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.
This project will provide novel information about mechanisms and predictors that underlie cardiovascular disease among bereaved adults. 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.
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