Objective This multimethod prospective study examined whether emotional disclosure and coping focus as conveyed through natural language use is associated with the psychological and marital adjustment of head and neck cancer patients and their spouses. Methods One-hundred twenty-three patients (85% men; age trueX‒=56.8 years, SD=10.4) and their spouses completed surveys prior to, following, and 4-months after engaging in a videotaped discussion about cancer in the laboratory. Linguistic Inquiry and Word Count (LIWC) software assessed counts of positive/negative emotion words and first-person singular (I-talk), second person (you-talk), and first-person plural (we-talk) pronouns. Using a Grounded Theory approach, discussions were also analyzed to describe how emotion words and pronouns were used and what was being discussed. Results Emotion words were most often used to disclose thoughts/feelings or worry/uncertainty about the future, and to express gratitude or acknowledgment to one’s partner. Although patients who disclosed more negative emotion during the discussion reported more positive mood following the discussion (p<.05), no significant associations between emotion word use and patient/partner psychological and marital adjustment were found. Patients used significantly more I-talk than spouses and spouses used significantly more you-talk than patients (p’s<.01). Patients and spouses reported more positive mood following the discussion when they used more we-talk, and less distress at the 4-month follow-up assessment when their partners used more we-talk (p <.01). Conclusion Findings suggest that emotional disclosure may be less important to one’s cancer adjustment than having a partner who one sees as instrumental to the coping process.

Background Providing informal care for a relative or friend with medical or mental needs can extol a physical burden on the caregiver, including impaired aspects of sleep quality such as suboptimal sleep duration, lengthened sleep latency, frequent awakenings, daytime sleepiness, and poor self-rated sleep quality. Diminished sleep quality can worsen the health in the caregiver, including dysregulation of hypothalamic-pituitary-adrenal axis (HPA) activity. Few studies have attempted to describe sleep in young adults who provide regular informal care. This study examines subjective and objective indicators of sleep quality and diurnal cortisol rhythms among young adult caregivers relative to non-caregiving peers. We expect that caregivers will exhibit poorer objective and subjective sleep quality and greater dysregulation in diurnal cortisol indices, than demographically similar non-caregivers, and that caregivers with poorer sleep will exhibit pronounced cortisol dysregulation. Methods Participant self-reported sleep quality over the prior month via the Pittsburgh Sleep Quality Index and objective sleep quality was observed via wrist actigraph for three consecutive days. Diurnal salivary cortisol was also measured across the three days of actigraph monitoring. Results Informal caregivers exhibited more self-reported sleep disturbance and greater sleep latency than non-caregivers, as well as more objectively measured sleep fragmentation. Caregivers with a shorter sleep duration were observed to have flatter diurnal cortisol slopes than caregivers with a relatively longer sleep duration. Conclusions Young adult caregivers appear to be at risk for impairment in sleep quality, which in turn might impact health through HPA axis dysregulation. Longitudinal research is needed to identify these relationships across time.

Objective: Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals. Method: Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk. Results: Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain. Conclusions: Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.

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Key Points What's already known about this topic? Young adult (YA; aged 18–39) cancer survivors report social isolation and unmet needs for social, emotional, and informational support. Mobile health applications offer a unique and scalable opportunity to provide access to YA peers and other resources, overcoming geographical distance and financial burden App features such as group chats, private messaging and “matching” to peers by age or cancer type serve to build relationships between YA survivors. Despite reporting moderately high perceived socioemotional support from their existing networks, YAs with more frequent symptoms of anxiety were the most likely to use the private messaging feature on the app. In addition to targeting supportive mobile health apps to YA survivors, assessing the mental health status of users and observing patterns of app usage can be used to tailor and improve uptake and utility.

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