Ari Elliot Final Dissertation

202 Pages·2015·1.55 MB·English

by  Ari Elliot

Life Course Disadvantage and Systemic Inflammation:
The Role of Psychosocial Functioning
by
Ari J. Elliot

Submitted in Partial Fulfillment of the
Requirements for the Degree
Doctor of Philosophy

Supervised by
Professor Kathryn Douthit

Margaret Warner School of Education and Human Development

University of Rochester
Rochester, NY
2015
ii
Biographical Sketch
The author was born in Elizabeth, New Jersey, United States. He attended Brandeis
University and graduated with a Bachelor of Arts degree in Economics, working in real
estate for several years thereafter. He came to the Warner School of Education in 2007
for a Master of Science degree in Mental Health Counseling, and commenced doctoral
studies in Human Development at the Warner School in the fall of 2010. He was awarded
a Scandling Scholarship in 2010 and a Pre-Dissertation Fellowship award in 2014, and
pursued his research in human development and the social determinants of health under
the direction of Dr. Kathryn Douthit and Dr. Andre Marquis.
The following publications were a result of work conducted during doctoral study:
Marquis, A., Douthit, K. Z., & Elliot, A. J. (2011). Best practice: A critical yet inclusive
vision for the counseling profession. Journal of Counseling & Development, 89(4), 397-
405.
Elliot, A. J., Mooney, C. J., Douthit, K. Z., & Lynch, M. F. (2014). Predictors of older
adults' technology use and its relationship to depressive symptoms and well-being. The
Journals of Gerontology Series B: Psychological Sciences and Social Sciences. doi:
10.1093/geronb/gbt109
Elliot, A. J. (2014). Sleep Disorders. In R. E. Ingersoll & A. Marquis, Psychopathology
for helping professionals: An integral exploration (pp. 446-492). Columbus, OH:
Pearson.
iii
Acknowledgments
This dissertation is dedicated to my wife Kim, whose faith in me kept me going in my
most difficult moments. You have sacrificed and supported me in innumerable ways.
Whether through gentle reminders and words of encouragement or desperate pleas,
countless times you inspired me to press on and to stay positive when this point felt so far
away. I’m forever indebted to you (also relieved you haven’t been keeping a tab) and
eternally grateful. I love you so much.
I would like to express my profound gratitude to my parents, Jeff and Lynnea,
whose tremendous support throughout my life has made this possible. You’ve always
stressed the importance of getting the highest possible degree, so to you I say, you’re
welcome! Just kidding. What I mean to say is thank you for inculcating in me the value
of education, of hard work and persistence, and of following your interests and
challenging yourself. The attitudes and abilities that you modeled and nurtured have been
instrumental in helping me meet this goal.
I want to thank my grandfather for his heartfelt involvement and interest, and for
sharing his wisdom. Grandpa, our weekly conversations have been a major source of
mental stability and comfort through the ups and downs of this process, and have helped
inspire and challenge me to stay on track. I feel like you were by my side throughout this
journey. 10^6 x 2.
I want to thank my brother and sister, Dan and Julie, for their belief in me, their
friendship, and for all of the great times and laughs we’ve had. The camaraderie we’ve
iv
shared being in school and writing theses together has been instrumental in helping me
maintain my sanity these last couple years (and last 48 hours). I adore you both.
I also want to thank my mother- and father-in-law, Jane and Rob, and my Pop. To
say that you’ve always treated me like a son and grandson is beyond an understatement.
Thank you for your tireless support and for all of the enjoyable visits (not to mention
delicious food) and holidays that we’ve shared over the years. You’ve had an
immeasurable impact in helping me reach this point.
Littlest but not least, I want to thank my son Evan. You’ve brought so much
lightness to my heart, a new and amazing experience, and an even greater sense of
purpose. Thank you for being such an adorable and easy baby (seriously clutch).
To all of my family, I’m extremely grateful for all of your encouragement and
support—mental, emotional, spiritual, and financial—as well as your faith in me. I love
you all!
I also want to thank all of my friends (you might know who you are). We may not
see each other as much as we’d like but your friendship has meant much to me. From
brief catch-ups to extended hangouts and visits, from celebrating to commiserating, your
friendship has been priceless in helping me to reach this point. I have much love and
respect for each of you.
I would like to acknowledge and express my gratitude to all of my dissertation
committee members for their time and for sharing their insight and expertise. It’s been an
honor to learn from such accomplished scholars and researchers and I truly could not
have asked for a more supportive and responsive committee.
v
To Dr. Douthit, thank you for sharing your advice and imparting your wisdom on
matters from doctoral studies to dissertation, career, and personal matters. I’m not sure
how you’ve accumulated so much knowledge and wisdom, but you’ve had a helpful
insight to offer on anything I’ve ever even thought to ask, and many things I haven’t.
Your guidance throughout this process has been invaluable and tremendously
appreciated.
To Dr. Marquis, your work is a major part of what brought me to the University
of Rochester in the first place and you’ve been one of my biggest supporters since. I’ve
always had deep admiration for your passion, conviction, and integrative thinking (and
your delectable cooking!).
Dr. Douthit and Dr. Marquis, both of you have, repeatedly, extended me the
greatest privilege a doctoral student can receive—the invitation to co-author and co-
present. The opportunities you’ve provided me have been invaluable in helping me to
build not only my CV but my skills and confidence as well. I owe so much of my
academic success to your tutelage. Your confidence in me has inspired me to continue to
grow personally and academically. I will always look up to you as scholars and will
always be grateful for your mentorship.
To Dr. Moynihan, thank you for your constructive, useful, and timely feedback,
and for taking the time to meet with me despite your extremely busy schedule. You’ve
been a part of my dissertation work from the very beginning and have been a supportive
presence throughout.
vi
To Dr. Seplaki, thank you for agreeing to serve on my committee on such short
notice, for your valuable insights and recommendations, and for squeezing me in for
meetings when I was in need of guidance regarding my models and methods, despite an
equally busy schedule.
Dr. Moynihan and Dr. Seplaki, both of you have gone above and beyond in your
work as committee members and I am deeply appreciative.
I would also like to thank Dr. Martin Lynch for his assistance on my
comprehensive examination committee, Dr. Kara Finnigan for serving as the independent
chairperson on my dissertation proposal, Dr. Brian Brent for serving as the independent
chairperson on my dissertation, Brenda Grosswirth for her generous assistance and
responsiveness, and Dean Borasi for all of her support. Finally, I’d like to thank the entire
Warner faculty. I owe much of my intellectual and professional growth during my time
here to your teaching and influence.
vii
Abstract
Experiences of disadvantage over the life course, including childhood adversity and low
socioeconomic status (SES), have been linked to low-grade systemic inflammation, a
potential risk factor for cardiovascular and other chronic diseases, late-life disability, and
earlier mortality. Using data from the Midlife in the United States (MIDUS) survey, this
study investigated the extent to which psychosocial functioning mediates or moderates
associations of childhood adversity and low SES with systemic inflammation among
middle-aged and older adults in the United States. Analytic aims were informed by
developmental, reserve capacity, and stress process models, which outline ways in which
the preceding exposures might adversely affect psychosocial functioning, thereby
increasing susceptibility to the emotional, behavioral, and biological concomitants of
stress. Structural equation modeling with latent variables revealed adverse effects of
childhood adversity and low SES on both psychosocial resources and psychological
distress, although neither psychosocial construct was significantly associated with
inflammation. Despite minimal evidence of mediation in full-sample analyses, multiple
groups analyses indicated that in women, there were small but statistically significant
indirect effects of both exposures on inflammation transmitted through psychological
distress and bio-behavioral risk. In Blacks/African-Americans, childhood adversity
exerted an indirect effect through the same pathway. Furthermore, resources and distress
interacted with SES to predict inflammation in men. Contrary to hypotheses,
inflammation was positively associated with resources and negatively associated with
distress at higher levels of SES, effects that were not attenuated by bio-behavioral risk.
viii
However, in supplemental analyses, effects of resources and distress on IL-6 were in the
expected directions at lower levels of SES. Results highlight the psychological cost of
disadvantage over the life course, as well as the potential role of associated distress in
pathways from social exposures to physiological dysregulation and disease risk. Results
also underscore the need for further investigation of how socioeconomic and
psychosocial factors interact in giving rise to systemic inflammation.
ix
Contributors and Funding Sources
This work was supported by a dissertation committee consisting of Professor Kathryn
Douthit and Professor Andre Marquis of the Warner School of Education and Human
Development, Professor Jan Moynihan of the University of Rochester Medical Center,
Department of Psychiatry, and Professor Christopher Seplaki of the University of
Rochester Medical Center, Department of Public Health Sciences. All work for the
dissertation was completed independently by the author. Graduate study was supported
by a Scandling Scholarship and Pre-Dissertation Fellowship from the Warner School of
Education.

The MIDUS I study (Midlife in the U.S.) was supported by the John D. and Catherine T.
MacArthur Foundation Research Network on Successful Midlife Development. The
MIDUS II research was supported by a grant from the National Institute on Aging (P01-
AG020166) to conduct a longitudinal follow-up of the MIDUS I investigation.
The MIDUS biomarker project was further supported by the following grants M01-
RR023942 (Georgetown), M01-RR00865 (UCLA) from the General Clinical Research
Centers Program and UL1TR000427 (UW) from the National Center for Advancing
Translational Sciences (NCATS), National Institutes of Health.
x
Table of Contents
Chapter 1: Conceptual Models .........................................................................................1
1.1 The Social Determinants of Health ........................................................................................ 1
1.2 Study Aims ............................................................................................................................. 3
1.3 The Life Course Framework .................................................................................................. 6
1.4 Biological Models .................................................................................................................. 9
1.4.1 Inflammation and the theory of inflammaging ............................................................... 9
1.4.2 Effects of stress on the immune system ........................................................................ 13
1.5 Models of the Long-Term Health Effects of Childhood Adversity .................................... 15
1.5.1 Biological, psychosocial, and behavioral pathways. ..................................................... 15
1.5.2 Health selection. ............................................................................................................ 18
1.6 Pathways Underlying Socioeconomic Disparities in Health in Adulthood ......................... 19
1.6.1 The Stress Process model .............................................................................................. 19
1.6.2 The Reserve Capacity model ........................................................................................ 21
1.6.3 Resilience ...................................................................................................................... 24
1.7 Summary and Study Aims .................................................................................................... 24
Chapter 2: Literature Review .........................................................................................27
2.1 Background and Chapter Outline ......................................................................................... 27
2.2 Measurement and Health Significance of Inflammation ...................................................... 28
2.3 The Socioeconomic Gradient in Inflammation ................................................................... 29
2.3.1 Associations of adult SES with markers of systemic inflammation ............................. 29
2.3.2 Demographic differences .............................................................................................. 30
2.4 Disadvantage and Inflammation Over the Life Course ....................................................... 32