Complicated Grief in Older Adults: Physiological Substrates of Emotion Regulation

描述（由申请人提供）：老年人的复杂悲伤：情绪调节的生理基础这一老年职业发展奖的申请描述了一个综合训练计划和研究项目，使候选人成为老年人情绪调节生理基础方面的专家。配偶丧偶在老年人中非常普遍，美国每年有超过90万人丧偶。尽管大多数人会逐渐适应寡妇的生活，但也有一些人会经历一个复杂的过程。研究发现，尽管进行了抗抑郁治疗，复杂的悲伤仍然存在，它是老年人认知能力下降、健康状况不佳、抑郁和自杀倾向的独立预测因素，使其成为一个主要的公共卫生问题。认知因素，如无法将注意力从对死者的侵入性想法中转移出来，被认为会损害适应寡妇生活的能力。此外，生理机制，如低级别炎症过程，可能有助于在这一人群中发现的情绪失调。这项拟议的研究将评估老年人的神经激活、免疫标记以及注意力和情绪调节的神经心理学测试。我们将招募135名老年人（45名患有复杂悲伤，45名患有非复杂悲伤，45名未失去亲人，通过新的共识标准的结构化访谈确定）。具体目的是：目的1)通过e-Stroop测量，与对照组（非复杂悲伤和非丧亲）相比，检查患有复杂悲伤的老年人的注意力缺陷；目的2)用功能磁共振成像（fMRI）检查这三组36名老年人注意缺陷的神经基础；目的3)与对照组（非复杂性悲伤和非丧亲）相比，评估复杂悲伤老年人的循环炎症标志物（如sTNF-RII、IL-6、slL-6R和IL-1Ra）。该项目的长期目标是探索神经活动是否介导炎症循环标志物与注意力缺陷之间的关系。加州大学洛杉矶分校的考辛斯心理神经免疫学中心拥有优秀的资源（如3T成像扫描仪）和优秀的导师（包括医学博士迈克尔·欧文博士），这对丧亲、免疫学和神经影像学研究的高级培训是必要的，这将促进候选人玛丽-弗朗西斯·奥康纳博士的发展，使她成为一名独立的研究者，并允许她制定R01建议，以评估复杂悲伤的治疗方法。基于生理和心理机制。

DESCRIPTION (provided by applicant): Complicated Grief in Older Adults: Physiological Substrates of Emotion Regulation This application for a Career Development Award in Aging describes an integrated training plan and research project to allow the candidate to become an expert in the physiological underpinnings of emotion regulation in older adults. Conjugal bereavement is highly prevalent in older adults, with more than 900,000 people widowed each year in the U.S. Although most adjust gradually to widow(er)hood, others experience a complicated course. Complicated grief, which persists despite anti-depressant treatment, has been found to be an independent predictor of cognitive decline, poor health, depression and suicidality in older adults, making it a major public health concern. Cognitive factors, such as the inability to shift attention away from intrusive thoughts of the deceased are hypothesized to impair adjusting to a life as a widow(er). Furthermore, physiological mechanisms, such as low-grade inflammatory processes, may contribute to emotional dysregulation found in this population. The proposed research will assess neural activation, immune markers, and neuropsychological tests of attention and emotion regulation in older adults. We will recruit 135 older adults (45 with complicated grief, 45 with uncomplicated grief and 45 non-bereaved, determined by a structured interview with new consensus criteria). The specific aims are: Aim 1) To examine attentional deficits in older adults with complicated grief as measured by the e-Stroop as compared to controls (uncomplicated grief and non-bereaved); Aim 2) To examine the neural substrates of attentional deficits in a subsample of 36 older adults with fMRI in these three groups; Aim 3) To evaluate circulating markers of inflammation (e.g., sTNF-RII, IL-6, slL-6R and IL-1Ra) in older adults with complicated grief as compared to controls (uncomplicated grief and non-bereaved). The long-term goal of the project is to explore whether neural activity mediates the relationship between circulating markers of inflammation and attentional deficits. The Cousins Center for Psychoneuroimmunology at UCLA has both excellent resources (e.g. 3T imaging scanner) and excellent mentors (including Dr. Michael Irwin, MD) necessary for advanced training in bereavement, immunology, and neuroimaging research that will facilitate development of the candidate, Dr. Mary-Frances O'Connor, into an independent investigator and allow her to develop an R01 proposal to evaluate treatment for complicated grief, based on both physiological and psychological mechanisms.