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Using Multivariate Statistics

1. Introduction and Overview. 2. Detecting Influential Observations and Outliers. 3. Detecting and Assessing Collinearity. 4. Applications and Remedies. 5. Research Issues and Directions for Extensions. Bibliography. Author Index. Subject Index.

Regression Diagnostics: Identifying Influential Data and Sources of Collinearity

Objective: The recent obesity epidemic has been accompanied by a parallel growth in chronic sleep deprivation. Physiologic studies suggest sleep deprivation may influence weight through effects on appetite, physical activity, and/or thermoregulation. This work reviews the literature regarding short sleep duration as an independent risk factor for obesity and weight gain.

Short sleep duration and weight gain : a systematic review

Inflammatory reactivity to acute laboratory stress is thought to reflect individual differences in responsivity to environmental stressors and may confer future health risk. To characterize this response, we conducted a meta-analysis of 34 studies that measured circulating inflammatory markers and 15 studies that measured stimulated production of inflammatory markers before and after exposure to laboratory challenge. Results showed significant stress-related increases in circulating interleukin (IL)-1β (d=0.66, p<0.001), IL-6 (d=0.35, p<0.001), IL-10 (d=0.69, p<0.001), and tumor necrosis factor(TNF)-α (d=0.28, p<0.001), but not IL-1ra, IL-2, interferon-γ, or C-reactive protein. There were sufficient data to assess the time course of IL-6, IL-1β, and TNF-α reactivity. IL-6 increased from baseline to measures taken 40-50, 60-75, 90, and 120min following stress, with the largest effect at 90min post-stress (d=0.70, p<0.001). IL-1β increased from baseline to 20-30, 40-50, and 60-70min following stress, with the largest effect between 40 and 50min post-stress (d=0.73, p=0.02). For TNF-α, there was a significant increase from baseline to 31-50min post stress (d=0.44, p=0.01), but not at later times. There was no difference in magnitude of IL-6 reactivity as a function of type of stress (social-evaluative versus other). For stimulated inflammatory markers, results showed stress-related increases in IL-1β when measured 20-120min post-stress (d=1.09, p<0.001), and in IL-4 and interferon-γ when measured 0-10min post stressor (d=-0.42, p<0.001 and d=0.47, p<0.001). These results extend findings from a prior meta-analysis (Steptoe et al., 2007) to show reliable increases in circulating IL-6, IL-1β, IL-10 and TNF-α and stimulated IL-1β, IL-4 and interferon-γ in response to acute stress. It is possible that these responses contribute to associations between exposure to life challenges and vulnerability to inflammatory disease.

The effects of acute psychological stress on circulating and stimulated inflammatory markers: A systematic review and meta-analysis.

BACKGROUND The PTSD Checklist for the DSM-5 (PCL-5) may be a suitable addition for routine outcome monitoring (ROM) for patients with PTSD AIM: To determine whether the PCL-5 is worth the extra effort that administration requires from the patient METHOD: Pretest and retest measurement results of the PCL-5 and the OQ-45 were compared head-to-head in 464 patients from the Sinai Center of Arkin RESULTS: The correlations between scores on the instruments were high and analysis of variance for repeated measurements revealed no difference in responsiveness Comparison of Cohen's d (049 vs 043) and Delta T (50 vs 44), indicated a slightly better responsiveness of the PCL-5 and also the proportion of recovered patients was greater according to the PCL-5 compared to the OQ-SD CONCLUSION: At first glance, the PCL-5 and the OQ-SD were equally sensitive to detect change during treatment However, the PCL-5 provided more detailed information about the nature and severity of symptomatology in an individual patient and with the PCL-5 we were slightly better able to demonstrate clinical significant change than with the OQ-SD We recommend to add the PCL-5 to ROM for patients with PTSD

De ptss Checklist voor dsm-5 (pcl-5) voor rom: Een vergelijking van de responsiviteit met de Outcome Questionnaire (oq-45) en praktische bruikbaarheid

There is burgeoning interest in the ability to detect inflammatory markers in response to stress within naturally occurring social contexts and/or across multiple time points per day within individuals. Salivary collection is a less invasive process than current methods of blood collection and enables intensive naturalistic methodologies, such as those involving extensive repeated measures per day over time. Yet the reliability and validity of saliva-based to blood-based inflammatory biomarkers in response to stress remains unclear. We review and synthesize the published studies that have examined salivary markers of inflammation following exposure to an acute laboratory stressor. Results from each study are reviewed by analyte (IL-1β, TNF-α, IL-6, IL-2, IL-4, IL-10, IL-12, CRP) and stress type (social-cognitive and exercise-physical), after which methodological issues and limitations are addressed. Although the literature is limited, several inflammatory markers (including IL-1β, TNF-α, and IL-6) have been reliably determined from saliva and have increased significantly in response to stress across multiple studies, with effect sizes ranging from very small to very large. Although CRP from saliva has been associated with CRP in circulating blood more consistently than other biomarkers have been associated with their counterparts in blood, evidence demonstrating it reliably responds to acute stress is absent. Although the current literature is presently too limited to allow broad assertion that inflammatory biomarkers determined from saliva are valuable for examining acute stress responses, this review suggests that specific targets may be valid and highlights specific areas of need for future research.

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Salivary markers of inflammation in response to acute stress.

Insomnia and cognitive performance: A systematic review and meta-analysis.

Study objectives Intraindividual variability (IIV) in sleep may be a risk factor for disease above the influence of mean sleep. Associations between IIV in sleep and risk for a comprehensive set of common medical and mental health conditions have not been assessed in a representative sample. Methods This study examined mean and IIV in total sleep time (TST), sleep quality (SQ), sleep efficiency (SE), and circadian midpoint (CM) in 771 adults recruited for an epidemiological study. Participants completed 14 days of sleep diaries to assess TST, SQ, SE, and CM, after which they reported on medical conditions and mental health symptoms. Data were analyzed using logistic regression, and models controlled for gender, body mass index, age, and race. Results Lower mean TST, SQ, and SE were related to increased odds of having gastrointestinal problems, depression, and anxiety. IIV in TST was related to increased odds of having neurological, breathing, and gastrointestinal problems, as well as pain and depression; all results held controlling for mean sleep and adjusting for false discovery rate. IIV in SQ and SE was not associated with odds of having any medical or mental health conditions after adjusting for false discovery rate, nor was IIV in CM or mean CM. Conclusions Confirming previous research, mean TST, SQ, and SE are related to risk for gastrointestinal problems, depression, and anxiety. IIV in TST may be a unique facet of disturbed sleep that is associated with increased risk for a diverse cluster of medical and mental health conditions.

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Intraindividual variability in sleep and comorbid medical and mental health conditions.

The psychological mechanisms by which depressed mood can lead to impaired sleep and poorer overall health remain unclear. The goal of this study was to investigate the extent to which a tendency to ruminate accounts for the associations between depressed mood and both sleep quality and self-reported health in 165 healthy young adults. Self-reported assessments of anxiety, depressed mood, rumination, sleep quality, and general health were collected at two different time points approximately 2 months apart. Structural equation modeling revealed that rumination measured at the earlier time point mediated the relationships between depressed mood and both sleep quality and health, all measured at the later time point, in a model that was a good fit to the data overall, χ2 (50, N = 165) = 103.08, p < 0.001; RMSEA = 0.08 (0.06–0.10), TLI = 0.91, CFI = 0.94. Results were similar whether or not anxiety was controlled. Results indicate that rumination may be a psychological mechanism by which negative mood leads to impaired sleep and poorer perceived health.

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Rumination mediates the relationships between depressed mood and both sleep quality and self-reported health in young adults.

STUDY OBJECTIVES Stress is associated with poor and short sleep, but the temporal order of these variables remains unclear. This study examined the temporal and bi-directional associations between stress and sleep and explored the moderating role of baseline sleep complaints, using daily, intensive longitudinal designs. METHODS Participants were 326 young adults (Mage = 23.24 ± 5.46), providing >2,500 nights of sleep altogether. Prospective total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were measured using actigraphy and sleep diaries. Perceived stress was reported three times daily between: 11:00-15:00, 15:30-19:30, and 20:00-02:00. Sleep complaints were measured at baseline using the PROMIS sleep disturbance scale. Within- and between-person sleep and stress variables were tested using cross-lagged multilevel models. RESULTS Controlling for covariates and lagged outcomes, within-person effects showed that higher evening stress predicted shorter actigraphic and self-reported TST (both p < .01). Conversely, shorter actigraphic and self-reported TST predicted higher next-day stress (both p < .001). Longer self-reported SOL and WASO (both p < .001), as well as lower actigraphic (p < .01) and self-reported SE (p < .001), predicted higher next-day stress. Between-person effects emerged only for self-reported TST predicting stress (p < .01). No significant results were found for the moderating role of baseline sleep complaints. CONCLUSIONS Results demonstrated bi-directional relations between stress and sleep quantity, and a consistent direction of worse sleep quantity and continuity predicting higher next-day stress. Results highlighted within-individual daily variation as being more important than between-individual differences when examining sleep and daytime functioning associations.

Danica C. Slavish

Papers

Salivary markers of inflammation in response to acute stress.

Insomnia and cognitive performance: A systematic review and meta-analysis.

Intraindividual variability in sleep and comorbid medical and mental health conditions.

Rumination mediates the relationships between depressed mood and both sleep quality and self-reported health in young adults.

Bi-directional relations between stress and self-reported and actigraphy-assessed sleep: a daily intensive longitudinal study.