Social media allows users to explore self-identity and express emotions or thoughts. Research looking into the association between social media use (SMU) and mental health outcomes, such as anxiety or depressive symptoms, have produced mixed findings. These contradictions may best be addressed by examining different patterns of SMU as they relate to depressive symptomatology. We sought to assess the independent associations between active versus passive SMU and depressive symptoms. For this, we conducted an online survey of adults 18-49 of age. Depressive symptoms were measured using the Patient-Reported Outcomes Measurement Information System brief depression scale. We measured active and passive SMU with previously developed items. Factor analysis was used to explore the underlying factor structure. Then, we used ordered logistic regression to assess associations between both passive and active SMU and depressive symptoms while controlling for sociodemographic covariates. Complete data were received from 702 participants. Active and passive SMU items loaded on separate factors. In multivariable analyses that controlled for all covariates, each one-point increase in passive SMU was associated with a 33 percent increase in depressive symptoms (adjusted odds ratio [AOR] = 1.33, 95 percent confidence interval [CI] = 1.17-1.51). However, in the same multivariable model, each one-point increase in active SMU was associated with a 15 percent decrease in depressive symptoms (AOR = 0.85, 95 percent CI = 0.75-0.96). To inform interventions, future research should determine directionality of these associations and investigate related factors.

Purpose Low socioeconomic status (SES) is associated with adverse outcomes among unrelated donor hematopoietic stem cell transplant (HCT) recipients, but the biological mechanisms contributing to this health disparity are poorly understood. Therefore, we examined whether social environment affects expression of a stress-related gene expression profile known as the conserved transcriptional response to adversity (CTRA), which involves up-regulation of pro-inflammatory genes and down-regulation of genes involved in type I IFN response and antibody synthesis. Experimental Design We compared pre-transplant leukocyte CTRA gene expression between a group of 78 high vs. low SES recipients of unrelated donor HCT for acute myelogenous leukemia in first remission. Post hoc exploratory analyses also evaluated whether CTRA gene expression was associated with poor clinical outcomes. Results Peripheral blood mononuclear cells collected pre-HCT from low SES individuals demonstrated significant CTRA up-regulation compared to matched HCT recipients of high SES. Promoter-based bioinformatics implicated distinct patterns of transcription factor activity including increased CREB signaling and decreased IRF and GR signaling. High expression of the CTRA gene profile was also associated with increased relapse risk and decreased leukemia-free survival. Conclusions Low SES is associated with increased expression of the CTRA gene profile, and CTRA gene expression is associated with adverse HCT clinical outcomes. These findings provide a biologic framework within which to understand how social environmental conditions may influence immune function and clinical outcomes in allogeneic HCT.

Practice of MBSR activities, particularly yoga, could provide benefits for specific aspects of physiologic function and positive affect. Changes in adaptive immunity in older adult MBSR practitioners warrant further study.

BACKGROUND In hematopoietic cell transplantation (HCT), current risk adjustment strategies are based upon clinical and disease-related variables. Though patient reported outcomes (PROs) predict mortality in multiple cancers, PROs have been less well studied within HCT. Improvements in risk adjustment strategies in HCT would inform patient selection, patient counseling, and quality reporting. Our objective was to determine whether pre-HCT PROs, in particular physical health, predict survival among patients undergoing autologous or allogeneic transplantation. METHODS In this secondary analysis, we studied pre-HCT PROs that were reported by 336 allogeneic and 310 autologous HCT recipients enrolled in the BMT CTN 0902 trial, a study with broad representation of patients transplanted in the US. RESULTS Among allogeneic HCT recipients, the pre-HCT SF-36 physical component summary score (PCS) independently predicted overall mortality (HR 1.40 per 10 point decrease, p<0.001) and performed at least as well as currently used, non-PRO risk indices. Survival probability estimates at one year for the first, second, third, and fourth quartiles of the baseline PCS were 50%, 65%, 75%, and 83%. Early post-HCT decreases in PCS were associated with higher overall and treatment-related mortality. When adjusted for patient variables included in the US Stem Cell Therapeutic Outcomes Database model for transplant center-specific reporting, the SF-36 PCS retained independent prognostic value. CONCLUSIONS PROs have the potential to improve prognostication in HCT. We recommend the routine collection of PROs prior to HCT, and consideration of incorporation of PROs into risk adjustment for quality reporting.

Background To evaluate the impact of depression prior to autologous and allogeneic HCT on clinical outcomes post-transplant. Methods We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n=3786) or allogeneic (n=7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment vs. those without pre-HCT depression. Using Cox regression models, we compared OS between patients with or without depression. We compared the number of days-alive-and-out-of-the-hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade II-IV acute and chronic GVHD in allogeneic HCT. Results 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression underwent allogeneic HCT in 2008-2012 were included. Pre-transplant depression was associated with lower OS (HR=1.13, 95%CI1.04-1.23, P=0.004) and higher incidence of grade II-IV acute GVHD (HR=1.25, 95%CI 1.14-1.37, P<0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days alive and out-of-the hospital (Means-Ratio (MR)=0.97, 95%CI0.95-0.99, P=0.004). There were 512 (13.5%) patients with pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT was not associated with OS (HR=1.15, 95%CI0.98-1.34, P=0.096), but was associated with fewer days-alive-and-out-of-the-hospital (MR=0.98, 95%CI0.97-0.99, P=0.002). Conclusions Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients, and fewer days-alive-and-out-of-the-hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a vulnerable population at risk for post-transplant complications.

Objective-To determine whether there is a relationship between depressive symptoms and cortisol assessed at first morning awakening, 6PM, and 9PM in a population-based sample of midlife women. If this relationship is not linear, we aim to test whether this relationship is nonlinear, only present in those with more severe depressive symptoms, better accounted for by diurnal slope, or only apparent under uncontaminated conditions. Methods-We investigated the cross-sectional association between cortisol and depressive symptoms, assessed by the Center for Epidemiological Studies Depression Scale (CES-D) in 408 midlife women (45.7% African-Americans, 54.3% white; mean age = 50.4) participating in the Chicago site of the Study of Women's Health Across the Nation (SWAN).Results-Diurnal cortisol slope is significantly flatter for women with higher CES-D scores than for less depressed women (p<.05 for the interaction). This relationship remains significant even after adjusting for age, smoking status, race, education, income, menopausal status, hormone replacement therapy (HRT), body mass index (BMI), medications, and wake time as well as possibly contaminating factors including physical activity, smoking, eating, or caffeine or alcohol consumption prior to saliva collection. Results using depression assessed categorically (CES-D cutoff ≥ 16) were similar to those using continuous depression in both unadjusted and adjusted analyses (p=.005 for the interaction of CES-D by time).Conclusions-In this population-based sample of midlife women, greater depressive symptoms were associated with a significantly flatter diurnal cortisol slope than those with fewer symptoms, even after adjusting for covariates and possibly contaminating behaviors.

While psychosocial factors are known to affect cancer progression via biobehavioral pathways in many patient populations, these relationships remain largely unexplored in hematopoietic stem cell transplant (HCT) patients. The purpose of this paper is to critically review the literature regarding psychosocial and endocrine/immune aspects of HCT, with an emphasis on exploring pathways that may mediate the associations between psychosocial factors and disease outcomes. These include the roles of catecholamines, glucocorticoids, inflammation, vascular endothelial growth factor (VEGF), immune reconstitution and infectious susceptibility, as well as the new opportunities available in genomics research. We also discuss the implications for potential immunomodulating psychosocial interventions. Elucidating the biological pathways that account for the associations between psychosocial factors and clinical course could ultimately lead to improved outcomes for this psychologically and immunologically vulnerable population.

Purpose: To examine the association between positive and negative experiences on social media (SM) and perceived social isolation (PSI). Design: Cross-sectional survey. Setting: One large mid-Atlantic University. Participants: A total of 1178 students aged 18 to 30 were recruited in August 2016. Measures: Participants completed an online survey assessing SM use and PSI. We assessed positive and negative experiences on SM by directly asking participants to estimate what percentage of their SM experiences involved positive and negative experiences, respectively. Social isolation was measured using the established Patient-Reported Outcomes Measures Information System scale. Analysis: We used multivariable logistic regression to assess associations between both positive and negative experiences on SM and PSI. Primary models controlled for sex, age, race/ethnicity, educational status, relationship status, and living situation. Results: Participants had an average age of 20.9 (standard deviation = 2.9) and were 62% female. Just over one-quarter (28%) were nonwhite. After controlling for all sociodemographic covariates, each 10% increase in positive experiences was not significantly associated with social isolation (adjusted odds ratio [AOR] = 0.97; 95% confidence interval [CI]: 0.93-1.005). However, each 10% increase in negative experiences was associated with a 13% increase in odds of PSI (AOR = 1.13; 95% CI: 1.05-1.21). Conclusion: Having positive experiences on SM is not associated with lower social isolation, whereas having negative experiences on SM is associated with higher social isolation. These findings are consistent with the concept of negativity bias, which suggests that humans tend to give greater weight to negative entities compared with positive ones.