Somatic-Vegetative Symptoms of Depression Predict 6-Year Increases in Insulin Resistance: Data from the Pittsburgh Healthy Heart Project

poster abstractAlthough prospective studies suggest a bidirectional association between depression and type 2 diabetes, few studies have examined depressive symptom clusters or concurrently evaluated both directions of this relationship. Consequently, our objective was to examine the longitudinal, bidirectional associations between the somatic-vegetative and cognitive-affective clusters of depressive symptoms and insulin resistance, which is implicated in the pathophysiology of type 2 diabetes. Participants were 269 adults (baseline age range: 50-70 years, 55% female, 14% non-white) without diabetes enrolled in the Pittsburgh Healthy Heart Project, a prospective cohort study. At baseline and the 6-year visits, participants completed the Beck Depression Inventory-II (BDI-II) to assess depressive symptoms and underwent a blood draw to quantify fasting serum insulin and glucose. We examined baseline BDI-II total and subscale scores as predictors of 6-year change in the homeostatic model assessment (HOMA) score, an index of insulin resistance computed from fasting insulin and glucose. We also examined baseline HOMA score as a predictor of 6-year change in BDI-II total and subscale scores. HOMA and BDI-II change were computed as follow-up score minus baseline score. Regression analyses, adjusted for baseline HOMA score and demographic factors, revealed that the baseline BDI-II somatic-vegetative score (beta=.14, p=.03), but not the total (beta=.10, p=.11) or cognitive-affective (beta=.004, p=.95) scores, was a predictor of 6-year increases in the HOMA score. The pattern of results was similar after further adjustment for body mass index, except that the BDI-II total score became a predictor of HOMA change (beta=.13, p=.03). In contrast, the baseline HOMA score did not predict 6-year change in BDI-II total, somatic-vegetative, or cognitive-affective scores (all p’s>.48). Our findings indicate that older adults experiencing the somatic-vegetative symptoms of depression (e.g., fatigue, sleep disturbance, and appetite changes) may be at an increased risk of insulin resistance and subsequent type 2 diabetes

Depressive symptom clusters as predictors of 6-year increases in insulin resistance: data from the Pittsburgh Healthy Heart Project

OBJECTIVE: To examine longitudinal bidirectional associations between two depressive symptom clusters-the cognitive-affective and somatic-vegetative clusters--and insulin resistance, a marker of prediabetes. METHODS: Participants were 269 adults aged 50 to 70 years without diabetes enrolled in the Pittsburgh Healthy Heart Project, a prospective cohort study. At baseline and 6-year visits, participants completed the Beck Depression Inventory-II (BDI-II) and underwent a blood draw to quantify fasting insulin and glucose. We examined baseline BDI-II total, cognitive-affective, and somatic-vegetative scores as predictors of 6-year change in the homeostatic model of assessment (HOMA) score, an estimate of insulin resistance computed from fasting insulin and glucose. We also examined baseline HOMA score as a predictor of 6-year change in BDI-II total and subscale scores. RESULTS: Regression analyses, adjusted for demographic factors and baseline HOMA score, revealed that the baseline BDI-II somatic-vegetative score (β = 0.14, p = .025), but not the cognitive-affective (β = 0.001, p = .98) or total (β = 0.10, p = .11) scores, predicted 6-year HOMA change. This result persisted in models controlling for anxiety symptoms and hostility. Several factors were examined as candidate mediators; however, only change in body mass index was a significant mediator (p = .042), accounting for 23% of the observed association. Baseline HOMA score did not predict 6-year change in BDI-II total or subscale scores (all p values >.56). CONCLUSIONS: Among adults aged 50 to 70 years, the somatic-vegetative symptoms of depression (e.g., fatigue, sleep disturbance, and appetite changes) may worsen insulin resistance and increase diabetes risk, partly, by increasing body mass index

The Double Burden of Racial Discrimination in Daily-Life Moments: Increases in Negative Emotions and Depletion of Psychosocial Resources Among Emerging Adult African Americans

Objective: Racial discrimination is a common experience for African Americans, but no research has examined how discrimination reported in daily-life moments influences concurrent negative emotions and psychosocial resources. Method: Emerging adult African Americans (N = 54) reported hourly on momentary racial discrimination, negative emotions, and psychosocial resources across two days. Results: Controlling for past discrimination and trait emotion, momentary racial discrimination was associated with greater negative emotions and lower psychosocial resources (ps \u3c .05). The relationship between momentary racial discrimination and negative emotions was stronger among individuals residing in areas with fewer African Americans (simple slope p \u3c .0001). The relationship between momentary racial discrimination and psychosocial resources was stronger among individuals reporting greater past discrimination (simple slope p \u3c .0001). Vicarious discrimination (exposure to discrimination experienced by another person) was associated with higher negative emotions, p \u3c .01, but not with psychosocial resources. Conclusion: These results are the first to demonstrate that personal and vicarious racial discrimination are associated with negative emotions and lower coping resources in daily-life moments and that contextual factors modify these associations. Results refine our understanding of the immediate sequelae of discrimination in daily life and point to possible targets for ecological momentary interventions

Trait positive and negative emotionality differentially associate withdiurnal cortisol activity

Inter-individual variability in metrics of hypothalamic-pituitary-adrenocortical (HPA) activity, such asthe slope of the diurnal decline in cortisol, cortisol awakening response (CAR), and total cortisol out-put, have been found to associate inversely with trait ratings of extraversion and positive affect (E/PA)and positively with neuroticism and negative affect (N/NA) in some, but not all, investigations. Theseinconsistencies may partly reflect varied intensity of cortisol sampling among studies and reliance onself-rated traits, which are subject to reporting biases and limitations of introspection. Here, we furtherexamined dispositional correlates of HPA activity in 490 healthy, employed midlife volunteers (M age = 43years; 54% Female; 86% white). Trait ratings were requested from participants and 2 participant-electedinformants using the Positive and Negative Affect Schedule (PANAS) and Extraversion and Neuroticismdimensions of NEO personality inventories. CAR was assessed as percent increase in cortisol levels fromawakening to 30 min after awakening; and the diurnal slope and total output of cortisol [Area Underthe Curve (AUC)] were determined from cortisol measurements taken at awakening, +4 and +9 h later,and bedtime, across 3 workdays. Structural equation modeling was used to estimate multi-informantE/PA and N/NA factors. We used 3 days of measurement as indicators to model each of the three latentcortisol factors (slope, CAR, and AUC). With the two latent emotionality and three latent cortisol indicesincluded there was good fit to the data ( 2(200)= 278.38, p = 0.0002; RMSEA = 0.028, 90% CI = 0.02–0.04;CFI/TLI = 0.97/0.96; SRMR = 0.04). After controlling for covariates (age, sex, race), results showed higherlatent E/PA associated with a steeper diurnal slope (Standardized ˇ = −0.19, p = 0.02) and smaller CAR(Standardized ˇ = −0.26, p = 0.004), whereas N/NA did not associate with any cortisol metric (Standard-ized ˇ’s = −0.12 to 0.13, p’s = 0.10 to 0.53). These findings suggest that positive emotionality may be moreclosely associated with indices of diurnal cortisol release than negative emotionality

Sleep duration partially accounts for race differences in diurnal cortisol dynamics

Objective: Emerging research demonstrates race differences in diurnal cortisol slope, an indicator of hypothalamic-pituitary-adrenocortical (HPA)-axis functioning associated with morbidity and mortality, with African Americans showing flatter diurnal slopes than their White counterparts. Sleep characteristics are associated with both race and with HPA-axis functioning. The present report examines whether sleep duration may account for race differences in cortisol dynamics. Method: Participants were 424 employed African American and White adults (mean age = 42.8 years, 84.2% White, 53.6% female) with no cardiovascular disease (Adult Health and Behavior Project—Phase 2 [AHAB-II] cohort, University of Pittsburgh). Cortisol slope was calculated using 4 salivary cortisol readings, averaged over each of 4 days. Demographic (age, sex), psychosocial (socioeconomic status [SES], affect, discrimination), and health behaviors (smoking, alcohol use, physical activity) variables were used as covariates, and sleep (self-report and accelerometry) was also assessed. Results: African Americans had flatter slopes than Whites (F(1, 411) = 10.45, B = .02, p = .001) in models adjusting for demographic, psychosocial, and health behavior covariates. Shorter actigraphy-assessed total sleep time was a second significant predictor of flatter cortisol slopes (F(1, 411) = 25.27, B = −.0002, p \u3c .0001). Total sleep time partially accounted for the relationship between race and diurnal slope [confidence interval = .05 (lower = .014, upper .04)]. Conclusions: African Americans have flatter diurnal cortisol slopes than their White counterparts, an effect that may be partially attributable to race differences in nightly sleep duration. Sleep parameters should be considered in further research on race and cortisol. (PsycINFO Database Record (c) 2017 APA, all rights reserved

Sleep duration partially accounts for race differences in diurnal cortisol dynamics

Objective: Emerging research demonstrates race differences in diurnal cortisol slope, an indicator of hypothalamic-pituitary-adrenocortical (HPA)-axis functioning associated with morbidity and mortality, with African Americans showing flatter diurnal slopes than their White counterparts. Sleep characteristics are associated with both race and with HPA-axis functioning. The present report examines whether sleep duration may account for race differences in cortisol dynamics. Method: Participants were 424 employed African American and White adults (mean age = 42.8 years, 84.2% White, 53.6% female) with no cardiovascular disease (Adult Health and Behavior Project—Phase 2 [AHAB-II] cohort, University of Pittsburgh). Cortisol slope was calculated using 4 salivary cortisol readings, averaged over each of 4 days. Demographic (age, sex), psychosocial (socioeconomic status [SES], affect, discrimination), and health behaviors (smoking, alcohol use, physical activity) variables were used as covariates, and sleep (self-report and accelerometry) was also assessed. Results: African Americans had flatter slopes than Whites (F(1, 411) = 10.45, B = .02, p = .001) in models adjusting for demographic, psychosocial, and health behavior covariates. Shorter actigraphy-assessed total sleep time was a second significant predictor of flatter cortisol slopes (F(1, 411) = 25.27, B = −.0002, p \u3c .0001). Total sleep time partially accounted for the relationship between race and diurnal slope [confidence interval = .05 (lower = .014, upper .04)]. Conclusions: African Americans have flatter diurnal cortisol slopes than their White counterparts, an effect that may be partially attributable to race differences in nightly sleep duration. Sleep parameters should be considered in further research on race and cortisol. (PsycINFO Database Record (c) 2017 APA, all rights reserved

Trait positive and negative emotionality differentially associate withdiurnal cortisol activity

Inter-individual variability in metrics of hypothalamic-pituitary-adrenocortical (HPA) activity, such asthe slope of the diurnal decline in cortisol, cortisol awakening response (CAR), and total cortisol out-put, have been found to associate inversely with trait ratings of extraversion and positive affect (E/PA)and positively with neuroticism and negative affect (N/NA) in some, but not all, investigations. Theseinconsistencies may partly reflect varied intensity of cortisol sampling among studies and reliance onself-rated traits, which are subject to reporting biases and limitations of introspection. Here, we furtherexamined dispositional correlates of HPA activity in 490 healthy, employed midlife volunteers (M age = 43years; 54% Female; 86% white). Trait ratings were requested from participants and 2 participant-electedinformants using the Positive and Negative Affect Schedule (PANAS) and Extraversion and Neuroticismdimensions of NEO personality inventories. CAR was assessed as percent increase in cortisol levels fromawakening to 30 min after awakening; and the diurnal slope and total output of cortisol [Area Underthe Curve (AUC)] were determined from cortisol measurements taken at awakening, +4 and +9 h later,and bedtime, across 3 workdays. Structural equation modeling was used to estimate multi-informantE/PA and N/NA factors. We used 3 days of measurement as indicators to model each of the three latentcortisol factors (slope, CAR, and AUC). With the two latent emotionality and three latent cortisol indicesincluded there was good fit to the data ( 2(200)= 278.38, p = 0.0002; RMSEA = 0.028, 90% CI = 0.02–0.04;CFI/TLI = 0.97/0.96; SRMR = 0.04). After controlling for covariates (age, sex, race), results showed higherlatent E/PA associated with a steeper diurnal slope (Standardized ˇ = −0.19, p = 0.02) and smaller CAR(Standardized ˇ = −0.26, p = 0.004), whereas N/NA did not associate with any cortisol metric (Standard-ized ˇ’s = −0.12 to 0.13, p’s = 0.10 to 0.53). These findings suggest that positive emotionality may be moreclosely associated with indices of diurnal cortisol release than negative emotionality

A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study.

BACKGROUND: Behavioral factors are important in disease incidence and mortality and may explain associations between mortality and various psychological traits. PURPOSE: These analyses investigated the impact of behavioral factors on the associations between depression, hostility and cardiovascular disease(CVD) incidence, CVD mortality, and all-cause mortality. METHODS: Data from the PRIME Study (N = 6953 men) were analyzed using Cox proportional hazards models, following adjustment for demographic and biological CVD risk factors, and other psychological traits, including social support. RESULTS: Following initial adjustment, both depression and hostility were significantly associated with both mortality outcomes (smallest SHR = 1.24, p < 0.001). Following adjustment for behavioral factors, all relationships were attenuated both when accounting for and not accounting for other psychological variables. Associations with all-cause mortality remained significant (smallest SHR = 1.14, p = 0.04). Of the behaviors included, the most significant contribution to outcomes was found for smoking, but a role was also found for fruit and vegetable intakes and high alcohol consumption. CONCLUSIONS: These findings demonstrate well-known associations between depression, hostility, and mortality and suggest the potential importance of behaviors in explaining these relationships

Validation of the detroit area study discrimination scale in a community sample of older African American adults: The Pittsburgh healthy heart project

This study examined the construct validity of the Detroit Area Study Discrimination Questionnaire (DAS-DQ) in 49 healthy African American adults, with respect to its association with global measures and daily experiences of psychological demand. Daily experiences of psychological demand were obtained using ecological momentary assessment (EMA) methods. Everyday Mistreatment, as measured by the DAS-DQ, was significantly related to global reports of perceived stress and depression but was unrelated to measures of hostility and social desirability. Everyday Mistreatment was significantly related to average EMA score measures of Negative Affect and Social Conflict but was unrelated to daily experiences of Task Demand or Decisional Control. Negative Affect mediated the relation between Everyday Mistreatment and global reports of perceived stress. In contrast, Lifetime History of Discrimination, as measured by the DAS-DQ, was unrelated to global measures or daily experiences of stress. Thus, this study lends support to the construct validity of the DAS-DQ

Cardiovascular Reactivity and Left Ventricular Mass: An Integrative Review

Left ventricular hypertrophy has been shown to be an independent predictor of risk for cardiovascular morbidity and mortality. Behavioral scientists have focused on how hemodynamic factors influenced by psychosocial stress may be associated with left ventricular mass (LVM). We reviewed existing studies examining stress-related cardiovascular reactivity (CVR) and LVM, with a goal of examining the moderating role of population (age and hypertensive status) and methodological factors (task type, sample size, and study design) explaining the observed results. Twenty-one studies met the criteria for this review. Results showed only a modestly consistent relationship between CVR and LVM. Forty-three percent of the studies reported 1 or more significant results linking systolic blood pressure reactivity with LVM, and 14% of the studies showed that diastolic blood pressure reactivity was significantly related to LVM. Hypertensive status, task type, and sample size did not play a major role in moderating the relationship between LVM and CVR. A somewhat larger percentage of positive results was shown in prospective and adult studies. The association between CVR and LVM may be real, although the effect size is modest, and we discuss methodological strategies for enhancing statistical power in future investigations. Additional sampling factors (e.g., race, gender) may also impact this relationship. Finally, greater attention is warranted to the role of the psychosocial environment, as this may interact with reactivity to influence LVM