Project Heart: Biobehavioral effects on Cardiovascular Risk for Bereaved Spouses

心脏项目：生物行为对失去亲人的配偶的心血管风险的影响

• 批准号: 9116277
• 负责人: Christopher Paul Fagundes
• 金额: $ 74.14万
• 依托单位: RICE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9116277
• 关键词: Accounting; Acute; Adult; Anxiety; Bereavement; Cardiac; Cardiovascular Diseases; Cessation of life; Characteristics; Chronic stress; Data; Dimensions; Distress; Emotional; Health; Heart; Individual; Individual Differences; Inflammation; Inflammatory; Informal Social Control; Intervention; Lesion; Link; Mental Depression; Morbidity - disease rate; NF-kappa B; Non-Small-Cell Lung Carcinoma; Participant; Pathway interactions; Patients; Pattern; Pharmacologic Substance; Production; Psychological Stress; Publishing; Reporting; Research Design; Research Personnel; Risk; Risk Factors; Sampling; Sinus Arrhythmia; Spouses; Staging; Stress; Stressful Event; Time; Ventilatory Depression; Work; biobehavior; biological adaptation to stress; cardiovascular risk factor; clinically significant; coping; cytokine; depressive symptoms; experience; indexing; inflammatory marker; loved ones; mortality; novel; prognostic; psychologic; psychological stressor; psychosocial; respiratory; response; socioeconomics; theories; therapy development; transcription factor

 DESCRIPTION (provided by applicant): The loss of a spouse is a highly stressful event that puts people at increased risk for morbidity and mortality. Cardiovascular disease (CVD) accounts for 20% to 53% of excess deaths during spousal bereavement. Stress, depression, and anxiety enhance the production of proinflammatory cytokines. Indeed, psychological stress and depression promote transcription factor nuclear factor kappa B (NF-kB) activation, a prime pathway for upregulating proinflammatory cytokine production. Importantly, inflammation is central to all stages of cardiovascular disease from initial lesion to end-stage thrombotic complications. Inflammation may be a key mechanism underlying CVD among the bereaved. Attachment theory is a useful framework for understanding individual differences in people's ability to adjust to the loss of a loved one. There are two patterns of attachment insecurity: attachment anxiety and attachment avoidance. People with high attachment anxiety use "hyperactivating" emotional coping strategies. People with high attachment avoidance are uncomfortable depending on others for support and use "deactivating" coping strategies that inhibit or suppress distressing experiences. Individual differences in attachment style may be prognostic for who is most at risk for enhanced inflammation and ultimately CVD after the loss of a spouse. Cardiac vagal tone (as reflected by respiratory sinus arrhythmia or RSA) is associated with self-regulation. Under stressful conditions individuals with low RSA display poorer self-regulatory control compared to those with high RSA. Low vagal tone is also a risk factor for CVD, partly due to elevations in inflammation. Recent work by this new/early stage investigator suggests that RSA and attachment style may jointly influence adjustment to a loss. This project builds upon these preliminary findings to examine mechanistic connections among attachment insecurity, depression, RSA, and inflammation cross-sectionally and longitudinally, with data on these key dimensions collected 1 month, 3 months, 6 months, and 12 months after the spouse's death. Participants will be spouses of patients who recently passed away to stage IV non-small cell lung cancer and matched controls. If inflammation is an important mechanism underlying bereavement, both psychosocial and pharmaceutical interventions aimed at reducing inflammation would be an important step toward the development of treatments for bereaved individuals. These interventions may be especially important for people with certain psychological characteristics.

 描述（由申请人提供）：失去配偶是一种压力很大的事件，会增加人们发病和死亡的风险。心血管疾病 (CVD) 占配偶丧亲期间额外死亡人数的 20% 至 53%。压力、抑郁和焦虑会增强促炎细胞因子的产生。事实上，心理压力和抑郁会促进转录因子核因子 kappa B (NF-kB) 激活，这是上调促炎细胞因子产生的主要途径。重要的是，炎症是心血管疾病从初始病变到终末期血栓并发症的所有阶段的核心。炎症可能是死者家属发生心血管疾病的一个关键机制。依恋理论是一个有用的框架，可以帮助我们理解人们适应失去亲人的能力的个体差异。依恋不安全感有两种模式：依恋焦虑和依恋回避。高度依恋焦虑的人会使用“过度活跃”的情绪应对策略。高度依恋回避的人对依赖他人的支持感到不舒服，并使用抑制或抑制痛苦经历的“停用”应对策略。依恋风格的个体差异可能预示着谁在失去配偶后最有可能患上炎症并最终患上心血管疾病。心脏迷走神经张力（由呼吸性窦性心律失常或 RSA 反映）与自我调节有关。在压力条件下，与 RSA 高的人相比，RSA 低的人表现出较差的自我调节控制能力。迷走神经张力低也是心血管疾病的危险因素，部分原因是炎症加剧。这位新/早期研究人员最近的工作表明，RSA 和依恋风格可能共同影响对损失的调整。该项目以这些初步发现为基础，从横截面和纵向角度检查依恋不安全感、抑郁、RSA 和炎症之间的机制联系，并在配偶去世后 1 个月、3 个月、6 个月和 12 个月收集这些关键维度的数据。参与者将是最近去世的第四期非小细胞肺癌患者的配偶以及匹配的对照。如果炎症是造成丧亲之痛的重要机制，那么旨在减少炎症的社会心理和药物干预措施将是开发丧亲者治疗方法的重要一步。这些干预措施对于具有某些心理特征的人来说可能尤其重要。