Physical activity, posttraumatic stress, and gender: A longitudinal study of post-9/11 veterans.

Given the importance of physical activity (PA) for both physical and mental health, the present study characterizes post-9/11 veterans' leisure-time PA engagement over time. Further, this study examines the relationship between PA and posttraumatic stress symptoms (PTSS), as well as whether this relation differs by gender and time since military discharge. This study was a secondary analysis of a 12-month longitudinal observational investigation of 410 (39.5% female) post-9/11 veterans. Participants completed self-report questionnaires at baseline and 12 months. Over a third of post-9/11 veterans were not engaging in any weekly leisure-time PA at study baseline and PA engagement significantly decreased in the subsequent year. The longitudinal relationship between PA and PTSS depended on both gender and time since military discharge. These results underscore the importance of considering both gender and time since discharge when tailoring interventions to support leisure-time PA as a key health habit in post-9/11 veterans.

When suffering contradicts belief: measuring theodical struggling.

Global meaning systems help people make sense of their experiences, but suffering can violate global meaning and create distress. One type of potential violation is conflict between one's experience of suffering and one's deeply-held beliefs about God as loving, powerful, and just. The problem of theodicy-why an all-powerful and all-loving God would allow suffering-has long been an important theological and philosophical concern, but little is known about how theodicy plays out psychologically for religious individuals facing serious life difficulties. To address this issue within a specific religious tradition, Christianity, we drew upon philosophy, Christian theology, and psychology to develop the construct of theodical struggling. Through theological and philosophical input, we generated a 28-item pool and conducted 10 cognitive interviews with a diverse sample of Christian adults. In three consecutive online studies of Christian adult samples, we reduced the scale to 11 items through PCA, found a strong one-factor solution using EFA, and found support for the one-factor solution along with preliminary reliability and validity. This newly-developed Theodical Struggling Scale represents an important advance in understanding individuals' experiences of ruptures in their beliefs regarding God's goodness and paves the way for future research on this topic. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04642-w.

Target-based fusion using social determinants of health to enhance suicide prediction with electronic health records.

OBJECTIVE: Preventing suicide in US youth is of paramount concern, with rates increasing over 50% between 2007 and 2018. Statistical modeling using electronic health records may help identify at-risk youth before a suicide attempt. While electronic health records contain diagnostic information, which are known risk factors, they generally lack or poorly document social determinants (e.g., social support), which are also known risk factors. If statistical models are built incorporating not only diagnostic records, but also social determinants measures, additional at-risk youth may be identified before a suicide attempt. METHODS: Suicide attempts were predicted in hospitalized patients, ages 10-24, from the State of Connecticut's Hospital Inpatient Discharge Database (HIDD; N = 38943). Predictors included demographic information, diagnosis codes, and using a data fusion framework, social determinants features transferred or fused from an external source of survey data, The National Longitudinal Study of Adolescent to Adult Health (Add Health). Social determinant information for each HIDD patient was generated by averaging values from their most similar Add Health individuals (e.g., top 10), based upon matching shared features between datasets (e.g., Pearson's r). Attempts were then modelled using an elastic net logistic regression with both HIDD features and fused Add Health features. RESULTS: The model including fused social determinants outperformed the conventional model (AUC = 0.83 v. 0.82). Sensitivity and positive predictive values at 90 and 95% specificity were almost 10% higher when including fused features (e.g., sensitivity at 90% specificity = 0.48 v. 0.44). Among social determinants variables, the perception that their mother cares and being non-religious appeared particularly important to performance improvement. DISCUSSION: This proof-of-concept study showed that incorporating social determinants measures from an external survey database could improve prediction of youth suicide risk from clinical data using a data fusion framework. While social determinant data directly from patients might be ideal, estimating these characteristics via data fusion avoids the task of data collection, which is generally time-consuming, expensive, and suffers from non-compliance.

Life meaning and mental health in post-9/11 veterans: the mediating role of perceived stress.

BACKGROUND AND OBJECTIVES: Post-9/11 veterans frequently experience diminished mental health following military service. Life meaning is related to better mental health in veterans, yet its mechanism of action is unknown. A meaning-making model suggests that life meaning can reduce perceived stress, thus enhancing mental health. The present study tested this meaning-making model by predicting multiple dimensions of mental health (i.e., symptoms of posttraumatic stress disorder, anxiety, insomnia, and depression, and mental health quality of life) from life meaning as mediated by perceived stress. DESIGN AND METHODS: The present study was a secondary analysis of a 12-month observational study of 367 post-9/11 veterans. Participants completed demographic and health surveys at baseline, 6-month, and 12-month follow-ups. A multivariate mediation model was created predicting changes in dimensions of mental health from 6 months to 12 months. RESULTS: Higher life meaning at baseline predicted changes in all dimensions of mental health between 6 and 12 months, an effect mediated by changes in perceived stress between baseline and 6 months. CONCLUSIONS: Across dimensions of mental health, the meaning-making model was supported. Understanding post-9/11 veteran mental health from this theoretical perspective may help better tailor healthcare efforts and enhance veteran health overall.

TV exposure, attitudes about targeted food ads and brands, and unhealthy consumption by adolescents: Modeling a hierarchical relationship.

Public health experts raise concerns that extensive exposure to advertising for calorie-dense nutrient-poor food negatively influences adolescents' diets, but few studies have explored how food advertising affects children over age 12. This study examines adolescents' attitudes about highly targeted unhealthy food brands and assesses the hierarchical relationship between TV exposure, intermediary measures of advertising effects, and healthy and unhealthy food consumption. A cross-sectional online survey of 1566 adolescents (13-17 years) measured TV exposure, attitudes about eight highly advertised teen-targeted food brands and their advertising, and unhealthy and healthy food consumption. A theory-based structural equation model (SEM) tested hypothesized paths from TV exposure to unhealthy food consumption, with attitudes about teen-targeted TV ads and brands as intermediary variables, controlling for healthy food consumption and demographic characteristics. Participants reported high liking of targeted-brand advertising (M = 4.05/5.0, SD = 0.65), strong perceptions that the ads were targeted to someone like them (M = 4.07/5.0, SD = 0.66), positive brand attitudes (M = 4.07/5.0, SD = 0.56), brand popularity (M = 4.01/5.0, SD = 0.63), and consuming the brands a few times in the past month on average. As hypothesized, the SEM supported significant positive paths from TV exposure to ad attitudes (ß = 0.50, 95% CI = 0.40-0.60) to brand attitudes (ß = 0.90, 95% CI = 0.87-0.92) to unhealthy food consumption (ß = 0.41, 95% CI = 0.32-0.50). Contrary to expectations, healthy consumption was positively associated with both brand attitudes (ß = 0.11, 95% CI = 0.04-0.18) and unhealthy consumption (ß = 0.42, 95% CI = 0.33-0.51). These results further public health concerns about the potential impact of adolescents' exposure to unhealthy food advertising on brand consumption and unhealthy food consumption more broadly. They also support marketing theories that ad liking and perceived targeting may increase the influence of ad exposure on brand attitudes and unhealthy consumption.

Influences of religiousness/spirituality on mental and physical health in OEF/OIF/OND military veterans varies by sex and race/ethnicity.

BACKGROUND: Religiousness/spirituality (R/S) has been associated with greater mental wellbeing in US military veterans, but this work has been conducted primarily with older veterans, cross-sectionally, using a constrained set of R/S and mental health constructs, and lacking consideration of the influence of sex and race/ethnicity. Further, few studies have focused on associations of R/S with veterans' physical health. METHOD: We investigated the relationship of R/S to mental and physical health in a sample of 410 Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn veterans within five years of military separation and one year later. RESULTS: In the full sample, R/S coping, R/S organized practices and private prayer minimally related to mental or physical wellbeing, yet R/S struggle related inversely to concurrent and subsequent mental and physical health. For women only, higher baseline organized R/S was associated with lower subsequent stress, anxiety, and insomnia. For men only, baseline R/S coping predicted subsequent poorer physical quality of life and baseline R/S struggle predicted subsequent increased pain. For minority race but not white veterans, higher baseline private prayer predicted increased current pain level at 12 months; for Latinx ethnicity only, higher baseline R/S coping predicted increased quality of life a year later and higher baseline R/S struggle predicted higher subsequent levels of anxiety. CONCLUSIONS: R/S, broadly conceptualized, may relate to wellbeing in military veterans in different ways depending on sex and race/ethnicity, with implications for the role of R/S and R/S struggle in personalizing mental and physical health services.

Post-9/11 military veterans' adjustment to civilian life over time following separation from service.

OBJECTIVES: US military veterans face many challenges in transitioning to civilian life; little information is available regarding veterans' reintegration experiences over time. The current study characterized veterans' postdeployment stressful life events and concurrent psychosocial wellbeing over one year and determined how stressors and wellbeing differ by demographic factors. METHODS: Recent Post-911 veterans (n = 402) were assessed approximately every three months for 1 year. Participants were 60% men, primarily White (78%), and 12% Latinx; the average age was 36 years. RESULTS: The frequency of stressful events decreased over time but was higher for men and minority-race veterans (independent of time since separation). Veterans reported high mean levels of posttraumatic stress disorder, anxiety, and insomnia symptoms, which improved slightly over time. Minority-race and Latinx veterans had higher symptom levels and slower rates of symptom reduction. CONCLUSION: Veterans remain distressed in their overall transition to civilian life. Interventions to promote resilience and help veterans manage readjustment to civilian life appear urgently needed.

How does yoga reduce stress? A clinical trial testing psychological mechanisms.

Yoga interventions can reduce stress, but the mechanisms underlying that stress reduction remain largely unidentified. Understanding how yoga works is essential to optimizing interventions. The present study tested five potential psychosocial mechanisms (increased mindfulness, interoceptive awareness, spiritual well-being, self-compassion and self-control) that have been proposed to explain yoga's impact on stress. Forty-two participants (62% female; 64% White) in a yoga program for stress reduction completed surveys at baseline (T1), mid-intervention (T2) and post-intervention (12 weeks; T3). We measured two aspects of stress, perceived stress and stress reactivity. Changes were assessed with paired t-tests; associations between changes in mechanisms were tested in residual change models. Only stress reactivity decreased, on average, from T1 to T3. Except for self-compassion, all psychosocial mechanisms increased from T1 to T3, with minimal changes from T2 to T3. Except for self-control, increases in each mechanism were strongly associated with decreases in both measures of stress between T1 and T2 and decreases in perceived stress from T1 to T3 (all p's < 0.05). Increased psychosocial resources are associated with stress reduction. Yoga interventions targeting these resources may show stronger stress reduction effects. Future research should test these linkages more rigorously using active comparison groups and larger samples.

The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study.

BACKGROUND: Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. OBJECTIVE: This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. METHODS: Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. RESULTS: In Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=-0.26; P=.06). CONCLUSIONS: The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244.

Meaning-making and quality of life in heart failure interventions: a systematic review.

PURPOSE: Heart failure (HF) patients often report high levels of psychological distress and diminished quality of life (QoL). As such, interventions aimed at improving their QoL and other positive psychosocial outcomes are needed. Some interventions have shown promise, but results are mixed. Interventions directed toward physical well-being (e.g., self-care behaviors, medical adherence) may be less effective at improving QoL than those aimed at improving psychological well-being (e.g., stress reduction, coping strategies). We systematically reviewed recent HF interventions and compared results of those emphasizing coping strategies related to meaning-making to those lacking meaning-making components as a possible factor in QoL discrepancies. METHODS: A systematic review of four databases produced 439 studies for potential inclusion, of which 25 qualified for review. These were coded into substantial or minimal meaning focus. RESULTS: Forty percent of all studies (n = 10) reported improved QoL due to intervention effects, while 60% reported no significant change in QoL (60%; n = 15). Fewer than one-third of minimal meaning focus studies demonstrated significant improvements in QoL (30.8%; n = 4). In contrast, half of substantial meaning focus studies demonstrated significant improvements in QoL (50%; n = 6). CONCLUSIONS: By clarifying the potential importance of promoting meaning-making in improving QoL of HF patients, we highlight its potential value in future interventions directed to this underserved, high-risk patient population.

Do religious habits and coping help in the immediate aftermath of a crisis? Relations with Hurricane Katrina evacuees' acute stress symptoms and functional impairment.

OBJECTIVE: Religious coping has been shown to relate to psychological adjustment in survivors of disasters months or even years afterward. However, because very few studies have assessed coping and well-being during the immediate crisis, little is known about the role of religiousness at this critical time. METHOD: We studied a sample of 132 Hurricane Katrina evacuees (56% male, 74.2% African American, mean age of 43 years) relocated to a Red Cross emergency shelter in Austin, Texas, within 19 days of Hurricane Katrina's landfall. RESULTS: Participants reported high levels of acute stress disorder (ASD) symptoms and functional impairment as well as high resource loss. Belief that God is in control and negative religious coping (perceiving punishment) were positively related to ASD symptoms while negative religious coping (perceiving abandonment) was related to higher functional impairment. The negative religious coping-ASD symptom relationship was moderated by resource loss, such that, for those with lower levels of resource loss, negative religious coping (perceiving punishment) related to even higher levels of ASD symptoms, an effect that diminished with higher resource loss. Neither positive religious coping nor pre-Katrina frequency of service attendance or private prayer related to ASD symptoms or functional impairment. CONCLUSIONS: At least in this sample at the height of disruption following a disaster, little evidence of salutary effects of religiousness were observed. It may be that such effects take time to emerge as people begin their recovery processes or that not all groups find help through their religious coping resources. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Heart failure patients' desires for spiritual care, perceived constraints, and unmet spiritual needs: relations with well-being and health-related quality of life.

Little information is available about HF patients' desires regarding having their healthcare providers address their spiritual concerns, feeling constrained in doing so, and the extent to which their spiritual needs go unmet. Nearly half of our sample reported high levels of unmet spiritual needs and reported moderately strong desires to have their doctor or other healthcare professional attend to their spiritual needs, and moderately strong feelings of constraint in doing so. Spiritual constraint and unmet spiritual needs were associated with poorer spiritual, psychological and physical well-being, but these effects varied, depending on patients' desire to discuss spiritual needs. These findings have important implications for clinical management of HF patients.

Living with heart failure: psychosocial resources, meaning, gratitude and well-being.

OBJECTIVES: The present study explored the experiences of people living with advanced heart failure (HF) to determine the extent to which (1) psychosocial resources relevant to HF patients were qualitatively reported, and (2) to determine the extent to which psychosocial resources were correlates of subsequent well-being as assessed by validated quantitative measures. BACKGROUND: HF is a serious life-limiting illness that involves impaired heart functionality. Patients commonly face severe physical fatigue and frequently endure disabling depression. Individuals with HF often report the use of social support and religion/spirituality (R/S) as helpful, but little work has systematically linked their reliance on these resources and well-being. METHODS: 111 participants completed four open-ended questions to assess aspects of living with HF. Open-ended questions were coded to identify psychosocial resources: positive meaning, gratitude, R/S, social support, and medical resources. Data were collected once and then again 3 months later. Participants also completed measures of well-being, including religious meaning, life meaning, satisfaction with life, depressive symptoms, death anxiety, and health-related quality of life. Bivariate correlations were used to relate psychosocial resources and well-being. RESULTS: Patients reported many psychosocial resources, particularly positive meaning, R/S, social support, and medical resources. Positive meaning and R/S were inversely linked with depressive symptoms. R/S was also related to less death anxiety, while social support was related to higher anxiety about death three months later. CONCLUSIONS: Findings advance our understanding of the struggles HF patients experience and the roles of psychosocial resources such as meaning and gratitude in alleviating these struggles. Results may help explain how resources like R/S and social support may influence well-being.

Expanding coping goodness-of-fit: religious coping, health locus of control, and depressed affect in heart failure patients.

The goodness-of-fit coping hypothesis posits that problem-focused (PF) coping is particularly helpful under high controllability conditions, while emotion-focused (EF) coping is more helpful in low controllability situations. However, little research has examined whether the goodness-of-fit hypothesis applies to religious coping, a distinct set of coping resources and efforts. Further, little goodness-of-fit research has been conducted in the context of life-threatening illness. We tested coping goodness-of-fit for PF and EF as well as religious coping resources and strategies in 202 congestive heart failure (CHF) patients. Multiple regression analyses examined the extent to which each type of coping, health locus of control (HLOC) regarding their CHF, and their interactions related to subsequent depressed affect. Neither religious coping efforts nor religious resources were related to depressed affect. However, when examined in conjunction with internal HLOC, active coping and organized religious commitment were related to less depression for those higher in internal HLOC, while daily spiritual experience was related to less depression for those lower in HLOC. These results partially support the goodness-of-fit hypothesis and indicate a need to consider the perceived controllability of situations when examining the associations of religious coping resources and activities on depressive symptoms in the context of illness.