to one of two conditions: the Take Care of Me program (an 8-week, online integrated treatment condition consisting of 12 modules), or an online psychoeducational control condition. Intervention modules incorporated content based on principles of cognitive behavioral therapy and motivational interviewing. Participants completed assessment data at baseline, at the end of treatment (i.e., 8 weeks), and at follow-up (i.e., 24 weeks). Data were analyzed using generalized linear mixed models. Results: We observed that participants in the treatment condition showed larger reductions in depression, hazardous drinking, as well as increases in psychological quality of life and confidence at the end of treatment. We did not find group differences on total alcohol use at follow-up, but participants in the treatment group reduced their hazardous drinking and improved their quality of life at 24-week follow-up. Conclusions: Our study provides promising initial evidence for the first iteration of the comorbid alcohol misuse and emotional problems online program.

Caregiver identity in care partners of persons living with mild cognitive impairment.

Research on caregiver identity in the context of memory impairment has focused primarily on more advanced stages of the cognitive impairment trajectory (e.g., dementia caregivers), failing to capture the complex dynamics of early caregiver identity development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was to develop a nuanced understanding of how caregiver identity develops in family and friends of persons living with MCI. Using constructivist grounded theory (ConGT), this study explored caregiver identity development from 18 in-depth interviews with spouses (n = 13), children (n = 3), and friends (n = 2) of persons recently diagnosed with MCI. The overarching themes influencing MCI caregiver identity development included MCI changes, care-related experiences, "caregiver" interpretation, and approach/avoidance coping. These themes influenced how participants primarily identified, represented as I am a caregiver, I am not a caregiver, or liminality (i.e., between their previous identity and a caregiver identity). Irrespective of their current self-identification, all conveyed thinking about their "future self," as providing more intensive care. MCI caregiver identity development in family and friends is a fluid and evolving process. Nearly all participants had taken on care tasks, yet the majority of these individuals did not clearly identify as caregivers. Irrespective of how participants identified, they were engaging in care, and would likely benefit from support with navigating these changes and their new, ambiguous, and evolving roles.

Examining the Dimensionality, Reliability, and Invariance of the Depression, Anxiety, and Stress Scale-21 (DASS-21) Across Eight Countries.

This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale-21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States (N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied.

Understanding the relationship between traumatic suffering, posttraumatic growth, and prosocial variables.

OBJECTIVE: We investigated facets of posttraumatic growth (PTG) theory, including the nature of the index event, the relationship between suffering and PTG, and prosocial correlates of PTG. METHODS: Undergraduate students (N = 253) completed measures of PTG and trauma-related, psychopathology/affect, and prosocial correlates. RESULTS: Differences emerged in PTG according to event severity, with greater PTG for those who experienced a trauma compared to a stressor. PTG was associated with nearly all trauma-related, select psychopathology/affect (e.g., anxiety, positive affect) and prosocial (e.g., empathy, volunteerism) variables. In a multivariable model, race/ethnicity, helpfulness, perceived chronicity of distress, and positive affect were associated with PTG. Curvilinear trends demonstrated that moderate chronicity of distress and current emotional distress from trauma were associated with the greatest PTG. CONCLUSIONS: Findings highlight factors associated with growth, including a moderately distressing trauma, positive affect, and prosocial behavior. Results clarify PTG theory and contribute to understanding conflicting evidence in prior PTG literature.

Associations between physical health conditions and posttraumatic stress disorder according to age.

OBJECTIVES: Posttraumatic stress disorder (PTSD) is associated with various physical health conditions. However, it is unclear whether the relationship between PTSD and physical health conditions differs according to age. This study aims to examine the associations between PTSD and physical health conditions across four adult age categories. METHODS: We analyzed data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed past-year DSM-5 PTSD. Multiple regression analyses examined associations between PTSD (reference = no PTSD) with number and type of physical health conditions in each age category (18-34: "younger adults," 35-49: "middle-aged adults," 50-64: "young-old adults," 65+: "older adults"). RESULTS: The prevalence of nearly all physical health conditions increased according to age, whereas the prevalence of PTSD tended to decrease with age. After adjustment, PTSD was associated with a greater number of physical health conditions among all age categories (b range: 0.62-1.29). Regardless of age category, PTSD was associated with increased odds of cardiovascular and musculoskeletal conditions (AOR range: 1.54-2.34). PTSD was also associated with increased odds of gastrointestinal, hepatobiliary, endocrine/metabolic, respiratory, neurologic conditions, cancer, sleep disorders, and anemia among select age categories (AOR range: 1.70-3.31). For most physical health conditions, the largest effect sizes emerged for younger and middle-aged adults. CONCLUSIONS: PTSD is associated with many physical health conditions across the age spectrum, particularly among younger and middle-aged adults. Results may inform targeted screening and intervention strategies to mitigate risk of physical health conditions among adults with PTSD.

Social engagement mediates the relationship between participation in social activities and psychological distress among older adults.

OBJECTIVE: Participation in social activities often has beneficial effects on mental health among older adults, although the reasons why this is true (i.e., mechanisms or mediators) have received less empirical attention. The objective of this study is to examine whether involvement in social activities is associated with less psychological distress because it fosters social engagement. METHOD: We explored this hypothesis with a sample of 1089 community dwelling Canadians ranging in age from 65 to 93 who completed a cross-sectional online survey that included measures of social participation (i.e., number of activities, time spent in them, and volunteerism), social engagement (i.e., the number of friends and family they see, feel close to, and can discuss personal matters with), and psychological distress. RESULTS: Mediation analyses confirmed our hypothesis that participation in social activities had beneficial effects on psychological distress through social engagement. That is, individuals who participated in greater numbers of social activities were more likely to report social engagement, and greater social engagement was associated with less psychological distress. In addition, when we controlled for the effect of social engagement, involvement in greater numbers of social activities was associated with greater distress. CONCLUSION: Our findings suggest that social engagement is a reason why participation in social activities has benefits for older adults' mental health, and that increasing engagement, both within and outside of typical social activities, is a worthwhile target for efforts to improve mental health among the growing older adult population.

Does Age Impact the Clinical Presentation of Adult Women Seeking Specialty Eating Disorder Treatment?

Recent evidence suggests that eating disorders (EDs) are becoming increasingly common in older women. Previous research examining differences between younger and older women with EDs has been mixed, making it unclear whether older women with EDs represent a distinct group. We sought to determine whether there are age differences in the clinical presentation of women seeking specialty treatment for an ED. We examined the linear relationship between age and clinical constructs among adult women (N = 436) diagnosed with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, ED. Across analyses, there was no impact of age on most measures of ED symptoms, comorbid psychopathology, self-esteem, quality of life, and motivation to change. However, older age was associated with fewer interoceptive awareness difficulties, maturity fears, anxiety symptoms, and body image concerns. These findings suggest that the clinical presentation of older ED cases is largely similar, although somewhat less severe than in younger women. The implications of this research for future research and treatment are discussed.

Choice, coercion, and/or muddling through: Older adults' experiences in seeking psychological treatment.

Help-seeking related to mental health concerns has been found to decrease as age increases . Despite extensive literature devoted to barriers to accessing mental health services, the reasons why older adults are especially unlikely to seek treatment are not well understood. The present study had two objectives concerning the experiences of older adults accessing outpatient psychological treatment: 1) classifying pathways into treatment using the Network Episode Model (NEM; Pescosolido et al., 1998), and 2) critically examining whether these pathways effectively captured the process of seeking treatment for older adults. Utilizing secondary qualitative data from three studies (N = 35), we met our first objective of classifying pathways according to the NEM with directed content analysis. The majority (n = 21, 60%) of older adults willingly accessed treatment (choice) and 42.9% of those involved 'others' in their help-seeking by way of referrals or support. The remaining participants' (n = 14, 40%) pathways into treatment reflected a process of muddling through (being unsure of their need for mental health services and where to access support, or bouncing around the treatment system). No participants' pathways were categorized as coercive. To meet our second objective, we used conventional content analysis to explore how best to categorize pathways to treatment. Findings demonstrated that a minority of participants (n = 10, 28.6%) had a help-seeking journey that represented only one of the three pathways. Instead, most participants described a lengthy period of muddling through, eventually followed by a willingness to seek help. These findings highlight the complex process of seeking treatment, and suggest a need to implement more direct mental health literacy interventions to reduce the amount of time spent muddling through, while improving the experience of mental health help-seeking for older adults.

Older Adults' Narratives of Seeking Mental Health Treatment: Making Sense of Mental Health Challenges and "Muddling Through" to Care.

Older adults who experience challenges related to mental health are unlikely to seek professional help. The voices of older adults who have navigated through mental health issues and systems of care to arrive at psychological treatment are less well understood. We conducted individual interviews with 15 adults aged 61 to 86 who sought psychological treatment. Interviews were audio-recorded, transcribed, and analyzed using narrative methods. We identified several main storylines that describe the meaning-making and treatment-seeking journeys of older adults: resistance to being labeled with mental health problems (telling stories of resistance, defining mental health issues in mysterious and uncontrollable terms, and experiencing internal role conflict); muddling through the help-seeking process (manifestations of chaos and system-level barriers); and emotional reactions to psychological treatment (hope, fear, and mistrust). Findings add to the literature base in the area of narrative gerontology, and highlight the complex experiences that older adults face when seeking psychological treatment.

Examining social isolation and loneliness in combination in relation to social support and psychological distress using Canadian Longitudinal Study of Aging (CLSA) data.

BACKGROUND: Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress. METHODS: The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789). RESULTS: Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group. CONCLUSION: Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals.

Examining the cross-sectional and longitudinal effects of anxiety sensitivity on indicators of disease severity among patients with inflammatory arthritis.

Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were self-reported. Arthritis severity was physician-assessed (disease activity scales) and self-reported (physical function; pain and fatigue). Cross-sectional correlations assessed the association between AS and arthritis severity outcomes. Longitudinal multivariable mixed-effect regressions assessed the association of AS total and AS factors at each visit with disease severity outcomes. All AS factors were significantly and positively correlated (at the same visit) with function, pain, and fatigue. AS total significantly predicted pain, fatigue, and function. Cognitive AS significantly predicted fatigue, and physical AS significantly predicted pain and fatigue. Social AS significantly predicted pain, fatigue, function and weighted joint count (articular burden). AS is associated with several indicators of disease severity among those with IA; unique findings emerged across factors with the broadest disease impact by social AS. The AS factors, especially social AS, may contribute to the development and severity of IA symptoms, which may have implications for interventions.