Rheumatic diseases substantially impair health-related quality of life (HRQoL). This study proposed a mediation-moderation analysis to explore fatigue as a possible mediator between disease activity and domains of physical HRQoL in patients with rheumatic diseases. The moderating effects of sex and rheumatological treatment, and the covariate role of comorbidities, were investigated. In a cohort of 807 patients with established rheumatic disease, disease activity was assessed using DAS28-CRP for rheumatoid arthritis, DAPSA for psoriatic arthritis, and ASDAS-CRP for axial spondyloarthritis. Physical HRQoL domains were evaluated with the Short Form-36 (SF-36), fatigue with the Chalder Fatigue Questionnaire (CFQ), and comorbidities with the Rheumatic Disease Comorbidity Index (RDCI). Rheumatological treatment was categorized as first- or second-line therapy. Mediation-moderation analyses were proposed for each disease type across physical HRQoL dimensions. Disease activity was significantly associated with all physical HRQoL dimensions (p < 0.001). Fatigue partially mediated these associations across all diseases and HRQoL domains (p < 0.05), with the highest percentage of explained variance on the Role-Physical domain (30.7–40.5
Spousal concordance in health has implications for couple-based interventions, yet evidence on health behavior concordance in couples has been limited. This study examined cross-sectional and longitudinal spousal associations for seven health behaviors among middle-aged and older Chinese couples. Data came from 6,579 couples (13,158 individuals) in the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018). Behaviors included obesity, physical inactivity, social inactivity, short/long sleep, extended napping, current smoking, and heavy drinking. Generalized estimating equations (GEE) was used to estimate cross-sectional spousal associations. Cross-lagged panel models (CLPM) tested longitudinal directional influences, and joint Wald tests assessed whether directional effects differed significantly by sex. Significant cross-sectional spousal associations emerged for all seven health behaviors. Longitudinally, bidirectional spousal influence was observed for short/long sleep (wife-to-husband OR=1.17; husband-to-wife OR=1.19), heavy drinking (wife-to-husband OR=2.78; husband-to-wife OR=2.29), social inactivity (wife-to-husband OR=1.14; husband-to-wife OR=1.11), and extended napping (wife-to-husband OR=1.55; husband-to-wife OR=1.28). Obesity showed a significant husband-to-wife path (OR=1.30). Physical inactivity and smoking showed no significant longitudinal influence in either direction. Formal testing found no statistically significant difference in magnitude between wife-to-husband and husband-to-wife paths for any behavior. Spousal concordance was moderate to strong for health behaviors, and longitudinal analyses revealed genuinely bidirectional mutual influence. These findings suggest that couple-based behavioral change interventions may be more effective than individual-focused approaches to benefit both members in the couple.
Exposure to traumatic events has many health-related sequalae, one of which is somatization. Somatization is the manifestation of psychological or emotional distress in bodily symptoms, often leading to distressing thoughts and behaviors related to the physical symptoms and unusual or persistent requests for medical assistance. Interpersonal trauma, which includes traumatic events that occur in the context of an interpersonal relationship (e.g., physical/emotional/sexual assault, intimate partner violence, childhood trauma) has been strongly linked to somatic symptoms. Another potential risk factor for somatization is alexithymia, such that individuals with alexithymia struggle to understand their emotional distress and thus confuse it with bodily distress. The current study utilized secondary data analysis to investigate these constructs using a subset of items from the Traumatic Life Events Questionnaire, the somatization subscale of the Symptom Checklist-90 Revised, and the Toronto Alexithymia Scale. It was hypothesized that higher ratings of interpersonal trauma would be associated with higher levels of somatization, and that this relationship would be moderated by levels of alexithymia. In a cross-sectional study of 531 young adults aged 18 to 29, interpersonal trauma and somatization demonstrated a small significant relationship (r = 0.178, p < 0.001), and the relationship between interpersonal trauma and somatization was moderated by alexithymia, β = 0.001, p = 0.027. The effect of interpersonal trauma on somatization was smaller when alexithymia was low (effect = 0.018) than the effect when alexithymia was high (effect = 0.043), showing that the relationship between trauma and somatization is stronger for individuals who have higher levels of alexithymia. Based on these findings, identification of alexithymia within trauma exposed individuals may be important in understanding one’s risk for developing somatic symptoms. Further implications for understanding, identifying, and treating somatization in traumatized samples are discussed, such as considering alexithymia as a treatment target in psychosocial interventions.
Acral lentiginous melanoma (ALM) is an aggressive type of melanoma that disproportionally impacts people of color, with rising incidence among Hispanic/Latino populations and the highest mortality rate among African Americans. Given these disparities, innovative strategies for communicating ALM risk are critically needed, especially to Hispanics/Latinos and African Americans. To address this need, the current study investigated the implications of targeted visuals to conveying ALM risk for Hispanic/Latino and African American participants through a 3 (Skin tone of models in patient education materials: white, light brown, or dark brown) × 2 (Race/Ethnicity of the participants: Hispanic/Latino vs. African American) message experiment. The findings revealed that Hispanic/Latino participants reported higher ALM knowledge when they were exposed to patient education materials depicting light or dark brown models, whereas African American participants performed better with either dark brown or white skin models. Additionally, there was an indirect effect of exposure to the patient education materials on ALM knowledge via memorability for Hispanic/Latino participants. The findings align with the theorizing on demographic targeting and memorable messages as both Hispanic/Latino and African American populations responded more positively to targeted models and memorability once again materialized as the key mechanism of effect.
Sleep during the perinatal period is often highly disrupted due to maternal biopsychosocial changes that accompany pregnancy. Poor sleep quality is a symptom of PTSD, while insomnia often emerges after a traumatic event and commonly co-occurs with PTSD. Trauma exposure as well as insomnia have been linked to increased risk for postpartum depression (PPD). The current study examined sleep trajectories across pregnancy and into the postpartum period, the impact of trauma exposure and PTSD on these sleep trajectories, and associations between these sleep trajectories and PPD. Participants completed psychiatric diagnostic evaluations for PTSD and other mental health conditions, as well as validated self-ratings of insomnia and depressive symptoms at four time points across pregnancy and at 6 weeks postpartum. Participants were categorized into one of four groups: (a) trauma exposure with PTSD, (b) trauma exposure with another mental health condition, (c) trauma exposure with no mental health conditions, or (d) no reported trauma exposure or current mental health conditions. Longitudinal growth mixture modeling revealed two distinct sleep trajectories across pregnancy: poor sleep (28.5
