Predictors Of Subsequent Changes Research Articles

Longitudinal associations between psychological and social well‐being: Exploring within‐person dynamics

AbstractThis study examines the longitudinal associations between psychological and social well‐being, which represent the private and public dimensions of eudaimonic well‐being, respectively. Data were drawn from the Midlife in the United States (MIDUS) project (N = 6,453). Participants were assessed at three‐time points, each approximately a decade apart. Both between‐person and within‐person associations between social and psychological well‐being are examined. The results reveal a strong between‐person association, consistent with previous cross‐sectional results. In addition, novel insights are gained by uncovering longitudinal within‐person associations that suggest consistent and coordinated changes in psychological and social well‐being over time. More specifically, deviations from typical levels in one dimension are associated with corresponding deviations in the other dimension after about 10 years, suggesting a reciprocal link. Notably, person‐specific changes in social well‐being are a better predictor of subsequent changes in psychological well‐being, than the other way around. These findings underscore the interdependence of the two facets of eudaimonic well‐being and highlight the importance of considering both dimensions in intervention strategies. Taken together, these findings enrich our understanding of the dynamic nature of eudaimonic well‐being. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

The diffusion of health care fraud: A bipartite network analysis

Many studies have examined the diffusion of health care innovation but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002–16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice (DOJ) anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies (HHAs) provides a mechanism for the rapid diffusion of fraudulent strategies. We measure such activity using a novel bipartite mixture (or BMIX) network index, which captures patient sharing across multiple agencies and thus conveys more information about the diffusion process than conventional unipartite network measures. Using a complete population of fee-for-service Medicare claims data, we first find a remarkable increase in home health care activity between 2002 and 2009 in many regions targeted by the DOJ; average billing per Medicare enrollee in McAllen TX and Miami increased by $2127 and $2422 compared to just an average $289 increase in other HRRs not targeted by the DOJ. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home health care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase billing. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002–9. These results highlight the importance of bipartite network structure in diffusion and in infection and contagion models more generally.

Basic psychological need satisfaction across the retirement transition: Changes and longitudinal associations with depressive symptoms

Drawing on self-determination theory, the present study examined how satisfaction of the basic psychological needs (autonomy, competence, and relatedness) changes across the retirement transition and how need satisfaction was related to depressive symptoms across the retirement transition. Participants (N = 2655) were drawn from the HEalth, Ageing and Retirement Transitions in Sweden (HEARTS) study. Latent growth curve modeling showed that autonomy need satisfaction increased across the retirement transition, whereas competence and relatedness remained relatively stable. Higher need satisfaction was related to less depressive symptoms at baseline, however, pre-retirement need satisfaction was not a statistically significant predictor of subsequent changes in depressive symptoms (or vice versa) across the retirement transition. At the within-person level, higher than usual need satisfaction at a specific time point was related to less than usual depressive symptoms. Need satisfaction may be an important factor to consider across the retirement transition and need satisfying activities prior, during, and after the transition may ease peoples’ adjustment to retirement.

Interparental conflict as a curvilinear risk factor of youth emotional and cortisol reactivity.

This study examined interparental conflict as a linear and curvilinear predictor of subsequent changes in adolescents' negative emotional reactivity and cortisol functioning during family conflict and, in turn, their psychological difficulties. In addition, adolescents' negative emotional reactivity and cortisol functioning during family conflict were examined as subsequent predictors of their psychological difficulties. Participants included 258 adolescents (52% girls) and their parents and teachers who participated in 3 annual measurement occasions. Adolescents were 13 years old on average (standard deviation [SD] = .57) at the first measurement occasion, were generally from middle- and working-class backgrounds, and identified mostly as White (e.g., 74%). The results of latent-difference score analyses indicated that a multimethod and multiinformant assessment of interparental conflict linearly predicted subsequent changes in observational ratings of adolescent emotional reactivity and their overall cortisol output in response to family conflict over a 1-year period. These changes, in turn, predicted increases in multiinformant reports of adolescent psychological problems over a 2-year period. However, the linear association in the first link in the cascade was qualified by the quadratic effects of interparental conflict as a predictor. Consistent with risk-saturation models, the relatively strong associations among interparental conflict and youth emotional reactivity and cortisol output at mild and moderate exposure to conflict weakened as exposure to conflict reached higher levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Momentary precipitants connecting stress and smoking lapse during a quit attempt.

Most attempts at smoking cessation are unsuccessful, and stress is frequently characterized both as a momentary precipitant of smoking lapse and a predictor of subsequent changes in other key precipitants of lapse. The current study examined longitudinal associations among stress, multiple precipitants of lapse, and lapse among smokers attempting to quit. Ecological momentary assessments (EMAs) were gathered from a multiethnic, gender-balanced sample of 370 adults enrolled in a smoking cessation program. EMAs (N = 32,563) assessed smoking lapse and precipitants of lapse, including stress, negative affect, smoking urge, abstinence self-efficacy, motivation to quit, difficulty concentrating, coping outcome expectancies, and smoking outcome expectancies. A multilevel structural equation model simultaneously estimated within-subject paths from stress to multiple precipitants and subsequent smoking lapse. Indirect effects of stress to smoking lapse through precipitants were computed. Results indicated that increased stress was significantly associated with all precipitants of lapse, consistent with a greater risk for lapse (i.e., increased negative affect, smoking urge, difficulty concentrating, and smoking outcome expectancies and reduced abstinence self-efficacy, motivation to quit, and coping outcome expectancies). All precipitants were significantly associated with subsequent lapse. Indirect effects indicated that stress was uniquely connected to lapse through negative affect, smoking urge, abstinence self-efficacy, coping outcome expectancies, and smoking outcome expectancies. Results of this study highlight the broad importance of stress for smoking lapse during a quit attempt. Smoking cessation programs should pay close attention to the role of stress in exacerbating key precipitants of lapse to improve cessation success rates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Patterns and temporal precedence of symptom change during cognitive processing therapy for military sexual trauma-related posttraumatic stress disorder.

Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD), including for veterans with military sexual trauma (MST)-related PTSD. Most CPT research to date has focused on pre- to post-treatment change in total PTSD symptoms; however, PTSD symptom criteria may not change equivalently over the course of treatment. For example, changes in re-experiencing symptoms have been shown to precede changes in other PTSD criteria during other PTSD treatments (i.e. virtual reality exposure therapy, venlafaxine ER). An improved understanding of the mechanism of change in PTSD symptoms during CPT may assist in optimizing treatment. The purpose of this study was to identify the pattern and temporal precedence of change in PTSD symptom criteria during and after CPT using cross-lagged panel analyses. Data from veterans (n = 32) enrolled in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD were utilized for this secondary analysis. Using hierarchical linear modelling, each symptom criterion was entered as a predictor of subsequent change in the other PTSD symptom criteria. All symptom criteria followed a logarithmic pattern of change. Hyperarousal symptoms were found to both predict and temporally precede change in avoidance symptoms, but not re-experiencing symptoms. Re-experiencing and avoidance symptoms did not predict change in other PTSD symptom criteria. These findings provide initial support that targeting and reducing hyperarousal symptoms may be a key component of PTSD intervention with CPT. Additional research is needed to identify factors that predict change in PTSD-related re-experiencing symptoms.

THE INTERPLAY BETWEEN BASELINE COGNITIVE STATUS AND FALLS HISTORY ON CHANGES IN MEMORY AND PHYSICAL FUNCTION AMONG OLDER ADULTS: A 1-YEAR PROSPECTIVE COHORT STUDY

Older adults with a history of falls are a risk for physical, cognitive, and functional decline. Among older adults with a recent history of falls, we aimed to determine baseline predictors of subsequent changes in aspects of cognitive, emotional, and physical functioning. Specifically, we focused on baseline cognitive status, and number of falls in the previous 12 months. We conducted a 1-year prospective cohort study that included 377 community-dwelling older adults aged ≥ 70 years with a history of ≥ 1 fall in the previous 12 months who presented to the Vancouver Falls Prevention Clinic (www.fallsclinic.ca). The Vancouver Falls Prevention Clinic provides a geriatrician based multifactorial intervention to individuals at high risk of falls. We report falls and cognitive function at baseline and examine changes between baseline and 1 year followup on cognitive, emotional, and physical functioning. Representing these aspects of cognitive, emotional and physical functioning are our key outcome measures consisting of five components derived from a principal component analysis: 1) attention and processing speed, 2) emotional functioning, 3) working memory, 4) physical functioning and 5) physical activity and comorbidities and fall risk. We used linear mixed effects models to examine the interaction of prior falls status (categorized as 1, 2 or 3 or more prior falls) and baseline MoCA score (a continuous variable) how these 5 components changed over 1 year. We observed a significant MoCA by prior falls by time interaction, F (2, 138) = 3.49, p = .03, on the working memory factor (Table 1). Among individuals with 3 or more prior falls, higher baseline MoCA score was protective of working memory performance decline over time (B = 0.17, SE = .08, p = .04). In contrast, those with ≥ 3 prior falls and lower baseline MoCA scores demonstrated the greatest decline in working memory performance (Figure 1). Baseline MoCA score did not appear to impact the trajectory of working memory performance among those with 1 or 2 prior falls.

Early development of mechanisms of change as a predictor of subsequent change and treatment outcome: The case of working alliance.

Advanced statistical tools have created the opportunity to systematically examine the effect of early trajectories in predictors of therapeutic change, such as early alliance development patterns, on outcome. To date, however, these methods have been used almost exclusively to examine the effect of the development of early symptoms on later ones. Development patterns of alliance early in treatment, and their association with treatment outcome, have received much theoretical attention, but few systematic examinations have been conducted so far. We integrated exploratory cluster analysis with the accumulated theoretical and empirical knowledge on patterns of alliance development to identify distinct patterns of early alliance development across the 1st 4 sessions of treatment in a sample of 166 patients receiving psychotherapy. Three patterns of early alliance development were identified: early gradual strengthening, early repaired rupture, and early unrepaired rupture. The gradual strengthening and the repaired rupture patterns early in treatment predicted alliance strengthening later in treatment, whereas the unrepaired rupture pattern early in treatment predicted alliance stability later in treatment. The effect of early alliance development patterns on treatment outcome was moderated by pretreatment interpersonal problems: For patients with better interpersonal functioning at intake, the gradual strengthening and the repaired rupture patterns showed better outcomes, whereas for those with poorer interpersonal functioning at intake, the early unrepaired rupture pattern showed better outcomes. Findings suggest that early alliance development patterns affect treatment process and outcome. (PsycINFO Database Record

Supplemental Material for Early Development of Mechanisms of Change as a Predictor of Subsequent Change and Treatment Outcome: The Case of Working Alliance

Supplemental Material for Early Development of Mechanisms of Change as a Predictor of Subsequent Change and Treatment Outcome: The Case of Working Alliance

Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study.

BackgroundHospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers.ObjectiveThe aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge.Materials and methodsThis was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months.ResultsA total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming depressed.ConclusionDepressive symptoms are common among caregivers when patients are hospitalized for exacerbation of COPD. Although illness factors are determinants of depression at hospitalization, patient dependence determines fluctuations in the depressive status of caregivers.

Is low positive emotionality a specific risk factor for depression? A meta-analysis of longitudinal studies.

Depression is well known to share a negative cross-sectional relationship with personality constructs defined by positive emotion (positive affect, extraversion, behavioral activation). These Positive Emotionality (PE) constructs have been proposed to represent stable temperamental risk factors for depression, not merely current mood state. These constructs have also been proposed to increase risk specifically for depression, relative to anxiety. We performed a meta-analysis of longitudinal studies to examine the relationship of PE to depression (59 effect sizes) and anxiety (26 effect sizes). In cross-sectional analyses, PE constructs were negatively associated with depression (r = -.34) and anxiety (r = -.24). PE constructs also prospectively predicted depression (r = -.26) and anxiety (r = -.19). These relationships remained statistically significant, but were markedly attenuated, when baseline levels of depression (β = -.08) and anxiety (β = -.06) were controlled. Moreover, depression and anxiety were equally strong predictors of subsequent changes in PE (β = -.07 and -.09, respectively). These findings are consistent with theoretical accounts of low PE as a temperamental vulnerability for depression, but suggest that the prospective relationship of PE to depression may be weaker and less specific than previously assumed. (PsycINFO Database Record

The benefits of being self‐determined in promoting physical activity and affective well‐being among women recently treated for breast cancer

In this study, changes in motivational regulations in women following treatment for breast cancer were described. Changes in motivational regulations as predictors of subsequent change in light and moderate-to-vigorous physical activity (PA) and affect were also examined. Women [n = 150; M(age) = 54.41 (SD = 10.87) years] completed self-report questionnaires and wore an accelerometer for 7 days at Time 1 [M = 3.94 (SD = 3.08) months following primary treatment], as well as 3 (Time 2) and 6 (Time 3) months later. Data were analyzed using repeated-measures analysis of variance and path analysis using residual change scores. Identified regulation and self-determined motivation (i.e., combined intrinsic motivation and identified regulation) scores decreased over time (p < 0.05). In the path model [χ(2)(4) = 5.66, p = 0.22, root mean square error of approximation = 0.05 (90% CI: 0.0; 0.15), comparative fit index = 0.99, standardized root mean square of the residuals = 0.03], ΔTime(1-2) in external regulation was associated with ΔTime(2-3) in positive affect (β = -0.16), ΔTime(1-2) in introjected (β = 0.25) and amotivation (β = 0.19) were related to ΔTime(2-3) in negative affect, and ΔTime(1-2) in self-determined motivation was related to ΔTime(2-3) in positive affect (β = 0.40) and moderate-to-vigorous PA (β = 0.21). Changes in motivational regulations were related to changes in PA and affect in the aftermath of breast cancer. Given the benefits of self-determined motivation, additional research is needed to develop and test interventions aimed at enhancing this type of motivation.

Recent Changes Leading to Subsequent Changes: Extensions of Multivariate Latent Difference Score Models

Latent difference score models (e.g., McArdle & Hamagami, 2001) are extended to include effects from prior changes to subsequent changes. This extension of latent difference scores allows for testing hypotheses where recent changes, as opposed to recent levels, are a primary predictor of subsequent changes. These models are applied to bivariate longitudinal data collected as part of the Baltimore Longitudinal Study of Aging on memory performance, measured by the California Verbal Learning Test, and lateral ventricle size, measured by structural MRIs. Results indicate that recent increases in the lateral ventricle size were a leading indicator of subsequent declines in memory performance from age 60 to 90.

The impact of left ventricular size on response to cardiac resynchronization therapy

Patients with nondilated (NDCM) or severely dilated cardiomyopathies (SDCM) have been underrepresented in clinical trials of cardiac resynchronization therapy (CRT). We examined changes in left ventricular ejection fraction (LVEF) and survival in patients with NDCM or SDCM compared with those with traditionally studied moderately dilated cardiomyopathy. We evaluated 800 consecutive patients undergoing the original implantation of a biventricular pacemaker between January 2004 and August 2007. For inclusion, patients had a baseline and pre-CRT echocardiogram, an LVEF ≤40%, a US social security number, and New York Heart Association class II to IV symptoms on standard medical therapy. Patients with a follow-up echocardiogram >2 months after device implantation were included in an analysis of remodeling. Using multivariate models, the impact of baseline left ventricular end-diastolic diameter (LVEDD) on change in LVEF and all-cause mortality was assessed. A total of 668 patients met inclusion criteria and were included in the assessment of mortality. Four hundred seventy-one had an appropriately timed follow-up echocardiogram and were included in the analysis of remodeling. Patients in all 3 groups realized improvements in LVEF (%) after CRT as follows: NDCM (n = 137; LVEDD ≤5.5 cm) 10.0 ± 12.7, P < .001; moderately dilated cardiomyopathy (n = 233; LVEDD 5.6-6.9 cm) 8.2 ± 11.3, P < .001; and SDCM (n = 101; LVEDD ≥7.0 cm) 5.4 ± 9.4, P < .001. In multivariate analysis, baseline LVEDD was inversely associated with change in LVEF (parameter estimate -3.13 ± 0.56, P < .001) and directly associated with increased all-cause mortality (hazard ratio 1.25 [1.05-1.47] P = .01). Patients with NDCM and SDCM experience significant improvements in LVEF after CRT. The degree of baseline left ventricular dilatation before CRT is an important predictor of subsequent changes in LVEF and survival.

Socioeconomic differences in cardiometabolic factors: social causation or health-related selection? Evidence from the Whitehall II Cohort Study, 1991-2004.

In this study, the health-related selection hypothesis (that health predicts social mobility) and the social causation hypothesis (that socioeconomic status influences health) were tested in relation to cardiometabolic factors. The authors screened 8,312 United Kingdom men and women 3 times over 10 years between 1991 and 2004 for waist circumference, body mass index, systolic and diastolic blood pressure, fasting glucose, fasting insulin, serum lipids, C-reactive protein, and interleukin-6; identified participants with the metabolic syndrome; and measured childhood health retrospectively. Health-related selection was examined in 2 ways: 1) childhood health problems as predictors of adult occupational position and 2) adult cardiometabolic factors as predictors of subsequent promotion at work. Social causation was assessed using adult occupational position as a predictor of subsequent change in cardiometabolic factors. Hospitalization during childhood and lower birth weight were associated with lower occupational position (both P’s ≤ 0.002). Cardiometabolic factors in adulthood did not consistently predict promotion. In contrast, lower adult occupational position predicted adverse changes in several cardiometabolic factors (waist circumference, body mass index, fasting glucose, and fasting insulin) and an increased risk of new-onset metabolic syndrome (all P’s ≤ 0.008). These findings suggest that health-related selection operates at younger ages and that social causation contributes to socioeconomic differences in cardiometabolic health in midlife.

P03-02 - Therapeutic alliance in the cognitive behavioral treatment of pediatric obsessive-compulsive disorder

ObjectivesThe purpose of the current study was to investigate the influence of therapeutic alliance (TA) as a treatment process variable on outcome in cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Although CBT for pediatric OCD disorder is considered a first-line treatment, not all youth have positive treatment responses, suggesting the need for investigating factors that enhance or reduce treatment effects.MethodsTwenty-five youth aged 7-17 years (M = 13.16, SD = 2.69) with a principal diagnosis of OCD and parents participated in the study. Using a multiple-informant, multiple-time point design, the current study examined the role of TA in family-based CBT for pediatric OCD.ResultsFindings indicated(1)stronger child-rated, parent-rated, and therapist-rated TAs were predictive of better treatment outcome,(2)larger, more positive early alliance shifts (rated by changes in child-rated TA between sessions 1 and 5) were predictive of better treatment outcome.ConclusionsTA was a predictor of subsequent change in OCD symptoms in youth treated with CBT. These findings correspond with alliance-outcome research among youth treated with evidence based therapies for behavior disorders.

Predictors of deterioration in health‐related quality of life in Parkinson's disease: Results from the DATATOP trial

The aim of this study was to investigate factors associated with decline in health-related quality of life in Parkinson's disease, by a retrospective cohort study from referral centers in Canada and the United States. Subjects were patients with early Parkinson's disease (N = 362) enrolled in a clinical trial of deprenyl (selegiline) and tocopherol (DATATOP) and followed prospectively. The main outcome measure was change in health-related quality of life using SF-36 Mental and Physical Component Summary scores. The mean interval between SF-36 measurements was 1.7 +/- 0.1 years, beginning 5 to 6 years after enrolment into the trial. In multivariable analysis, baseline Hamilton Depression Scale scores and self-rated cognitive function were associated with subsequent decline in Physical Component Summary scores, while older age and Schwab and England activities of daily living scores were associated with decline in Mental Component Summary scores. The Postural Instability Gait Disorder score was the only variable found to decline concurrently with HRQOL. Our results suggest that depression, self-rated cognitive function, and one's degree of functional independence are predictors of subsequent changes in HRQOL. Our focus in clinical care needs to be broadened beyond assessing and treating Parkinsonism, recognizing the impact of mood, cognition and function on HRQOL.

Factors associated with changes in antidepressant use in a community-dwelling elderly cohort: the Three-City Study

This study aimed to examine changes in antidepressant use in an elderly population over a 2-year period and to determine which factors could predict these changes. This longitudinal study was conducted in 8,061 French community-dwelling subjects aged 65 years and over. At each wave, data on antidepressant use and general health status were collected and depressive symptoms were evaluated using a standardized instrument. Logistic regression models were used to identify baseline predictors of subsequent changes in antidepressant use. Prevalence of antidepressant use increased from 7.0% at baseline to 8.6% at 2-year follow-up. Selective serotonin reuptake inhibitors (SSRI) accounted for the main part of this increase. Four percent of the baseline nonusers took antidepressants 2 years later. This change was significantly associated with female gender, older age, higher education level, elevated depressive symptoms at baseline, history of major depression, poor self-perceived health, high consumption of nonpsychotropic drugs and cognitive impairment (in particular dementia). Approximately 5% of the elderly population was treated with antidepressants at both examinations, and most of them reported using the same class of antidepressant. Antidepressant withdrawal occurred in only 30% of antidepressant users; we did not find any factor significantly associated with termination of antidepressant use. In this large elderly population, the proportion of antidepressant users increased by 23% over a 2-year period. Increasing use was found in all age groups. Our data suggested that many elderly people are chronic users of antidepressants independently of their depression status.

Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury

The adverse consequences of burn injuries include pain and psychological distress, which show bidirectional associations. However, much of the existing research has relied on global measures of distress that do not separate distinct symptoms of anxiety and depression. The purpose is to assess the prospective effects of anxiety and depression on pain and functional outcomes following burn injury. This article describes a 2-year cohort study in patients hospitalized for serious burn injuries (assessments at discharge and 6-month, 1-year, and 2-year follow-up). Linear mixed effects analyses were conducted to model anxiety and depression's unique longitudinal effects; at each time point, depressive and anxiety symptoms were studied as predictors of subsequent changes in pain, fatigue, and physical function. When studied in separate prediction models, both depression and anxiety were strong prospective predictors of greater pain, more fatigue, and physical dysfunction at the subsequent time point (ps < .01). However, when both were included in a single model to study their unique effects, depressive symptoms (but not anxiety) emerged as a significant predictor of subsequent increases in pain and reductions in physical functioning, whereas anxiety (but not depression) predicted subsequent elevations in fatigue. These findings suggest potentially distinct effects of depression and anxiety and imply that assessment and early treatment of both depressive and anxiety symptoms may help improve a broad range of long-term pain-related outcomes following burn injury.

From overt rejection to enthusiastic embracement: changing state discourses on Israeli emigration

This paper deploys a critical discourse analysis methodology to examine the emergence of three (sometimes overlapping) discourses on emigration in Israel. It examines the linkages between the various discursive phases and processes of (trans-) national identity formation among emigrants. It argues that emigration discourses have often been strong predictors of subsequent changes in state policies—and other programmatic initiatives—aimed at Israeli citizens abroad. By juxtaposing the discursive construction of emigration (and its linkages to nation-forming political strategies in Israel) and the effects they have had on emigrant identities the paper contributes to the emerging literature on state-diaspora relations and transnational politics.