Alex J. Zautra - US grants

This grant requests support of 2 more years of analyses and followup data collection for a grant now in its 3rd year of funding (NIA R01 AG04924, "Life Events and Demoralization in the Elderly"). Interviews on samples of recently disabled and conjugally bereaved older adults and matched control samples have been conducted monthly for 10 month and 1 followup interview 6 months later has been completed. The research has focused on the relationships between these stressors and mental health. Analyses have determined the latent structure of mental health and social support, intergroup differences in those structures; the effects of an experimental intervention aimed at improving personal mastery also have been determined. Initial assessment of the occurrence of, and reaction to, both major and everyday small events have been performed. A new conceptual framework for understanding stress and recovery has superseded the framework guiding the initial grant. Two classes of psychosocial variables are studied as predictors of mental health: Risk Factors, variables which tend to reduce adequacy of adaptation efforts, and Resistance Resources, variables which enhance recovery and reduce vulnerability. Analyses to date indicate that disability and bereavement lead to very different patterns of recovery. Different risk and resource factors appear to influence adaptation depending upon the nature of the stressor. Our methods to date have been retrospective. However, significant number of our subjects experienced illness/injury, bereavement and other loss events during the course of the project, providing the capability of prospective analyses. However, an additional followup is needed to insure adequate time passage and sample sizes. As central issues in this framework, 3 sets of tasks remain: (a) assessing, through repeated measures, how everyday stressful events act as stable or changing sources of influence on mental health; (b) moving beyond our initial single-scale assessment of physical health by determining the latent structure of 104 items (10 subscales) measuring various aspects of physical health, and testing that model's relationship with mental health, both longitudinally and prospectively, and (c) assessing how changes in social networks effect mental health as individuals enter and leave social networks over time.

This project involves both assessmental and experimental analyses of the role of life events in demoralization and well-being of two at risk groups of the elderly, recently bereaved and recently disabled (plus matched controls): N=240. A longitudinal assessment covers 10 monthly interviews within which is contained an experimental intervention for half the sample. The guiding conceptual theme of the project concerns personal mastery and perceived personal control; event measures and special scales assess it and the intervention directly manipulates it. Trained elderly peers conduct the contracts. The renewal proposes: (1) extension of time and support for extensive data analyses and (2) extension of time and support for conducting two 6-month follow-ups. Participants in the current project are being asked if they wish to be contacted later and the interviewer staff has been alerted to the possibility of follow-up assessment. The relative ease of maintaining ongoing project activities to acquire the followup data provides a unique opportunity to study the time course of events and adjustment in these two at risk populations. Data collection from the original grant will be completed by the proposed start date for renewal. However, delays in acquiring participants has moved forward the date of completion of data acquisition; completion of final analysis has been moved forward into the time period covered by this renewal application. Preliminary analyses of data gathered to date are showing clear differences between risk groups and significant relationship among assessed variables. Particularly striking are the relationships among recurrent stresses of daily living and demoralization. These relationships need more extensive analysis. Complex casual modeling techniques and high order analyses of variance and multiple regression are necessary. The intervention's impact must be assessed over a longer term since it is necessary to determine if its effects endure and are not short-term in duration only. Long-term trends in the assessmental data would provide valuable insights into the time course of adjustment, and prospective analyses made possible only by such long-term coverage provide evidence of the predictive power of the variables under investigation.

This research will test the hypothesis that interpersonal stressors affect the course of rheumatoid arthritis (RA) among women (age 55-75) through activation of the endocrine and immune systems. RA is a progressive systemic disease involving disturbance in the regulation of the neuroendocrine and auto-immune systems. In our prior research, we found strong evidence that a key factor in RA disease progression may be the patient's reactivity to life circumstances: Stressful events appear to have a greater impact on the physiological responses and mental health of RA patients as compared to OA patients. This study is designed to examine this hypothesis by following RA patients over time with repeated measures to assess their psychological and physiological reactions to naturally occurring interpersonal stressor events. Their reactions will be compared to the reactions of OA patients and healthy controls, matched in age and marital status. 80 female rheumatoid arthritis (RA) patients, 80 female osteoarthritis (OA) patients, and 80 healthy controls will be interviewed weekly by telephone to assess interpersonal stress levels and monitor disease state, after an initial baseline assessment. Coincident with a baseline interview, during a period of increased interpersonal stress and a period of disease flare among the patient groups, clinical assessments of disease state will be made and blood samples drawn. The blood samples will be analyzed to detect changes in levels of stress hormones, and immune parameters between baseline and a time of stress, and between baseline and a time of flare, for each group.

Description (adapted from investigator's abstract): This research is designed to determine the extent to which variations in cognitive behavior therapy reduce disease activity and improve the mental health of older adults with rheumatoid arthritis (RA). The study combines field assessments, laboratory tests of stress reactivity and clinical evaluations of the mental and physical health of subjects in a longitudinal design. After pre-testing, 210 RA patients will be randomly selected in one of three treatments: Cognitive-Behavior Therapy for Pain (CBT-P), Cognitive-Behavior Therapy for Depression (CBT-D) or Education Group only (EG), which serves as a control. The distinction between pain and depression as foci of CBT in RA is supported by previously funded research by the investigator on interpersonal stress and disease activity in persons with arthritis. Illness severity, depressive symptoms and interpersonal difficulties are expected to predict psychological and physiologic stress responses in participants. Stress reactivity measures are expected to predict the course of illness over time. Those receiving CBT-D are expected to show the greatest improvement in physical functioning, mental health and disease activity. Successful treatment is expected to alter stress responses, leading to better physical and mental health over time.

APPLICANT?S DESCRIPTION: This grant focuses on individual differences in the stress response as significant factors determining who develops a chronic pain syndrome characterized by widespread pain, and who is unable to recover from it. Maladaptive responses to pain and withdrawal from positive social interactions are studied as key factors that underlie the affective distress and persistence of fibromyalgia symptoms. To test this model three well established methods of inquiry are used: 1. Field assessments of responses to stress, developed in prior research on arthritis patients, and 2. Laboratory tests of stress reactivity under controlled experimental conditions. 3. Longitudinal follow-up of patient status 2 years after pre-tests. Two groups of Osteoarthritis participants are studied: (1) 150 OA participants who meet criteria for Fibromyalgia (FM), and (2) 200 participants with osteoarthritis (OA) who report levels of pain comparable to the FM group, but who do not display the classic tender point symptoms found among those with FM. Longitudinal assessments on all subjects as well as thorough initial testing will permit three types of comparisons. 1.The examination of case-control differences between groups of FM respondents and those with OA only. 2.The examination of variables predictive of recovery among those with FM. 3. The examination of those factors predictive of the onset of widespread pain among the OA sample that displayed only regional pain at the initial assessment.

[unreadable] DESCRIPTION (provided by applicant): The fundamental question asked in this investigation is whether measures of resilience capacity, identified from recent theoretical advances and empirical study, will predict physical and emotional functioning beyond that provided from well-established risk factors for disease and psychological ill-health for community residents from a wide range of backgrounds. A community sample of men and women aged 40 to 65 (total N = 800) will be drawn from 40 census neighborhoods that vary in average income, age, and ethnic composition. Using multi-level methods, participants and their neighborhoods will be evaluated on global indices of risk and resilience. Deeper probing of the underlying bio-behavioral mechanisms of risk and resilience will be conducted through laboratory testing and electronic diary assessments with a sub-sample (N = 200) drawn from the larger pool of participants. Current functioning and precursors of future health status of the mid-aged adults will be taken as outcomes. For those mid-aged adults with children, the outcome measures will also be assessed in one their children approaching adult life (aged 16 to 24 years; N = 160) to probe the transmission of resilience across generations. [unreadable] [unreadable]

? DESCRIPTION (provided by applicant): It is indisputable that health declines with age, and that the rate of decline is not the same for everyone. Many sources of accelerated risk of illness have been identified in prior research, and among the most reliable predictors of ill health are social stressors, including abusive social relations in childhood. Early life adversity may lead to poorer mental health and physical functioning in midlife through various pathways; among the most likely paths are social in origin, including troubled family relationships, heightened sensitivity to interpersonal stressors, and social isolation. Is it possible to interrupt this caus-effect pairing between early adversity and illness in later life? This grant examines that question Specifically, we address whether the individual differences in risk attributable to childhood adversity are reversible through a social intelligence (SI) intervention for an established cohort of community residents who were part of a comprehensive study of biopsychosocial markers of resilience at Mid-Life. We have three primary objectives in this research: (1) to examine whether an SI intervention can enhance the capacity for rewarding social relations, especially for individuals with a history of early life adversity. (2) To examine evidence for our hypothesis that intervention-related gains in the quality of social relationship will be responsible for the improvements in psychological, and physical functioning, and influence two bio- markers of health risk and resilience: interleukin 6 (IL-6) and DHEA-S. (3) To probe for individual differences in age, gender, history of abuse, personality, and genetic markers of risk that identif participants most responsive to the intervention. To address these questions, an SI intervention will be delivered to a random-selected half of 220 middle-aged participants: Half with a history of child abuse and half who did not report abuse. The program is an on-line self-instructional series of videos with awareness exercises and behavioral practices designed to enhance fund of knowledge about relationships, increase skills, and enhance motivation to engage socially. In addition to charting social relations with daily diaries, we will assess participants' social, psychological, and physical functioning at pre-test, post-test, three months, and six months following the intervention. We hypothesize that the SI intervention will prompt lasting improvement in the ability to establish, maintain, and benefit from social relations in comparison to controls, which will lead to better psychological and physical functioning. We will examine evidence for the hypothesis that the benefits of the intervention will be largest for individuals who have experienced greater early childhood adversity, as well as probe other individual differences in receptivity to the SI program that will inform future efforts to refine, test and disseminate this innovative program.