Childhood maltreatment dysregulates an individual's physiological response to stress, increasing reactivity to stressors across the lifespan. Given the prevalence and impact of bereavement, we examined whether the association between childhood maltreatment and depression was exacerbated by spousal bereavement. We identified an interaction between childhood maltreatment and bereavement using linear regression analysis (B = 0.79, p < .001). A simple slopes test indicated a positive association between childhood maltreatment and depressive symptoms among those who were bereaved (B = 0.86, p < .001), but such association did not emerge among those who were not bereaved (B = 0.06, p = .60).
Abstract Purpose To evaluate the utility of ultrawide-field fluorescein angiography (UWFFA) in patients with anterior uveitis by investigating the detection of retinal vascular leakage (RVL) and the subsequent implications on disease diagnosis and management. Study design/materials and methods Patients, who were referred to the National Eye Institute (NEI) for evaluation of anterior uveitis and underwent UWFFA imaging at the initial visit, were included in this study. The electronic medical records of eligible patients were reviewed. The UWFFA images were assessed for severity of retinal vascular leakage, presence of macular leakage, and optic disc leakage by a two-grader system, and intergrader agreement was calculated using the κ-value. Patients with altered diagnoses and management attributable to UWFFA results were noted. Results A total of 93 eyes of 63 patients were included in the study. Of 93 eyes, 31 (33.3%) eyes had RVL on UWFFA, with 26 (28.0%) eyes and 5 (5.4%) eyes showing mild and moderate-severe RVL, respectively. Twenty-five (26.9%) eyes showed macular leakage, and 7 (7.5%) eyes showed optic disc leakage. The κ-values ranged from 0.85 – 0.87 indicating excellent intergrader agreement. Of the 31 eyes with RVL, the diagnosis was changed to anterior/intermediate uveitis for 9 (29.0%) eyes and to panuveitis for 4 (12.9%) eyes. Systemic treatment was escalated in 5 patients. Conclusion Our results suggest that UWFFA imaging is useful in detecting subclinical posterior involvement in patients with anterior uveitis. Moreover, UWFFA results in altered diagnosis and treatment approaches in a portion of patients.
Childhood adversity is associated with a host of mental and physical health problems across the lifespan. Individuals who have experienced childhood adversity (e.g., child abuse and neglect, family conflict, poor parent/child relationships, low socioeconomic status or extreme poverty) are at a greater risk for morbidity and premature mortality than those not exposed to childhood adversity. Several mechanisms likely contribute to the relationship between childhood adversity and health across the lifespan (e.g., health behaviors, cardiovascular reactivity). In this paper, we review a large body of research within the field of psychoneuroimmunology, demonstrating the relationship between early life stress and alterations of the immune system. We first review the literature demonstrating that childhood adversity is associated with immune dysregulation across different indices, including proinflammatory cytokine production (and its impact on telomere length), illness and infection susceptibility, latent herpesvirus reactivation, and immune response to a tumor. We then summarize the growing literature on how childhood adversity may alter epigenetic processes. Finally, we propose future directions related to this work that have basic and applied implications.
Abstract In the context of bereavement, little is known about the mechanisms that differentiate normative adjustment patterns from those that may indicate potential psychopathology. This study aimed to replicate and extend previous work by (1) characterizing the trajectories of depressive symptoms from 3 to 12 months after the loss of a spouse, (2) examining whether (a) childhood maltreatment and attachment style predicted distinct depression trajectories, and (b) different depression trajectories were associated with the risk of prolonged grief at 12 months post‐loss. Recently bereaved individuals ( N = 175) completed self‐report assessments at 3, 4, 6, and 12‐months post‐loss. Trajectories of depressive symptoms were estimated using group‐based trajectory modelling. Four distinct trajectories of depressive symptoms were identified: (1) resilience (minimal/no depression across time points; 45%), (2) moderate depression‐improved (alleviated to ‘mild’ by 12 months; 31%), (3) severe depression‐improved (alleviated to ‘moderate’ by 12 months; 15%), and (4) chronic depression (‘severe’ symptoms across time points; 9%). Higher childhood maltreatment predicted a greater likelihood of belonging to the ‘severe depression‐improved’ and ‘chronic depression’ groups than the ‘resilient’ and ‘moderate depression‐improved’ groups. Widow(er)s with higher attachment anxiety were more likely to belong to the ‘severe depression‐improved’ and ‘chronic depression’ groups than the ‘resilient’ group. The trajectory groups with persistent levels of depressive symptoms up until 6 months were more likely to exhibit prolonged grief at 12 months post‐loss. Changes from pre‐loss functioning cannot be estimated. Our findings provide insight into the early identification of post‐loss prolonged grief.
Objective Sleep quality is an important health-protective factor. Psychosocial factors, including attachment orientation, may be valuable for understanding who is at risk of poor sleep quality and associated adverse health outcomes. High attachment anxiety is reliably associated with adverse health outcomes, whereas high attachment avoidance is associated with adverse health outcomes when co-occurring with poor self-regulatory capacity, indexed by heart rate variability (HRV). We examined the associations between attachment anxiety, attachment avoidance, HRV, and sleep quality. Methods Using longitudinal data from a sample of 171 older adults measured four times over 1 year ( M = 66.18 years old; 67.83% women), we separated the between-person variance (which we call “trait”) and within-person variance (which we call “state”) for attachment anxiety, attachment avoidance, and HRV (via the root mean square of successive differences). Sleep quality was measured with the Pittsburgh Sleep Quality Index. Results Higher trait attachment anxiety was associated with poorer global sleep quality ( B = 0.22, p = .005). Higher state attachment avoidance was associated with poorer sleep quality ( B = −0.13, p = .01), except for those with higher trait HRV. Higher state attachment anxiety was associated with poorer sleep quality ( B = −0.15, p = .002), except for those with higher or mean trait HRV. Higher trait attachment anxiety was associated with poorer sleep quality ( B = −0.31, p = .02), except for those with higher trait HRV. Conclusions High trait HRV mitigated the adverse effects of attachment insecurity on sleep quality. Our results suggest that people with high trait HRV had greater self-regulation capacity, which may enable them to enact emotion regulation strategies effectively.
The field of psychoneuroimmunology is concerned with how psychological factors “get under the skin” to impact the nervous system and immune system. Using observational longitudinal and experimental methods, researchers in the field of psychoneuroimmunology have found that psychological factors can dysregulate the immune system, the central and peripheral nervous system, and the endocrine system in ways that influence wound healing, latent herpesvirus reactivation, vaccine responses, susceptibility to viruses, and pro-inflammatory cytokine production (i.e., production of proteins that signal immune cells that promote inflammation). Specifically, neurotransmitters and hormones regulate immune cells, which in turn have vast clinical implications on health and immunity. Theories and methods within psychoneuroimmunology have been utilized to investigate a wide array of physical health problems from asthma to cardiovascular disease and some cancers. Interpersonal stressors appear to have a particularly significant impact on these systems in comparison to non-interpersonal stressors. Furthermore, stressors that occur early in life may have a lasting effect on the immune system, the endocrine system, and the nervous system into adulthood and old age. The field has become increasingly focused on how the immune system can impact mood and behavior. Indeed, certain types of depression and fatigue appear to be affected by dysregulated immunity. Emerging areas of investigation include a focus on interactions between the brain, gut, mitochondria, and diet. Finally, there is great interest in understanding how epigenetic processes (i.e., how genes are expressed) emerge from life experiences, impacting immunity and disease.
There is widespread literature linking church attendance to physical health. However, little is known about the association of church attendance and the immune system, particularly during difficult life transitions. This study investigated the association between church attendance and CMV herpes-virus latency by assessing Cytomegalovirus (CMV) IgG antibody titers among bereaved and non-bereaved individuals.
Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.
