Individual Growth Curve Models Research Articles

The course of self-perceived cognitive functioning among patients with lymphoma and the co-occurrence with fatigue and psychological distress.

To investigate the proportion of patients with lymphoma with persistent clinically relevant cognitive impairment, and its relation to treatment, fatigue, and psychological distress. Patients with diffuse-large-B-cell-lymphoma (DLBCL), follicular-lymphoma (FL), and chronic-lymphocytic-leukemia (CLL)/small-lymphocytic-lymphoma (SLL), diagnosed between 2004-2010 or 2015-2019, were followed up to 8years post-diagnosis. Sociodemographic and clinical data were obtained from the Netherlands Cancer Registry and the Population-based HAematological Registry for Observational Studies. The EORTC QLQ-C30 was used to assess cognitive functioning and fatigue, and the HADS to assess psychological distress. Individual growth curve models were performed. Results were compared with an age- and sex-matched normative population. A total of 924 patients were included (70% response rate). Persistent cognitive impairment was twice as high in patients (30%) compared to the normative population (15%). Additionally, 74% of patients reported co-occurring symptoms of persistent fatigue and/or psychological distress. Patients with FL (- 23 points, p < 0.001) and CLL/SLL (- 10 points, p < 0.05) reported clinically relevant deterioration of cognitive functioning, as did the normative population (FLnorm - 5 points, DLBCLnorm - 4 points, both p < 0.05). Younger age, higher fatigue, and/or psychological distress at inclusion were associated with worse cognitive functioning (all p's < 0.01). Treatment appeared less relevant. Almost one-third of patients with lymphoma report persistent cognitive impairment, remaining present up to 8years post-diagnosis. Early onset and co-occurrence of symptoms highlight the need for clinicians to discuss symptoms with patients early. Early recognition of cognitive impairment could increase timely referral to suitable supportive care (i.e., lifestyle interventions) and reduce (long-term) symptom burden.

Call me maybe? In-person vs. teletherapy outcomes among married couples

ABSTRACT Objective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance. Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators. Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction. Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality.

Individual growth curve modeling for applied linguistics research

In applied linguistics research interest has surged in recent years for questions related to individuals’ development and change. The most commonly used methods in the field for analyzing repeated measures data, for studying variation and stability in individual change, and for investigating how individual level outcomes relate to the group may not be the most robust available. In this methods tutorial, we introduce a state-of-the-art longitudinal data analysis method: individual growth curve modeling. We describe the various uses for individual growth curve models (IGCM) in comparison with other cross-sectional or single-subject analytical methods, define important terms related to such models that describe outcome variable Y at time t, and show how IGCM can be used to analyze variables at the individual and group levels simultaneously. In our tutorial, we provide a worked example of IGCM that draws on a dataset of L2 students’ classroom disengagement and use R to exemplify the necessary steps for conducting IGC modeling. Through this example, we demonstrate how IGCM are especially suited to data structured on multiple levels, where repeated measures varying across time are nested within individuals, and where both time-variant and time-invariant measures are of interest. We further demonstrate how, in addition to examining changes over time in the outcome variable for the same individual using repeated measures, IGCM can also capture individual differences in those changes. We conclude with a brief review of how such models have been used recently across a selective sample of research domains in applied linguistics

Blended Care Therapy for Depression and Anxiety: Outcomes across Diverse Racial and Ethnic Groups

BackgroundStudies have reported positive outcomes of blended care therapy (BCT), which combines face-to-face care with internet modules. However, there is insufficient evidence of its effectiveness across racial and ethnic groups. This study evaluated outcomes of a BCT program, which combined video psychotherapy with internet cognitive-behavioral modules, across race and ethnicity.MethodsParticipants were 6492 adults, with elevated anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) symptoms, enrolled in employer-offered BCT. Changes in anxiety (GAD-7) and depression (PHQ-9) symptoms during treatment were evaluated using individual growth curve models. Interaction terms of time with race and ethnicity tested for between-group differences. Treatment satisfaction was assessed using a Net Promoter measure (range = 1 (lowest satisfaction) to 5 (greatest satisfaction)).ResultsParticipants’ self-reported race and ethnicity included Asian or Pacific Islander (27.5%), Black or African American (5.4%), Hispanic or Latino (9.3%), and White (47.2%). Anxiety symptoms decreased during treatment (p < 0.01), with greater reductions among Hispanic or Latino participants compared to White participants (p < 0.05). Depressive symptoms decreased across treatment (p < 0.01), with significantly greater decreases among some racial and ethnic groups compared to White participants. Declines in anxiety and depressive symptoms slowed across treatment (p’s < 0.01), with statistically significant differences in slowing rates of depressive symptoms across some racial and ethnic groups. Among participants with responses (28.45%), average treatment satisfaction ranged from 4.46 (SD = 0.73) to 4.67 (SD = 0.68) across race and ethnicity (p = 0.001). Racial and ethnic differences in outcomes were small in magnitude.ConclusionsBCT for anxiety and depression can be effective across diverse racial and ethnic groups.

Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness.

Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness. PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences. Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences. Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

The Effects of Remote Activity Monitoring on Family Caregivers of People Living With Dementia Over an 18-Month Period

Technology interventions for older persons and long-term care are generally utilized as real-time data capture tools to complement clinical or family care for older persons or as interventions themselves designed to improve important dementia care outcomes. Although research on novel technological interventions for people with Alzheimer's disease and related dementias (ADRD) and their family caregivers has grown considerably in the past two decades, much of this work continues to focus on design, feasibility, and acceptability (with a need for conceptual refinement in these areas) and less on controlled outcome studies. The objective of this experimental mixed methods demonstration was to determine the 18-month effectiveness of remote activity monitoring (RAM) technology in improving outcomes among family caregivers of community-dwelling persons with dementia. We used an embedded experimental mixed methods design, collecting qualitative data within the structure of a traditional randomized controlled trial ([QUAN+qual]→QUAN) over an 18-month period for 171 dementia caregivers. Change in caregiver self-efficacy, sense of competence, and caregiver distress served as the main quantitative outcomes of interest. Individual growth curve models indicated that the RAM technology did not have direct effects on caregiving outcomes, and although the qualitative findings indicated several potential moderators of RAM effectiveness on caregiving outcomes, the inclusion of these qualitatively-identified moderators did not result in statistically significant (p < .05) effects. Ensuring effective human care management alongside RAM technology may help to overcome the barriers reported by dementia caregivers in this demonstration study.

Mindfulness-Based Stress Reduction Increases Mental Wellbeing and Emotion Regulation During the First Wave of the COVID-19 Pandemic: A Synchronous Online Intervention Study.

The COVID-19 pandemic imposed extreme living conditions of social distancing, which triggered negative mental health problems and created challenges in seeking mental health support. Mindfulness-based interventions (MBIs) have been found to enhance wellbeing and mental health by reducing stress and anxiety and improving emotion regulation. Preliminary evidence suggests that online, synchronous MBIs may produce beneficial effects similar to face-to-face programs. However, the effectiveness of such online-MBIs to support mental health in highly stressful times, such as a global pandemic, requires further study. To this end, we investigated the effect of an online 8-week Mindfulness-Based Stress Reduction (MBSR) program on aspects of mental health during the first wave of the COVID-19 pandemic. Participants (N=92) who expressed interest in discounted online-MBSR programs were recruited for the study. The division into experimental and control groups was based on actual enrollment to the courses. Those who enrolled in a program were assigned to the experimental condition and those who decided not to enroll served as controls. Participants were assessed pre-intervention, post-intervention, and 1-month post-intervention for levels of mindfulness, perceived stress, anxiety, emotion regulation, and intolerance of uncertainty. Differences between the groups were tested using the general linear mixed effects model (GLMM) and Individual Growth Curve Models (IGCM) in intent to treat analysis. The findings indicated that, relative to the control group, MBSR improved mindfulness abilities (p <0.001), decreased anxiety (p <0.001), and stress (p <0.001) and increased emotion regulation (p <0.001). These effects were found to persist 1 month after the end of the program, despite the increased governmental public-health restrictions due to COVID-19 at that time. The ability to tolerate uncertainty, a central characteristic of the pandemic, was not found to be affected by the program. A mediation analysis revealed that the effect of the intervention on mental health improvement was partially mediated by the improvement in emotion regulation. Overall, the findings provide positive evidence for the feasibility of an online-MBSR program to support the mental health of individuals from the general population through the mediation of emotion regulation in challenging times, such as a global pandemic.

Physical Function Recovery Trajectories After Spinal Cord Injury

ObjectiveTo explore trajectories of functional recovery that occur during the first 2 years after spinal cord injury (SCI). DesignObservational cohort study. SettingEight SCI Model System sites. ParticipantsA total of 479 adults with SCI completed 4 Spinal Cord Injury–Functional Index (SCI-FI) item banks within 4 months of injury and again at 2 weeks, 3, 6, 12, and 24 months after baseline assessment (N=479). InterventionNone. Main Outcome MeasuresSCI-FI Basic Mobility/Capacity (C), Fine Motor Function/C, Self-care/C, and Wheelchair Mobility/Assistive Technology (AT) item banks. ResultsGrowth mixture modeling was used to identify groups with similar trajectory patterns. For the Basic Mobility/C and Wheelchair Mobility/AT domains, models specifying 2 trajectory groups were selected. For both domains, a majority class exhibited average functional levels and gradual improvement, primarily in the first 6 months. A smaller group of individuals made gradual improvements but had greater initial functional limitations. The Self Care/C domain exhibited a similar pattern; however, a third, small class emerged that exhibited substantial improvement in the first 6 months. Finally, for individuals with tetraplegia, trajectories of Fine Motor Function/C scores followed 2 patterns, with individuals reporting generally low initial scores and then making either modest or large improvements. In individual growth curve models, injury/demographic factors predicted initial functional levels but less so regarding rates of recovery. ConclusionsTrajectories of functional recovery followed a small number of change patterns, although variation around these patterns emerged. During the first 2 years after initial hospitalization, SCI-FI scores showed modest improvements; however, substantial improvements were noted for a small number of individuals with severe limitations in fine motor and self-care function. Future studies should further explore the personal, medical, and environmental characteristics that influence functional trajectories during these first 2 years and beyond.

The Effect of Childhood Socioeconomic Position and Social Mobility on Cognitive Function and Change Among Older Adults: A Comparison Between the United States and England.

This study aims to examine the relationship between childhood socioeconomic position (SEP) and cognitive function in later life within nationally representative samples of older adults in the United States and England, investigate whether these effects are mediated by later-life SEP, and determine whether social mobility from childhood to adulthood affects cognitive function and decline. Using data from the Health and Retirement Study (HRS) and the English Longitudinal Survey of Ageing (ELSA), we examined the relationships between measures of SEP, cognitive performance and decline using individual growth curve models. High childhood SEP was associated with higher cognitive performance at baseline in both cohorts and did not affect the rate of decline. This benefit dissipated after adjusting for education and adult wealth in the United States. Respondents with low childhood SEP, above median education, and high adult SEP had better cognitive performance at baseline than respondents with a similar childhood background and less upward mobility in both countries. These findings emphasize the impact of childhood SEP on cognitive trajectories among older adults. Upward mobility may partially compensate for disadvantage early in life but does not protect against cognitive decline.

Stability of and change in substance use risk personality: Gender differences and smoking cigarettes among early adolescents

ObjectiveAdolescents show a steadily increasing inclination toward health risk behaviors, including smoking cigarettes. There is ample evidence that personality traits are related to smoking behavior. However, less is known about the stability of and change in these personality traits during early adolescence and whether smoking behavior affects the developmental trajectories. Moreover, less is known about the influence of gender on the course of personality. MethodLongitudinal data of three waves were used from 1121 early adolescents. To measure personality, the Substance Use Risk Profile Scale was used. Individual growth curve models were conducted to measure the stability, mean-level change and individual differences in change for personality. ResultsStability of personality was moderate for boys and ranged from moderate to high for girls. On average early adolescents became more impulsive and more sensation seeking over a period of 18 months. Furthermore, hopelessness for girls increased and the increase in sensation seeking was higher for girls than for boys. Third, smoking behavior was related to all personality traits, indicating that smoking adolescents are more anxious, hopeless, impulsive and sensation seeking than non-smoking adolescents. ConclusionsOur results are in line with the disruption hypothesis, i.e., during early adolescence there is a dip in personality maturity. There are clear differences between girls and boys in stability of and change in personality traits. Besides, although smoking behavior is related to personality, the change in personality is probably related to other variables.

Longitudinal analysis of the recovery of trunk control and upper extremity following stroke: An individual growth curve approach

ABSTRACT Background and Purpose Trunk control is thought to contribute to upper extremity function. It is unclear whether recovery of trunk control has an impact on the recovery of the upper extremity in people with stroke. This longitudinal study monitored the recovery of trunk control and upper extremity in the first 6 months following stroke. Methods Forty-five participants with stroke were assessed monthly for 6 months following stroke. Trunk control was assessed using the Trunk Impairment Scale (TIS); upper extremity impairment and function were assessed with the Fugl-Meyer (FMA) and Streamlined Wolf Motor Function Test (SWMFT) respectively. The SWMFT included the performance time (SWMFT-Time) and functional ability scale (SWMFT-FAS). The individual growth curve modeling was used to analyze the longitudinal data. Results The recovery curve of TIS, FMA, SWMFT-Time and SWMFT-FAS followed a quadratic trend, with the rate of recovery decreasing from the first to sixth month. As TIS score improved over time, FMA, SWMFT-Time and SWMFT-FAS improved in parallel with the TIS score. TIS at each time point was found to be a significant predictor of FMA, SWMFT-Time and SWMFT-FAS at 6 months post stroke. Conclusion Our work has provided, for the first time, substantial evidence that the pattern of recovery of trunk control is similar to that of the recovery of upper extremity following stroke. In addition, this study provides evidence on which to design a prospective study to evaluate whether improvement in trunk control early post-stroke results in better long-term upper extremity function.

A randomized controlled trial on the comparative effectiveness of mindfulness-based cognitive therapy and health qigong-based cognitive therapy among Chinese people with depression and anxiety disorders

BackgroundThe goal of this study was to investigate treatment outcome and related intervention processes of mindfulness-based cognitive therapy versus health qigong-based cognitive therapy versus waitlist control among individuals with mood disorders.MethodsA total of 187 individuals with mood disorders were randomized and allocated into mindfulness-based cognitive therapy, health qigong-based cognitive therapy, or waitlist control groups. All participants were assessed at three time points with regard to depressive and anxiety symptoms, physical and mental health status, perceived stress, sleep quality, and self-efficacy. Linear mixed models analysis was used to test the individual growth model by studying the longitudinal data.ResultsMindfulness-based cognitive therapy and health qigong-based cognitive therapy both produced greater improvements on all outcome measures as compared with waitlist control. Relatively, more reductions of mood symptoms were observed in the health qigong-based cognitive therapy group as compared with the mindfulness-based cognitive therapy group. Health qigong-based cognitive therapy is more conducive to physical health status whereas mindfulness-based cognitive therapy has more favorable mental health outcomes. Individual growth curve models indicated that alterations in perceived stress was the common predictor of mood changes in both intervention groups.ConclusionsThe predominant emphasis on physical health in health qigong-based cognitive therapy makes it more acceptable and effective than mindfulness-based cognitive therapy as applied in Chinese individuals with mood disorders. The influence of Chinese culture is discussed.Trial registrationHKU Clinical Trials Registry. Identifier: HKUCTR-2558. Registered 21st Nov 2018.

Growth Trajectories of Perceived Parental Behavior During Adolescence.

Perceived parental behaviour has mainly been studied in association with various developmental outcomes in children and adolescents but less is known about the underlying developmental change of parental behavior during adolescence. In the present study, a sample of N = 552 participants aged 11-12years were assessed at three measurement times during adolescence. Perceived acceptance, psychological control, and structure were measured separately for both parents with the brief Perceived Parental Behavior Inventory (PPBI). Trajectories were analyzed using individual growth curve models. Perceived acceptance did not change over time for either parent and there were no sex differences. In contrast, parental psychological control and structure decreased and showed sex differences during adolescence. The latter effect was stronger in boys. This study documents normative developmental trajectories of perceived parental behaviour during adolescence. The PPBI adequately reflects developmental changes in perceived parental behaviour across adolescence and may represent a useful tool in future studies.

Sex Differences in Rates of Change and Burden of Metabolic Risk Factors Among Adults Who Did and Did Not Go On to Develop Diabetes: Two Decades of Follow-up From the Tehran Lipid and Glucose Study.

We investigated the cumulative burden and linear rates of change of major metabolic risk factors (MRFs) among Iranian adults in whom type 2 diabetes did and did not develop. We included 7,163 participants (3,069 men) aged 20-70 years at baseline with at least three examinations during 1999-2018. Individual growth curve modeling was used for data analysis. Statistical interactions for sex by diabetes status were adjusted for age, family history of diabetes, smoking status, and physical activity level. Study sample included 743 (316 men) new case subjects with diabetes. In both men and women, compared with individuals in whom diabetes did not develop, individuals in whom diabetes developed had a higher burden of all MRFs and a greater rate of change in BMI, fasting plasma glucose (FPG), systolic blood pressure (SBP), and diastolic blood pressure; however, the differences in burden and rate of change between those who did and did not develop diabetes were greater in women than in men. During the transition to diabetes, women experienced more adverse change in BMI, FPG, triglyceride, and HDL cholesterol (HDL-C) (diabetes-sex interaction P values <0.05) and faster rates of change in BMI, FPG, HDL-C, and total cholesterol (interaction P values <0.01) and SBP (interaction P = 0.055) than men. The greater exposure of women to and burden of MRFs before onset of diabetes may have implications for implementing sex-specific strategies in order to prevent or delay diabetes complications.

Promotion of Thriving Among Hong Kong Chinese Adolescents: Evidence From Eight-Wave Data

Objectives:This study evaluated the longitudinal effect of a positive youth development (PYD) program entitled “Positive Adolescent Training through Holistic Social Programmes” (Project P.A.T.H.S.) on perceived thriving among Chinese adolescents in Hong Kong.Method:Individual growth curve modeling analyses were performed using eight waves of data collected over 5 years from 23 experimental schools ( N = 3,607) and 24 control schools ( N = 3,574).Results:Adolescent thriving declined faster among control school students relative to experimental school students. While the two groups did not differ at Wave 1 and Wave 2 on the mean thriving levels, experimental school students showed higher thriving levels at Wave 3 to Wave 7 than did the control group students. Such differences between the two groups were more salient among girls than among boys, suggesting a stronger intervention effect for girls.Conclusion:The present findings suggest that PYD programs can promote thriving in Chinese adolescents.

0291 Recovery Sleep Alleviates Mood Disturbance Following Chronic Sleep Restriction, Albeit Transiently and in a Dose-Dependent Manner

Abstract Introduction Fatigue is one contributor to mood disturbance observed following sleep restriction; however, the contribution of other factors remains unclear. This study examined contributions to mood disturbance resulting from sleep restriction beyond that of fatigue, evaluated the benefit of recovery sleep, and assessed whether recovery sleep buffered the re-emergence of mood disturbance upon re-exposure to sleep restriction. Methods N=223 healthy participants (48% female; n=108) approximately 30-years-old (SD=6.89, range=22–45 years) completed two baseline nights of 8h time in bed (TIB), followed by five nights of 4h TIB, and were then then randomized to one of 7 sleep recovery opportunities (i.e., 0, 2, 4, 6, 8, 10, or 12 hours TIB). Following the sleep period, a subset of participants (n=72) were re-exposed to five consecutive nights of 4h TIB. The profile of mood states (POMS) was completed every 2h during wakefulness and daily averages were calculated. The POMS total mood disturbance (TMD) score without the fatigue subscale (i.e., mood disturbance = TMD - fatigue) was the primary outcome to isolate changes in mood disturbance beyond fatigue. Individual growth curve models were applied to the trajectory of mood disturbance. General linear models were used to evaluate the dose-response function of mood disturbance after recovery sleep. Results Mood disturbance (absent the POMS fatigue scale) increased with each day of sleep restriction (β=1.550 per day; P&amp;lt;0.0001), and decreased with longer recovery sleep durations in a dose-dependent manner (β=-1.614 for every 2h increase; P&amp;lt;0.0001). The benefits of recovery sleep were abated by the second night of 4h sleep during re-exposure, where mood disturbance was slightly higher than that observed before recovery, but this difference was not statistically significant (β=0.046; P=0.85). Conclusion The study findings suggest that fatigue is not the only contributor to mood disturbance following sleep restriction. Recovery sleep attenuates mood disturbance in a dose-dependent manner, albeit transiently. Candidate pathways linking sleep restriction and mood include the immune system and the dynamics of sleep physiology. Support This work was funded by National Institute of Health NIH R01NR004281 and National Space and Biomedical Research Institute NSRBI NCC 5–98.

The Role of Internalizing Mental Health Problems in Substance Use Trajectories for Minority Adolescents

Research on adolescence and substance use point to a link between internalizing problems and substance use. The current longitudinal study investigates how internalizing problems and substance use change over time among minority adolescents and the role of internalizing problems in predicting trajectories of substance use among African American and Latinx adolescents, with attention to variation by gender, ethnicity, and generation status. This study follows a large sample of minority immigrant adolescents over three waves of data collection (10th, 11th, and 12th grades). Individual growth curve modeling showed that substance use increased over time while internalizing problems decreased overtime. Results showed that changes in internalizing problems over time significantly predicted changes in substance use over time. Ethnicity moderated this relation; specifically, greater internalizing problems predicted greater substance use for Latinx, but not African Americans. No significant interactions were found among gender or generation status in predicting substance use at intercept. Implications for future research are discussed.

Functional Outcome Trajectories Following Inpatient Rehabilitation for TBI in the United States: A NIDILRR TBIMS and CDC Interagency Collaboration.

To describe trajectories of functioning up to 5 years after traumatic brain injury (TBI) that required inpatient rehabilitation in the United States using individual growth curve models conditioned on factors associated with variability in functioning and independence over time. Secondary analysis of population-weighted data from a multicenter longitudinal cohort study. Acute inpatient rehabilitation facilities. A total of 4624 individuals 16 years and older with a primary diagnosis of TBI. Ratings of global disability and supervision needs as reported by participants or proxy during follow-up telephone interviews at 1, 2, and 5 years postinjury. Many TBI survivors experience functional improvement through 1 and 2 years postinjury, followed by a decline in functioning and decreased independence by 5 years. However, there was considerable heterogeneity in outcomes across individuals. Factors such as older age, non-White race, lower preinjury productivity, public payer source, longer length of inpatient rehabilitation stay, and lower discharge functional status were found to negatively impact trajectories of change over time. These findings can inform the content, timing, and target recipients of interventions designed to maximize functional independence after TBI.

The Longitudinal Effects of Comorbid Health Burden on Functional Outcomes for Adults With Moderate to Severe Traumatic Brain Injury.

To evaluate the impact of physical, mental, and total health condition burden on functional outcome and life satisfaction up to 10 years after moderate to severe traumatic brain injury (TBI). Six TBI Model Systems centers. Three hundred ninety-three participants in the TBI Model Systems National Database. Retrospective cohort study. Self-reported physical and mental health conditions at 10 years postinjury. Functional Independence Measure Motor and Cognitive subscales and the Satisfaction With Life Scale measured at 1, 2, 5, and 10 years. In 10-year longitudinal individual growth curve models adjusted for covariates and inverse probability weighted to account for selection bias, greater physical and mental health comorbidity burden was negatively associated with functional cognition and life satisfaction trajectories. Physical, but not mental, comorbidity burden was negatively associated with functional motor trajectories. Higher total health burden was associated with poorer functional motor and cognitive trajectories and lower life satisfaction. This study offers evidence that comorbidity burden negatively impacts longitudinal functional and life satisfaction outcomes after TBI. The findings suggest that better identification and treatment of comorbidities may benefit life satisfaction, functional outcome, reduce healthcare costs, and decrease reinjury. Specific guidelines are needed for the management of comorbidities in TBI populations.

Examining the role of emotion regulation in the bidirectional relation between physiological and subjective stress response among daily cigarette smokers

Cigarette smoking is associated with autonomic dysregulation and altered stress responsivity. There exists a reciprocal relation between subjective and physiological stress reactivity and recovery in smokers. Emotion regulation may impact the extent to which these domains influence each other. The current study examined the moderating role of lack of emotional awareness, lack of emotional clarity, and nonacceptance of emotions, in the relation between heart rate reactivity to, and subjective recovery from, stress, and vice versa. To determine specificity of cross-domain findings, these relations were also examined within domain. Fifty-six daily smokers (46.4% female; Mage = 29.33, SD = 11.92) participated in a biological challenge. Heart rate and subjective distress were assessed continuously before, during, and after the challenge. Individual growth curve models revealed that deficits in emotional clarity significantly moderated the effect of heart rate reactivity on subjective recovery. Lack of emotional awareness also moderated the association between subjective reactivity and heart rate recovery. Emotion regulation processes did not affect relations within the same domain, but altered the relation across domains.