Claudia Trudel-Fitzgerald

Psychosocial well-being relates to lower cardiovascular risk, and a healthy lifestyle may contribute to this association. Prior research has focused on aging adults, although health behaviors are usually consolidated in early adulthood. This longitudinal study assessed the association between two psychosocial well-being indicators and subsequent healthy lifestyles in young adults. Participants (n = 799; age_mean = 30.6 years) in the Nicotine Dependence in Teens Study completed items to derive the emotional vitality score, a flourishing scale, and covariates in 2017-2020. Data on selected outcomes (i.e., smoking, sleep, physical activity, alcohol intake, diet quality), collected in 2017-2020 and 2020-2021, were combined into a lifestyle score used categorically (≥ 4 healthy behaviors) and continuously (0-5 scores). Associations between psychosocial well-being indicators and lifestyle up to 4 years later were modeled using logistic and linear regressions. In model 3 adjusting for sociodemographic, health-related, and depression covariates, higher likelihood of a healthy lifestyle (≥ 4 healthy behaviors) was observed with flourishing (OR = 1.56, 95%CI = 1.02-2.40), but the CI for emotional vitality included the null (OR = 1.62, 95%CI = 0.93-2.81). Both well-being indicators were similarly associated with continuous lifestyle scores (e.g., model 3, per 1-SD unit: β_flourishing = 0.13, 95%CI = 0.06-0.21; β_{emotional vitality} = 0.10, 95%CI = 0.02-0.17). Further controlling for baseline lifestyle attenuated associations (model 4; β_flourishing = 0.10, 95%CI = 0.03-0.18; β_{emotional vitality} = 0.06, 95%CI = -0.02 to 0.14). When assessing behaviors separately, both well-being indicators were associated with healthy diets and sleep only. Flourishing and emotional vitality may promote healthy behaviors among young adults and be considered in prevention strategies aiming to foster healthy lifestyles in this age group.

Background: Intensive measures of well-being and behaviors in large epidemiologic cohorts have the potential to enhance health research in these areas. Yet, little is known regarding the feasibility of using mobile technology to collect intensive data in the “natural” environment in the context of ongoing large cohort studies. Objective: We examined the feasibility of using smartphone digital phenotyping to collect highly resolved psychological and behavioral data from participants in a pilot study with participants in Nurses’ Health Study II, a nationwide prospective cohort of women. Methods: In this pilot study, an 8-day intensive smartphone protocol was implemented using the “Beiwe” smartphone app. Participants (n=181) completed a baseline survey on day 1 and answered ecological momentary assessment (EMA) surveys twice daily (days 2-8; early afternoon and evening) using their smartphone and provided minute-level accelerometer and GPS data. A feedback survey at the end of Substudy queried participants’ experience with the app and data collection process. We assessed adherence to the protocol by examining completion on EMA surveys and completeness of accelerometer and GPS data at the participant, participant day, and prompt levels. Results: Our pilot study demonstrated modest overall compliance with smartphone-based surveys: the baseline survey completion rate was high (156/181, 86.2%), but average daily EMA response rates during the 7-day period were lower with 55.6% (SD 3.9%) for early afternoon and 54.7% (SD 3.2%) for evening. We also observed good average daily completeness of smartphone accelerometer (mean 62.0%, SD 4.5%) data and GPS data (mean 57.7%, SD 3.1%). The feedback survey revealed that the participants found “the app easy to use” (median 85.0 on a scale of 1‐100) and were “willing to repeat similar studies” (median 85.0 on a scale of 1‐100). Although participants reported feeling their participation was a positive experience (median 64.0 on a scale of 1‐100), they also identified some important issues, including user fatigue due to repetitive daily surveys. Conclusions: We observed modest compliance with smartphone surveys and completeness of smartphone passive sensing data in this pilot study compared with similar studies in the past. However, this was not unexpected, given our participants were older (aged 57‐75 years, with more than 3 decades of follow-up at the time of the substudy) and may encounter more technological barriers, not to mention that the indication of willingness to participate in such studies again was fairly high. Our findings also highlight that the success and data quality of efforts to obtain daily measures may vary depending on data type and emphasize the need to improve the design of the EMA survey to improve or sustain participant engagement over the study period. Overall, our findings suggest smartphone-based digital phenotyping as a promising technology when embedding in large epidemiological cohorts to collect intensive longitudinal observation data.

Purpose Stress-related coping is an important mechanism of mental health functioning. However, the distribution of coping processes across various factors (e.g., individual like sex, contextual like perceived social status) remain under-explored. This study identified individual, intergenerational, and contextual factors associated with coping strategies, variability in their use (as a proxy for using strategies flexibly across contexts), and perceived coping efficacy to handle stressors among young adults. Methods Participants from the Nicotine Dependence in Teens study (NDIT; N = 827) completed the validated Coping Inventory for Stressful Situations scale in 2011–12 (age ~ 24). Data on many factors, including race/ethnicity, intergenerational education patterns, and perceived social status, were collected from 1999–2000 (at NDIT inception; age 12–13) to 2011–12. Linear and multinominal regressions modeled the associations between individual, intergenerational, and contextual factors and coping strategies, variability, and efficacy, separately. Results Women versus men reported more frequent use of emotion-, distraction-, and social diversion-oriented strategies and higher variability levels (e.g., B_emotion=0.40, 95%CI = 0.28, 0.51), but less frequent use of task-oriented strategies and lower coping efficacy (e.g., B_efficacy=-0.46, 95%CI=-0.59, -0.32). Higher incomes, more educated mothers, and higher perceived social status in the community were associated with more frequent use of task-oriented strategies and coping efficacy, and less frequent use of emotion-oriented strategies. Other factors, including race/ethnicity, marital status, and school socio-economic status, were not robustly related to coping processes. Conclusion Findings document the distribution of coping processes across individual, intergenerational, and contextual factors among young adults, which may more broadly increase understanding of social disparities in mental health.

Objective: Emerging evidence suggests maladaptive (eg, suppression) versus adaptive (eg, reappraisal) emotion regulation strategies predict the risk of cardiovascular disease, which is the leading cause of death among women. Recognizing that health encompasses more than the absence of disease, we investigated whether reappraisal and suppression strategies are individually or jointly related to favorable cardiovascular health (CVH) over time among women. Methods: At baseline in 2017-2018, 28,759 postmenopausal women free of cardiovascular disease (age _mean =63) from the Nurses’ Health Study II cohort answered the validated Emotion Regulation Questionnaire assessing reappraisal and suppression strategies. Favorable CVH was defined at baseline and in 2019 based on self-reported diagnoses of hypertension, cholesterol, and diabetes, as well as body mass index and smoking status. Poisson regression models evaluated the relative risk (RR) and 95% CI of having favorable CVH in 2019 related to baseline use of each emotion regulation strategy and their interplay, considering relevant covariates. Results: In sociodemographic-adjusted models, greater reappraisal use was related to a higher likelihood of having favorable CVH (RR _{per 1-SD increase} =1.07, 95% CI=1.06-1.09), while greater suppression use was related to a lower likelihood (RR _{per 1-SD increase} =0.96, 95% CI=0.94-0.97). Relative to women reporting lower use of both strategies, those using both strategies frequently (RR=1.13, 95% CI=1.08-1.19) and those favoring reappraisal over suppression use (RR=1.21, 95% CI=1.14-1.27) had a higher likelihood of favorable CVH. Associations were attenuated, but most remained evident after adjusting for baseline CVH and health behaviors. Conclusions: Use of adaptive versus maladaptive emotion regulation strategies predicts the likelihood of having favorable CVH in expected directions.

Objective: Although growing evidence indicates that distinct affect regulation strategies (e.g., positive reappraisal, anger suppression) predict mortality risk, the biological processes involved remain understudied. We investigated the association of various affect regulation exposures with mortality risk while examining the role of allostatic load. Method: In 2004-2006, 1,941 participants from the Midlife in the United States longitudinal study completed validated scales assessing use of nine general and emotion-specific regulatory strategies (e.g., denial, anger expression). A standard deviation-based algorithm was also used to characterize how flexibly participants regulate their affect (lower, moderate, or greater variability). Participants further provided data on relevant covariates and 24 allostatic load biomarkers (e.g., cortisol, glucose). Cox regressions modeled hazard ratios (HRs) and 95% confidence intervals (CI) examined associations of affect regulation variables and all-cause mortality risk until 2022. The confounding, mediating, and moderating role of allostatic load was examined in subsequent models. Results: In fully-adjusted models, only greater vs. lower affect regulation variability (HR=1.54; 95%CI=1.11-2.14) significantly predicted a higher mortality risk. Associations were relatively unchanged with further inclusion of allostatic load in models and allostatic load did not mediate affect regulation-mortality relationships. Yet, when evaluating moderation effects, greater vs. lower and moderate variability as well as denial were marginally or significantly related to higher mortality risk among adults with lower allostatic load only. Conclusions: Allostatic load may modify rather than confound or mediate the association between some dimensions of affect regulation and mortality risk. Future work should evaluate the potential roles of allostatic load among diverse samples.

Objective: Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (eg, anxiety) and states (eg, happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes, including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (eg, seeking emotional support) and maladaptive (eg, denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in the use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle. Methods: Women (N = 46 067) from the Nurses’ Health Study II cohort reported their use of 8 coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (eg, physical activity, smoking, sleep), self-reported every 4 years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health-related factors, were performed. Results: Most adaptive strategies and greater variability levels were associated with a higher likelihood of sustaining a healthy lifestyle (eg, active coping, relative risk [RR] = 1.09, 95% confidence interval [CI], 1.08-1.11), with the reverse evident with maladaptive strategies (eg, behavioral disengagement, RR = 0.94, CI, 0.93-0.95), but some unexpected results also emerged. Conclusions: Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.

Integrative models of mental illness and health in psycho-oncology are aimed at all types of cancer, although the patients' experiences and issues may vary. This review summarizes the different theories and models of mental illness and health pertaining to the breast cancer experience and proposes an integrative phasic model applicable to the breast cancer trajectory. Five databases were searched for studies related to breast cancer mental health and illness theories and models. The PRISMA checklist form was used to extract the essential information from the included studies. Eleven theories and models on the experience of breast cancer were found. The integrative model based on these theories and models illustrates that the breast cancer experience is conceptualized as a trajectory with seven landmark 'events', each associated with a pathogenic 'challenge' leading to six possible 'symptoms', 1) psychological distress with anxious features, 2) psychological distress with depressive features, 3) non-specific distress 4) psychological distress with trauma-related features 5) low health-related quality of life, and 6) fear of recurrence. The Breast Cancer Psychological Integrative Phasic Model is supported by a simple clinical tool (BreastCancerPsych - Integrative Clinical Tool) that serves as a valuable resource throughout the care trajectory. These integrative phasic model and clinical tool are designed to help mental health clinicians formulate treatments that are tailored to the needs of their patients, especially for trajectories that are not marked by resilience.