Outlook: Newsletter of the Society of Behavorial Medicine
Winter 2017-18

New Articles from Annals of Behavioral Medicine and Translational Behavioral Medicine

SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine: Practice, Policy, Research (TBM), continuously publish online articles, many of which become available before issues are printed. Three recently published Annals online articles are listed below. There are no new TBM online articles to share.

SBM members who have paid their 2016 membership dues are able to access the full text of all Annals and TBM online articles via the SBM website by following the steps below.

  1. Go to the Members Only section of the SBM website (http://www.sbm.org/membership/members).
  2. Log in with your username and password.
  3. Click on the Journals link (listed third in the list of member benefits).
  4. Click on the title of the journal which you would like to electronically access.

To check if you are a current SBM member, or if you are having trouble accessing the journals online, please contact the SBM national office at info@sbm.org or (414) 918-3156.

Annals of Behavioral Medicine

Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specific Outcome Analysis
Joseph Chilcot, Ayman Guirguis, Karin Friedli, Michael Almond, Clara Day, Maria Da Silva-Gane, Andrew Davenport, Naomi A. Fineberg, Benjamin Spencer, David Wellsted, Ken Farrington
Depression is common in haemodialysis (HD) patients and associated with poor outcomes.
To evaluate whether depression symptoms predict survival and transplantation in a large sample of haemodialysis patients using cause-specific survival models.
Survival data was collected between April 2013 and November 2015, as part of the screening phase of a multicentre randomised placebo-controlled trial of sertraline in HD patients. Depression was measured using the Beck Depression Inventory-II (BDI-II) and the Patient Health Questionnaire-9 (PHQ-9). Demographic and clinical data were collected via a self-report questionnaire and medical records. Competing risk survival analysis involved cause-specific and subdistribution hazard survival models. All models were adjusted for appropriate covariates including comorbidity and C-reactive protein (CRP) in a subanalysis.
Of 707 cases available for analysis, there were 148 deaths. The mean survival time was 787.5 days. Cumulative survival at 12 months was 88.5%. During the study follow-up period, there were 92 transplants. The cumulative transplant event rate at 12 months was 7.8%. In separate adjusted models, depression symptoms predicted mortality (BDI-II HR = 1.03 95% CI 1.01, 1.04; PHQ-9 HR = 1.04 95% CI 1.01, 1.06). With respect to screening cut-off scores, a PHQ-9 ≥ 10 was associated with mortality (HR = 1.51 95% CI 1.01, 2.19) but not a BDI-II ≥ 16. Depression symptoms were not associated with time to transplantation in either cause-specific or subdistribution model.
Consistent with past findings in HD patients, depression symptoms predicted survival but were not associated with kidney transplantation. Suitable treatments for depression need further evaluation, and their impact upon quality of life and clinical outcomes determined.

Mediators of Physical Activity Adherence: Results from an Action Control Intervention in Couples
Corina Berli, Gertraud Stadler, Patrick E. Shrout, Niall Bolger, Urte Scholz
Behavior change interventions targeting self-regulation skills have generally shown promising effects. However, the psychological working mechanisms remain poorly understood.
We examined theory-based mediators of a randomized controlled trial in couples targeting action control (i.e., continuously monitoring and evaluating an ongoing behavior). Self-reported action control was tested as the main mediating mechanism of physical activity adherence, and in addition self-efficacy and received social support from the partner.
Overweight individuals (N = 121) and their heterosexual partners were randomly allocated to an intervention (information + action control text messages) or a control group (information only). Across a period of 28 days, participants reported on action control, self-efficacy, and received support in end-of-day diaries, and wore triaxial accelerometers to assess stable between-person differences in mediators and the outcome adherence to recommended daily activity levels (≥30 min of moderate activity in bouts of at least 10 min).
On average, participants in the intervention group showed higher physical activity adherence levels and higher action control, self-efficacy, and received support compared to participants in the control group. Action control and received support emerged as mediating mechanisms, explaining 19.7 and 24.6% of the total intervention effect, respectively, in separate analyses, and 13.9 and 22.2% when analyzed simultaneously. No evidence emerged for self-efficacy as mediator.
Action control and received support partly explain the effects of an action control intervention on physical activity adherence levels. Continued research is needed to better understand what drives intervention effects to guide innovative and effective health promotion.

Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City
Isabel Martinez, Trace S. Kershaw, Danya Keene, Rafael Perez-Escamilla, Jessica B. Lewis, Jonathan N. Tobin, Jeannette R. Ickovics

Syndemics are co-occurring epidemics that synergistically contribute to specific risks or health outcomes. Although there is substantial evidence demonstrating their existence, little is known about their change over time in adolescents.
The objectives of this paper were to identify longitudinal changes in a syndemic of substance use, intimate partner violence, and depression and determine whether immigration/cultural factors moderate this syndemic over time.
In a cohort of 772 pregnant Latina adolescents (ages 14–21) in New York City, we examined substance use, intimate partner violence, and depression as a syndemic. We used longitudinal mixed-effect modeling to evaluate whether higher syndemic score predicted higher syndemic severity, from pregnancy through 1 year postpartum. Interaction terms were used to determine whether immigrant generation and separated orientation were significant moderators of change over time.
We found a significant increasing linear effect for syndemic severity over time (β = 0.0413, P = 0.005). Syndemic score significantly predicted syndemic severity (β = −0.1390, P ≤ 0.0001), as did immigrant generation (βImmigrant = −0.1348, P ≤ 0.0001; β1st Gen = −0.1932, P = 0.0005). Both immigrant generation (βImmigrant = −0.1125, P = 0.0035; β1st Gen = −0.0135, P = 0.7279) and separated orientation (β = 0.0946, P = 0.0299) were significantly associated with change in severity from pregnancy to 1 year postpartum.
Pregnancy provides an opportunity for reducing syndemic risk among Latina adolescents. Future research should explore syndemic changes over time, particularly among high-risk adolescents. Prevention should target syndemic risk reduction in the postpartum period to ensure that risk factors do not increase after pregnancy.