Clear evidence indicates that affective disorders, such as depression, anxiety, and stress disorders emerge at the intersection of pre-existing vulnerability and significant, highly stressful life events. However, there is little research mapping trajectories of psychological adjustment following traumatic events in older adults and existing evidence suggests both advantages and disadvantages to aging in basic emotional processes that underlie disease risk. Current assessment and interventions targeting older populations are inadequate and there is an urgent need for improvements in both conceptual and applied knowledge. This proposed supplement to R01MH113622 will address these needs by the additional recruitment of 100 older adults (age >65) to the existing cohort (n = 400; age 21-65) to facilitate comparison across the adult lifespan. Patients without severe cognitive dysfunction or dementia will be recruited in hospital, and as with the parent grant, assessed beginning at 1 month following injury until 18 months. Assessments include rigorous in-lab indices of cognitive and emotional processes, psychiatric and treatment history, as well as experience sampling at 4 months post injury. Then subsequent follow-up assessments occur at 9, 12, and 18 months. This approach will facilitate modelling of adjustment over time, by age, as well as the investigation of key facets of emotion processing known to predict affective disease. We focus on the super-ordinate construct of Emotion Flexibility (EF) which encompasses the ability to generate or up-regulate emotions, as well as to shift or down-regulate emotions according to needs and/or environmental demands. EF is well- suited to inform models of emotion-related risk and adjustment as it characterizes an optimal balance of two biologically-based, constituent dimensions: ?bottom-up? threat-related processing and ?top-down? cognitive control increasingly recognized as central to all emotion processing. Both dimensions may show meaningful changes with aging, independently, and in relation to each other. Finally, we assess the relationship between EF and the onset of three key transdiagnostic symptoms following trauma: negative mood, ruminative cognition, and sleep disruption. Consistent with NIMH priorities, this supplement would help to explicate the processes that underlie emotion disruptions in older adults as well as begin to identify unique age-related factors that could prove to be predictive of emotion-related disease, thereby informing the development of improved risk assessments and treatment for older patients.
Emotion-related psychiatric disorders, including depression and anxiety, affect a considerable portion of adults in this country and rank as many of the most burdensome diseases worldwide. In this supplement to the parent grant R01MH113622, we follow an additional sample of older adults in order to better understand how aging influences risk for emotion-related diseases over time. In addition, we test the role by which certain other factors, both contemporary and historical (physical health, life stress, social support, psychiatric treatment history, or childhood experiences) may increase or decrease risk across the adult lifespan.
